The clinical diagnostic accuracy rate regarding the immediate cause of death in a hospitalized geriatric population: an autopsy study of 1594 patients

Attems, Johannes; Arbes, Stephanie; Böhm, G.; Böhmer, Femke; Lintner, Felix

doi:10.1007/s10354-004-0057-0

Cited by 54 publications

(31 citation statements)

References 26 publications

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“…5 In recent reports, only approximately 20% of PE confirmed by autopsy was diagnosed clinically. 38,39 On the other hand, there was improvement in the diagnosis of PE in a Swedish study. 40 Taken together, all the results shown indicate that fatal PE is difficult to diagnose before death.…”

Section: Rate Of Diagnosis Of Pementioning

confidence: 95%

Pulmonary Embolism is an Important Cause of Death in Young Adults

Sakuma

Nakamura

Takahashi

et al. 2007

Circ J

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he number of deaths from pulmonary embolism (PE) has been increasing in Japan, 1 and the incidence of PE in autopsy cases is also reported to have increased from 1958 to 1986. 2,3 Population-based analysis shows that deaths from PE are increasing in older age groups but PE is often misdiagnosed. 4,5 There are no reports on the incidence of PE in autopsy cases after 1986 in Japan and the following remain to be solved: (1) to what degree does PE contribute to death in different ages and genders and (2) what factor (s) contributes to diagnosis of PE before death. Therefore, our aims in the present study were to examine the incidence of PE in autopsy cases after 1986, and to clarify these 2 unsolved questions. MethodsThe subjects of the present study included PE cases confirmed by autopsy in Japan between 1987 and 1998. 6-17 We excluded cases of pulmonary microembolism with disseminated intravascular coagulation from our analysis. Circulation Journal Vol.71, November 2007PE was defined as critical (critical PE) when it was the primary cause of death or the main diagnosis and it includes all types of PE. The term "all PE" was used to indicate the total number of thrombotic PEs, tumor PEs, bacterial PEs, mycotic PEs and other emboli (eg, fat, amniotic fluid, etc). 18 To make it possible to compare our data with those reported by Mieno et al, 3 we analyzed our PE cases according to Mieno's criteria in which cases less than 1 year old and those with non-thrombotic PE were excluded. Statistical AnalysisStatistical analysis was performed using SPSS 13.0 (SPSS Inc, Chicago, IL, USA). Non-ordinal categorical data using the chi-square test. The results of the logistic regression models and Poisson regression analysis 19 are presented as estimated odds ratios (ORs) with the corresponding 95% confidence intervals (CIs).Circ J 2007; 71: 1765 -1770 (Received April 18, 2007 revised manuscript received July 9, 2007; accepted July 24, 2007

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Section: Rate Of Diagnosis Of Pementioning

confidence: 95%

Pulmonary Embolism is an Important Cause of Death in Young Adults

Sakuma

Nakamura

Takahashi

et al. 2007

Circ J

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“…It serves to determine the exact cause of death, reveals unexpected complications of disease processes including adverse or any other effects of treatment as well as validates the cause of death for epidemiological statistics [1][2][3]. Autopsies make important contribution to the under-and postgraduate training in medicine.…”

Section: Introductionmentioning

confidence: 99%

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

Szepesi

Csokonay

Murnyák

et al. 2016

Journal of the Neurological Sciences

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ObjectivesThe vast majority of literature on the frequency of the haemorrhagic transformation of ischaemic stroke is based on imaging studies. The purpose of the present study was to assess the added value of autopsy and neuropathological analysis in a neurology centre with emphasis on acute stroke care. MethodsWe retrospectively analysed the findings of 100 consecutive brain autopsies followed by detailed clinical correlation. ResultsThe clinical diagnosis was confirmed by neuropathology in every patient with intracerebral haemorrhage and with non-cerebrovascular neurological disorders (e.g. primary tumours, metastases, infections). At admission 64 patients (age 62 years, SD 6.5) were diagnosed with acute ischaemic stroke. In 10 of these patients (16%) haemorrhagic transformation was diagnosed clinically by a second CT. In 24 cases (38%) haemorrhagic transformation was detected only at autopsy. The distribution of haemorrhagic transformation in our material was the following: small petechiae in 26.5%, more confluent petechiae in 29.4%, ≤ 30% of the infarcted area with some mild space-occupying effect in 29.4% and > 30% of the infarcted area with significant space-occupying effect or clot remote from infarcted area in 14.7%. Most of the PH1-2 transformations developed in thrombolysed patients and all of the PH2 type transformations were diagnosed already clinically. ConclusionsWe demonstrated that haemorrhagic transformation is frequent and often undiscovered in vivo. Our findings underline the importance of post-mortem neuropathological examination also in the era of advanced imaging techniques and prove that autopsy is the ultimate yardstick of our diagnostic and therapeutic efforts. The high number of haemorrhagic transformations diagnosed only after death is an important novel finding with clinical implications.

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“…(7) In geriatric patients, a discrepancy rate of 52.5% (19) was reported. In a subset of patients with cardiovascular diseases, a 29,9% discrepancy rate was found.…”

Section: Discussionmentioning

confidence: 99%

Discrepâncias clínico-patológicas em pacientes graves com difícil diagnóstico pre-mortem

Fares¹,

Cury²,

Lobo³

2011

Rev. bras. ter. intensiva

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The clinical diagnostic accuracy rate regarding the immediate cause of death in a hospitalized geriatric population: an autopsy study of 1594 patients

Abstract: The low CDARCD in our study strongly indicates the need for autopsy when reliable mortality statistics are desired.

Cited by 54 publications

References 26 publications

Pulmonary Embolism is an Important Cause of Death in Young Adults

Pulmonary Embolism is an Important Cause of Death in Young Adults

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

Discrepâncias clínico-patológicas em pacientes graves com difícil diagnóstico pre-mortem

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