Journal of Postgraduate Medicine
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LETTER
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Year : 2013  |  Volume : 59  |  Issue : 2  |  Page : 157-158  

Autopsy findings and clinical diagnoses: A retrospective analysis of 641 cases in Greece

SA Papadodima, CI Evaggelakos, IN Sergentanis, CA Spiliopoulou 
 Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens, Athens, Greece

Correspondence Address:
S A Papadodima
Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens, Athens
Greece




How to cite this article:
Papadodima S A, Evaggelakos C I, Sergentanis I N, Spiliopoulou C A. Autopsy findings and clinical diagnoses: A retrospective analysis of 641 cases in Greece.J Postgrad Med 2013;59:157-158


How to cite this URL:
Papadodima S A, Evaggelakos C I, Sergentanis I N, Spiliopoulou C A. Autopsy findings and clinical diagnoses: A retrospective analysis of 641 cases in Greece. J Postgrad Med [serial online] 2013 [cited 2020 Jun 6 ];59:157-158
Available from: http://www.jpgmonline.com/text.asp?2013/59/2/157/113809


Full Text

Dear Editor,

Several recent studies have consistently demonstrated a high rate of disparity between clinical and postmortem diagnoses. [1],[2],[3],[4] In consequence with the above studies, our previous one concerning the discrepancy between clinical diagnoses and postmortem finding during the period 1999-2003 showed a 29% for concordant cases and a 19% for discordant cases. The most frequently misdiagnosed diseases were coronary disease and pulmonary embolism. [5]

In order to investigate if there was any progress in the concordance between ante and postmortem diagnosis, the protocols of 641 consecutive cases of adult patients autopsied by forensic pathologists in the Department of Forensic Medicine and Toxicology of School of Athens Medical School, during the period 2004-2009. Data relative to the clinical diagnosis established during life, as well as the cause of death suggested by the clinicians were assessed by the autopsy requests and medical records.

The results showed that in 379 cases (59%), the autopsy findings confirmed the clinical diagnosis and the cause of death suggested by the clinicians. In 210 cases (33%), the clinical diagnosis and the cause of death suggested by the clinicians were discordant with the autopsy findings. In 45 cases (7%), the autopsy requests did not include any suggestion about clinical diagnoses and cause of death, and finally in 7 cases (1%) the death was due to senile myocardium degeneration and old age (physical death).

The most frequently misdiagnosed diseases were cardiovascular diseases. Discordant cases represented a 29% of the total number of coronary cases, which is very close to the previous one, 23%. [5] Previous studies have shown that diagnoses of cardiovascular diseases are the most frequently missed diagnoses in the patients that died in a general hospital experience, probably due to the high frequency of the disease, diagnostic difficulties, or even because of the sudden nature of some diseases (myocardial infarction, aorta dissection, pulmonary embolism, stroke), which do not allow adequate time for clinical investigations. [1],[4],[5]

Discrepancy concerning the diagnosis of pulmonary embolism was 22% whereas the percentage of discordant cases in deaths due to pulmonary infection was 26%. In two cases out of six, the diagnosis of peritonitis was missed. Finally, in the present study, the rate of undetected tumor (considered as cause of death) was 31%.

Discrepancy rates were higher for patients 60 years and older, whereas gender was not found to affect the discrepancy rates, in agreement with previous studies. [3],[4],[5] Finally, the rate of discrepancies did not differ between the group of patients hospitalized for less than 24 h and the group hospitalized for more than 1 day, which is in agreement with the most of other previous investigations of hospital wide populations [Table 1]. [4],[5]{Table 1}

Our study emphasizes that autopsy remains an important tool in assessing discrepant diagnoses, especially in the areas of coronary deaths, pulmonary embolism, and pulmonary infections. Clinicians should be encouraged to remember the value of postmortem examination in case of doubtful cause of death. Autopsies can provide valuable information for the quality control of the healthcare system and the full development of medical art and science. Accepting imperfections, detecting errors, and learning from them are essential attitudes in order to improve the patient care given by the clinicians.

References

1Fares AF, Fares J, Fares GF, Cordeiro JA, Nakazone MA, Cury PM. Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies. Arq Bras Cardiol 2011;97:449-55.
2Combes A, Mokhtari M, Couvelard A, Trouillet JL, Baudot J, Hénin D, et al. Clinical and autopsy diagnoses in the intensive care unit: A prospective study. Arch Intern Med 2004;164:389-92.
3Pastores SM, Dulu A, Voigt L, Raoof N, Alicea M, Halpern NA. Premortem clinical diagnoses and postmortem autopsy findings: Discrepancies in critically ill cancer patients. Crit Care 2007;11:R48.
4Tavora F, Crowder CD, Sun CC, Burke AP. Discrepancies between clinical and autopsy diagnoses: A comparison of university, community, and private autopsy practices. Am J Clin Pathol 2008;129:102-9.
5Spiliopoulou C, Papadodima S, Kotakidis N, Koutselinis A. Clinical diagnoses and autopsy findings: A retrospective analysis of 252 cases in Greece. Arch Pathol Lab Med 2005;129:210-4.

 
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