| 1.
AUTHOR | Nichols
L; Aronica P; Babe C |
| INSTITUTION | Department
of Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA. |
| TITLE | Are
autopsies obsolete? |
| SOURCE | Am
J Clin Pathol 1998 Aug;110(2):210-8 |
| ISSN | 0002-9173 |
| ABSTRACT | To
determine the current frequency of discovering important diagnoses at autopsy,
the diagnoses made in all complete or "no head" autopsies during 1994 at a major
tertiary care transplantation referral center were retrospectively compared with
the diagnoses made antemortem. Of 176 autopsies, 79 (44.9%) revealed 1 or more
undiagnosed causes of death. Of the 123 undiagnosed causes of death, 13 were sole
immediate causes of death, 72 were one of multiple immediate causes, 22 were intervening
causes, and 16 were underlying causes. The causes of death were as follows: infections,
34; infarctions, 11; malignant neoplasms, 8; pulmonary emboli, 7; gastrointestinal
ulcers, 7; hemorrhages, 6; thromboses, 3; amyloidosis, 1; genetic hemochromatosis,
1; and cardiac tamponade, 1. Of 35 autopsies of transplant recipients, 16 (46%)
disclosed undiagnosed causes of death, compared with 63 (44.7%) of 141 autopsies
of patients who had not received transplants. Approximately two thirds of the
undiagnosed causes of death were judged to be treatable conditions. This and similar
studies suggest that old-fashioned low-technology autopsies can uncover many important
diagnoses missed by modern high-technology medicine. |
| |
| 2.
AUTHOR | Veress
B; Alafuzoff I |
| INSTITUTION | Department
of Pathology, Karolinska Institute, Huddinge University Hospital, Sweden. |
| TITLE | A
retrospective analysis of clinical diagnoses and autopsy findings in 3,042 cases
during two different time periods. |
| SOURCE | Hum
Pathol 1994 Feb;25(2):140-5 |
| ISSN | 0046-8177 |
| ABSTRACT | The
accuracy of clinical diagnoses was determined and compared between the two periods
of time 1977 to 1978 and 1987 to 1988 based on the analysis of 3,042 autopsies
at Huddinge University Hospital. The discrepancy rates were calculated by counting
the number of missed or incompletely diagnosed major diseases and their complications.
Moreover, sensitivity, specificity, and clinical accuracy for positive and negative
diagnoses also were calculated for all cases of acute myocardial infarction and
malignant tumors. The autopsy rate decreased from 80% to 39%. The autopsy successfully
addressed the clinical questions in 97% of the cases. The selection of the cases
possibly could explain the significant 5% increase in the proportion of clinically
undetected major underlying diseases. The discrepancy rate was higher among the
older patients. There were no significant changes in the diagnosis of cardiovascular
diseases apart from thrombosis of the mesenteric artery, which more than doubled.
The proportion of infectious diseases increased significantly from 27% to 32%.
The number of cases with clinically missed tuberculosis was twice as high in the
1987 to 1988 period as in the 1977 to 1978 period and there was a marked increase
in fungal and viral infections. There was no significant change in the clinical
diagnosis of malignant tumors between the two periods. Approximately 15% of all
major cancers were not diagnosed before autopsy; half of these tumors were lethal.
We conclude that the role of the autopsy has not diminished in spite of advanced
diagnostic methods and it remains an effective tool in the assessment of medical
care.
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