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The value of autopsies in the era of high-tech medicine: discrepant findings persist
  1. Chantal C H J Kuijpers1,
  2. Judith Fronczek1,2,
  3. Frank R W van de Goot1,
  4. Hans W M Niessen2,3,4,
  5. Paul J van Diest5,
  6. Mehdi Jiwa1
  1. 1Symbiant Pathology Expert Centre, Alkmaar, The Netherlands
  2. 2Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands
  3. 3Department of Cardiac Surgery, VU Medical Centre, Amsterdam, The Netherlands
  4. 4ICaR-VU, VU Medical Centre, Amsterdam, the Netherlands
  5. 5Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Mehdi Jiwa, Department of Pathology, Alkmaar Medical Centre, Symbiant Pathology Expert Centre, PO Box 501, Alkmaar, Noord-Holland 1815 JD, The Netherlands; m.jiwa{at}symbiant.nl

Abstract

Aims Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have been declining over the last decades to <10%. The aim of this study was to investigate the value of autopsies in the high-tech medicine era by determining the frequency of discrepancies between clinical and autopsy diagnoses.

Methods We classified all adult autopsy cases (n=460), performed at Symbiant, Pathology Expert Centre, in 2007 and 2012/2013, as having major, or minor discrepancy or total concordance. The roles of possible contributory factors were analysed. Finally, we assessed the role of microscopic examination in identifying cause of death.

Results Major and minor discrepancies were found in 23.5% and 32.6% of the classifiable autopsies, respectively. Most commonly observed major discrepancies were myocardial infarction, pulmonary embolism and pneumonia. Improper imaging and discontinuation of active treatment were significantly associated with a higher and a lower frequency of major discrepancies, respectively. Comparing 2007 and 2012/2013, the frequency of minor discrepancies significantly increased from 26.8% to 39.3%. Final admission length of >2 days was significantly associated with a lower frequency of class III minor discrepancies. Microscopic examination contributed to establishing cause of death in 19.6% of the cases.

Conclusions Discrepant findings persist at autopsy, even in the era of high-tech medicine. Therefore, autopsies still should serve as a very important part of quality control in clinical diagnosis and treatment. Learning from individual and system-related diagnostic errors can aid in improving patient safety.

  • AUTOPSY PATHOLOGY
  • POSTMORTEM
  • SAFETY
  • QUALITY CONTROL
  • HISTOPATHOLOGY

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