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Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?
  1. Danyang Liu1,2,
  2. Rongchang Gan3,
  3. Weidi Zhang1,
  4. Wei Wang1,
  5. Hexige Saiyin4,
  6. Wenjiao Zeng1,
  7. Guoyuan Liu1
  1. 1 Department of Pathology, School of Basic Medical Sciences, Fudan University, Shanghai, China
  2. 2 Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
  3. 3 Judicial Authentication Institution of Shanghai Minhang District Central Hospital, Shanghai, China
  4. 4 The State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
  1. Correspondence to Dr Guoyuan Liu, Department of Pathology, School of Basic Medical Sciences, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China; gyliu{at}


Aims Emergency medicine is a ‘high risk’ specialty. Some diseases develop suddenly and progress rapidly, and sudden unexpected deaths in the emergency department (ED) may cause medical disputes. We aimed to assess discrepancies between antemortem clinical diagnoses and postmortem autopsy findings concerning emergency medicine dispute cases and to figure out the most common major missed diagnoses.

Methods Clinical files and autopsy reports were retrospectively analysed and interpreted. Discrepancies between clinical diagnoses and autopsy diagnoses were evaluated using modified Goldman classification as major and minor discrepancy. The difference between diagnosis groups was compared with Pearson χ2 test.

Results Of the 117 cases included in this study, 71 of cases (58 class I and 13 class II diagnostic errors) were revealed as major discrepancies (60.7%). The most common major diagnoses were cardiovascular diseases (54 cases), followed by pulmonary diseases, infectious diseases and so on. The difference of major discrepancy between the diagnoses groups was significant (p<0.001). Aortic dissection and myocardial infarction were the most common cause of death (15 cases for each disease) and the most common missed class I diagnoses (80% and 66.7% for each), higher than the average 49.6% of all class I errors of the study patients.

Conclusions High major disparities between clinical diagnoses and postmortem examinations exist in emergency medical disputes cases; acute aortic dissection and myocardial infarction are the most frequently major missed diagnoses that ED clinicians should pay special attention to in practice. This study reaffirmed the necessity and usefulness of autopsy in auditing death in EDs.

  • cardiovascular diseases
  • autopsy pathology
  • diagnosis discrepancy
  • emergency medicine
  • medical dispute

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  • Contributors GL and DL conceived the study and participated in data collection, data interpretation and analysis, and manuscript writing. RG, WZ and WenZ participated in the data collection and interpretation. HS participated in statistical analysis. WW participated in critical analysis.

  • Funding This work was supported by the Natural Science Foundation of China (NSFC 31671461, NSFC 31301162).

  • Competing interests None declared.

  • Ethics approval The Medicine Ethics Committee of School of Basic Medical Sciences, Fudan University.

  • Provenance and peer review Not commissioned; externally peer reviewed.