The Value of Autopsies in the Era of High-Tech Medicine
The Value of Autopsies in the Era of High-Tech Medicine
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.
The autopsy is for long been regarded as the 'gold standard' as the most important tool for retrospective quality assessment of clinical diagnoses as well as a key educational tool. This is evident from previous studies comparing clinical diagnoses and autopsy findings, which revealed major discrepancies in approximately 25% of the deceased patients that underwent postmortem examination.
However, throughout the world, autopsy rates have been declining over the past few decades. Reasons for this decline include the non-reimbursement of autopsies, clinicians' fear of medicolegal problems and advances in laboratory testing and imaging techniques that often result in the belief among clinicians that the autopsy had become redundant.
We assessed the value of autopsies by determining the major and minor discrepancy rates in a total of 460 consecutive autopsy cases, divided over two time periods. In the most recent time period, the majority of autopsies was performed by a specialised autopsy pathologist. Furthermore, we analysed the influence of several factors, including age, sex, length of final admission and the use of imaging techniques on the frequency of major and minor discrepancies. Finally, we determined the role of microscopic examination in identifying the cause of death (COD).
Abstract and Introduction
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.
Introduction
The autopsy is for long been regarded as the 'gold standard' as the most important tool for retrospective quality assessment of clinical diagnoses as well as a key educational tool. This is evident from previous studies comparing clinical diagnoses and autopsy findings, which revealed major discrepancies in approximately 25% of the deceased patients that underwent postmortem examination.
However, throughout the world, autopsy rates have been declining over the past few decades. Reasons for this decline include the non-reimbursement of autopsies, clinicians' fear of medicolegal problems and advances in laboratory testing and imaging techniques that often result in the belief among clinicians that the autopsy had become redundant.
We assessed the value of autopsies by determining the major and minor discrepancy rates in a total of 460 consecutive autopsy cases, divided over two time periods. In the most recent time period, the majority of autopsies was performed by a specialised autopsy pathologist. Furthermore, we analysed the influence of several factors, including age, sex, length of final admission and the use of imaging techniques on the frequency of major and minor discrepancies. Finally, we determined the role of microscopic examination in identifying the cause of death (COD).
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