Bayer-Garner Ilene B, M Fink Louis, Lamps Laura W
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Arch Pathol Lab Med. 2002 Apr;126(4):442-7. doi: 10.5858/2002-126-0442-PIATIA.
With the advent of modern diagnostic technology, use of the autopsy as a means of assessing diagnostic accuracy has declined precipitously. Interestingly, during the same period, the rate of misdiagnosis found at autopsy has not changed.
To ascertain why an autopsy was requested, whether or not questions asked by clinicians were specifically addressed, and what types of misdiagnoses were found.
One hundred forty-two consecutive autopsy records from the University of Arkansas for Medical Sciences Hospital were reviewed. In the same period, 715 deaths occurred, giving an overall autopsy rate of 20.14%.
Of the 125 autopsies in which the problem-oriented autopsy request was available for review, a reason for the autopsy was given in only 69 cases (55%). One hundred three clinical questions were asked, and of these, 81 were specifically addressed in the final anatomic diagnosis, 10 were addressed in some part of the autopsy report but not in the final anatomic diagnosis, 10 were not addressed at all, and 2 could not be answered by the autopsy. Sixty-one autopsies revealed 81 misdiagnoses: 47 class I (missed major diagnosis that, if detected before death, could have led to a change in management that might have resulted in cure or prolonged survival) and 34 class II misdiagnoses (missed major diagnosis in which antemortem detection would have not led to a change in management).
The autopsy continues to be a vital part of medical education and quality assurance. It is important for the clinician to provide a clinical summary and specific clinical questions to be addressed or to speak directly with the pathologist and for the pathologist to provide answers that are easily accessible within the autopsy report. In this way, a problem-oriented autopsy can be performed based on questions raised by the clinician and the pathologist as a result of the gross dissection and microscopic evaluation.
随着现代诊断技术的出现，尸检作为评估诊断准确性的一种手段已急剧减少。有趣的是，在同一时期，尸检发现的误诊率并未改变。
确定进行尸检的原因、临床医生提出的问题是否得到具体解答以及发现了哪些类型的误诊。
回顾了阿肯色大学医学科学医院连续142份尸检记录。同一时期共发生715例死亡，总体尸检率为20.14%。
在125份可用于审查的以问题为导向的尸检申请中，仅69例（55%）给出了尸检原因。提出了103个临床问题，其中81个在最终解剖诊断中得到了具体解答，10个在尸检报告的某些部分有所涉及但未在最终解剖诊断中提及，10个完全未得到解答，2个尸检无法回答。61例尸检发现了81例假诊：47例为I类（漏诊的主要诊断，若生前检测到可能导致治疗改变从而可能治愈或延长生存期）和34例II类误诊（漏诊的主要诊断，生前检测到也不会导致治疗改变）。
尸检仍然是医学教育和质量保证的重要组成部分。临床医生提供临床总结和需要解答的具体临床问题或直接与病理学家沟通，以及病理学家在尸检报告中提供易于获取的答案非常重要。通过这种方式，可以根据临床医生提出的问题以及病理学家在大体解剖和显微镜评估后提出的问题进行以问题为导向的尸检。
