O'Connor Alan E, Parry Jeremy T, Richardson Drew B, Jain Sanjiv, Herdson Peter B
Department of Emergency Medicine, The Canberra Hospital, ACT, Australia.
Acad Emerg Med. 2002 Sep;9(9):957-9. doi: 10.1111/j.1553-2712.2002.tb02198.x.
In spite of advances in medical technology, there remains a high discrepancy rate between the antemortem clinical diagnosis and postmortem examination diagnosis for patients who die in hospitals. The aim of this study was to compare the clinical and postmortem examination diagnoses of patients who died in the emergency department (ED) of a tertiary hospital, and to analyze any discrepancy between them.
The study was a retrospective chart review of patients who died in the ED of a tertiary referral teaching hospital and a comparison of the antemortem diagnosis with the autopsy diagnosis. Any missed diagnosis was classified, according to the Goldman criteria, into major and minor missed diagnoses.
A total of 59 patients were eligible for inclusion in the study. There was complete agreement between the antemortem diagnosis and the autopsy result in 51% of cases. The incidence of major missed diagnoses-where if the diagnosis had been known before the patient died, treatment may have been altered or survival may have been prolonged-was 7%.
There is a significant discrepancy rate between the antemortem diagnosis and the autopsy diagnosis. However, in this study, serious missed diagnoses in which outcome may have been significantly altered are unusual among those who die in the ED of a tertiary referral hospital.
尽管医疗技术有所进步，但在医院死亡患者中，生前临床诊断与尸检诊断之间仍存在较高的差异率。本研究的目的是比较在一家三级医院急诊科死亡患者的临床诊断和尸检诊断，并分析两者之间的差异。
本研究是对一家三级转诊教学医院急诊科死亡患者的病历进行回顾性审查，并将生前诊断与尸检诊断进行比较。根据戈德曼标准，任何漏诊都被分为重大漏诊和轻微漏诊。
共有59例患者符合纳入本研究的条件。在51%的病例中，生前诊断与尸检结果完全一致。重大漏诊（即如果在患者死亡前已知诊断，治疗可能会改变或生存期可能会延长）的发生率为7%。
生前诊断与尸检诊断之间存在显著差异率。然而，在本研究中，在三级转诊医院急诊科死亡的患者中，可能显著改变结局的严重漏诊并不常见。
