Coradazzi A L, Morganti A L C, Montenegro M R G
Departamento de Hematologia e Oncologia Clínica, Hospital Amaral Carvalho, Jaú, SP, Brasil.
Braz J Med Biol Res. 2003 Mar;36(3):385-91. doi: 10.1590/s0100-879x2003000300014. Epub 2003 Mar 7.
Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.
尸检被认为是医学审计和教学的重要组成部分。尽管诊断程序取得了重大进展，但尸检并不总是能证实临床诊断。在本研究中，我们将巴西圣保罗州博图卡图医学院大学教学医院1975年至1982年间进行的96例尸检报告以及1992年至1996年间在同一机构进行的156例尸检报告与病历记录的诊断进行了比较。尸检证实77%的病例临床诊断的根本死因正确。若考虑直接死因，确诊率降至60%，且在25%的病例中，仅通过尸检才诊断出死因。临床诊断与尸检诊断之间的差异在次要诊断中甚至更大：其中50%在临床诊断时未被怀疑。其中，我们着重指出静脉血栓形成（83%）、肺栓塞（80%）、支气管肺炎（46%）和肿瘤（38%）的诊断。医源性损伤非常常见，其中约90%在临床报告中未被描述。我们的结果表明，高灵敏度和特异性的诊断测试是必要的，但不能替代临床实践来做出正确诊断。
