Ornelas-Aguirre Jose M, Vázquez-Camacho Gonzalo, Gonzalez-Lopez Laura, Garcia-Gonzalez Araceli, Gamez-Nava Jorge I
Department of Pathology and the Unidad de Investigación en Epidemiología Clínica, Centro Médico Nacional de Occidente, Guadalajara, Jalisco, México.
Ann Diagn Pathol. 2003 Aug;7(4):223-30. doi: 10.1016/s1092-9134(03)00050-9.
We describe the concordance between clinical diagnoses and autopsy findings in a tertiary care center. Clinical autopsy is a useful tool for the evaluation of accuracy of the clinical diagnoses. However, autopsy rates have declined around the world recently. We randomly evaluated 500 of 2,211 autopsies performed in the department of pathology of a tertiary care hospital during a 10-year period. We computed the sensitivity, specificity, predictive values, and concordance scores between premortem and postmortem diagnoses. The autopsy diagnoses were used as the "gold standard." Four-hundred twenty-two (84.4%) of the autopsies met inclusion criteria. Diseases of the respiratory tract were diagnosed in 44.1% (186) of all autopsy reports reviewed. The higher sensitivity for diagnosis was observed in congenital anomalies (87.5%), while the higher specificity was observed in diagnosis of complications of pregnancy, childbirth, and the puerperium (98.98%). The higher concordance between premortem and postmortem diagnosis was observed with the diagnoses of neoplasms (kappa = 0.76), and for the group of complications of pregnancy, childbirth, and the puerperium (kappa = 0.76). A clinical diagnosis successfully addressed the cause of death in 40% of the cases Low values for concordance between autopsy reports and clinical diagnoses were present in most of the autopsies reports reviewed. We encourage physicians to continue considering the autopsy as an important tool that extends our understanding of diseases.
我们描述了一家三级医疗中心临床诊断与尸检结果之间的一致性。临床尸检是评估临床诊断准确性的有用工具。然而，近年来全球尸检率有所下降。我们在10年期间随机评估了一家三级医疗医院病理科进行的2211例尸检中的500例。我们计算了死前诊断与死后诊断之间的敏感性、特异性、预测值和一致性评分。尸检诊断被用作“金标准”。422例（84.4%）尸检符合纳入标准。在所有审查的尸检报告中，44.1%（186例）诊断为呼吸道疾病。先天性异常的诊断敏感性较高（87.5%），而妊娠、分娩和产褥期并发症的诊断特异性较高（98.98%）。肿瘤诊断（kappa = 0.76）以及妊娠、分娩和产褥期并发症组（kappa = 0.76）的死前诊断与死后诊断之间的一致性较高。在40%的病例中，临床诊断成功确定了死因。在大多数审查的尸检报告中，尸检报告与临床诊断之间的一致性值较低。我们鼓励医生继续将尸检视为扩展我们对疾病理解的重要工具。
