Vuichard P, Magnenat P, Schindler A M, Yersin B
Département de médecine interne, CHUV, Lausanne.
Schweiz Med Wochenschr. 1992 Dec 5;122(49):1869-74.
In order to assess the level of agreement between clinical and autopsy diagnoses in the medical wards of a city and teaching hospital, we studied 94 consecutive patients autopsied during a 12 months' period. The rate of autopsy in this study was 59%. The main diagnosis was confirmed at autopsy in 80% of the cases, more precisely defined in 11% and discovered in 9%. Among 124 secondary diagnoses, 34% were diagnosed by the pathologist. The retrospective analysis of the cases in which there was disagreement between clinical and autopsy diagnosis showed that in 8 of them (8.5% of all patients), a clinical impact on survival was possible. However, all of these patients were over 80 and had multiple and/or terminal diseases. Thus, the real impact of these diagnostic errors is debatable.
为评估某市教学医院内科病房临床诊断与尸检诊断之间的一致性水平,我们研究了12个月期间连续进行尸检的94例患者。本研究中的尸检率为59%。主要诊断在80%的病例中经尸检得到证实,在11%的病例中得到更精确的界定,在9%的病例中是尸检新发现的。在124项次要诊断中,34%是由病理学家诊断的。对临床诊断与尸检诊断存在分歧的病例进行回顾性分析发现,其中8例(占所有患者的8.5%)可能对生存有临床影响。然而,所有这些患者年龄均超过80岁,且患有多种和/或晚期疾病。因此,这些诊断错误的实际影响存在争议。