Grade M H C, Zucoloto S, Kajiwara J K, Fernandes M T P, Couto L G F, Garcia S B
Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Campus FMRP, USP, 14.049-000, Ribeirão Preto, Brazil.
J Clin Pathol. 2004 Apr;57(4):369-73. doi: 10.1136/jcp.2003.013235.
To determine the agreement between clinical and necropsy diagnoses of the basic cause of death, and to compare the results with those obtained in a previous study carried out at the same university hospital.
In total, 4828 necropsies, performed between 1990 and 1995 in the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil, were reviewed. Examinations were concluded at the macroscopic part of the necropsy in nearly 35% of the cases. Statistical analysis was carried out using the kappa coefficient comparing the clinical diagnosis and the diagnosis obtained after necropsy. The jackknife method was used to identify comparable kappa values for the comparison of the two periods.
Compared with the 1978-80 period, a significant increase in diagnostic agreement was seen for the group submitted to complete necropsy, whereas no similar increase was detected when only the macroscopic step was analysed.
There was a discrete tendency to an improved correlation between clinical and postmortem data stated by full necropsy analysis. The findings show that microscopic analysis remains important to confirm the cause of death in many cases. Diagnostic discrepancies remained high, and therefore complete necropsy continues to be an essential instrument for the assessment of clinical diagnosis.
确定临床诊断与尸检诊断在根本死因方面的一致性，并将结果与此前在同一大学医院开展的一项研究所得结果进行比较。
对1990年至1995年期间在巴西圣保罗大学里贝朗普雷图医学院大学医院进行的总共4828例尸检进行回顾。近35%的病例在尸检的宏观部分结束检查。使用kappa系数进行统计分析，比较临床诊断和尸检后得出的诊断。采用刀切法确定两个时期比较的可比kappa值。
与1978 - 1980年期间相比，接受完整尸检的组诊断一致性显著提高，而仅分析宏观步骤时未检测到类似的增加。
全面尸检分析表明临床数据与尸检数据之间的相关性有离散的改善趋势。研究结果表明，在许多情况下，显微镜分析对于确认死因仍然很重要。诊断差异仍然很大，因此完整尸检仍然是评估临床诊断的重要手段。
