Department of Anatomic and Clinical Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Mod Pathol. 2010 Sep;23(9):1225-30. doi: 10.1038/modpathol.2010.107. Epub 2010 Jun 4.
Autopsy rates have been affected by a number of factors, including technological advances and clinician beliefs of the diminished value of the autopsy. Such factors have resulted in a cultural shift in medicine away from the autopsy. Despite this shift, a number of studies have shown significant differences between antemortem clinical diagnoses and postmortem findings. Surveys of clinician beliefs about the autopsy have pointed toward antemortem diagnostic advancements as an important factor in declining rates. No study to date has addressed the hypothesis that such perceptions in diagnostic certainty have been matched by an actual decay in the yield of valuable or new information obtained by the autopsy. To address this hypothesis, we retrospectively compared the class I and class II discrepancies identified in 284 patients who died in three clinical settings with differing intensities of antemortem diagnostic workup. Despite a significantly different intensity of antemortem workup for patients in each clinical setting, including patients on a medical intensive care unit, patients on a surgical service and patients in an affiliated nursing home, discrepancy rates were found to be similar. Overall discrepancy rates for the medical intensive care unit, surgery service and nursing home patients were 27.8, 32.7 and 31.3%, respectively (P=0.84). In addition, we found no statistical difference in the complexity of workup in discrepant and nondiscrepant cases in each clinical setting. Our study data refute the hypothesis that the intensity of antemortem diagnostic evaluation correlates with an actual decrease in the rate of major diagnostic discrepancies identified at autopsy.
尸检率受到多种因素的影响，包括技术进步和临床医生对尸检价值降低的信念。这些因素导致医学文化从尸检转向。尽管如此，许多研究表明，生前临床诊断与死后发现之间存在显著差异。对临床医生对尸检的信念的调查表明，生前诊断进展是尸检率下降的一个重要因素。迄今为止，尚无研究探讨这样一种假设，即对诊断确定性的这种看法是否与尸检获得的有价值或新信息的实际衰减相匹配。为了验证这一假设，我们回顾性比较了在三个临床环境中死亡的 284 名患者的 I 级和 II 级差异，这些患者的生前诊断检查强度不同。尽管每个临床环境中的患者的生前检查强度明显不同，包括在重症监护病房的患者、外科病房的患者和附属疗养院的患者，但发现差异率相似。重症监护病房、外科病房和疗养院患者的总体差异率分别为 27.8%、32.7%和 31.3%（P=0.84）。此外，我们还发现，在每个临床环境中，差异和非差异病例的检查复杂性之间没有统计学差异。我们的研究数据反驳了这样一种假设，即生前诊断评估的强度与在尸检中确定的主要诊断差异的实际发生率下降相关。
