Koukolík F
Oddĕlení patologie fakultní Thomayerovy nemocnice, Praha.
Cas Lek Cesk. 1990 Jun 1;129(22):689-92.
In a group of 1100 autopsies made in 1987-1989 the author correlates the clinical and autoptic diagnosis of embolism of the pulmonary artery, acute myocardial infarction, valvular defects, chronic cor pulmonale, cardiomyopathies, cerebrovascular attacks, subarachnoid haemorrhage; the latter was compared with the diagnosis of chronic subdural haematoma. The sensitivity of the clinical diagnosis of some diseases is low, in different categories 10-80% of diseases escape the clinical diagnosis. As compared with correlations of clinical and pathological findings published abroad, the standard of diagnosis of embolism of the pulmonary artery is roughly the same (some 80% controversial clinical and autoptic diagnoses), in acute infarction it is worse (some 50% controversial diagnoses), in acute cerebrovascular attacks it is worse only when compared with some (cca 25-40% controversial diagnoses according to the categories of the international classification). Evaluation of the sensitivity and specificity of the clinical diagnosis is only orientational, more important is the frequency of diagnostic controversies with regard to severity. Errors of the first type, i.e. those where knowledge of the autoptic diagnosis before death would have most probably influenced the therapy and prognosis is in embolism of the pulmonary artery and myocardial infarction 10 and 13% resp., in the other categories errors are rare or absent, there are, however, frequent errors in the diagnosis of subdural haematoma.
在1987年至1989年进行的1100例尸检中，作者将肺动脉栓塞、急性心肌梗死、瓣膜缺损、慢性肺源性心脏病、心肌病、脑血管意外、蛛网膜下腔出血的临床诊断与尸检诊断进行了关联；并将后者与慢性硬膜下血肿的诊断进行了比较。某些疾病的临床诊断敏感性较低，在不同类别中，10% - 80%的疾病未被临床诊断出来。与国外发表的临床和病理结果的相关性相比，肺动脉栓塞的诊断标准大致相同（约80%的临床和尸检诊断存在争议），急性梗死的诊断标准较差（约50%的诊断存在争议），急性脑血管意外只有与某些情况（根据国际分类类别，约25% - 40%的诊断存在争议）相比时诊断标准才较差。对临床诊断敏感性和特异性的评估只是指导性的，更重要的是关于严重程度的诊断争议频率。第一类错误，即在死亡前了解尸检诊断很可能会影响治疗和预后的错误，在肺动脉栓塞和心肌梗死中分别为10%和13%，在其他类别中错误很少或不存在，然而，硬膜下血肿的诊断中经常出现错误。
