Symbiant Pathology Expert Centre, Alkmaar, The Netherlands.
Symbiant Pathology Expert Centre, Alkmaar, The Netherlands Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands.
J Clin Pathol. 2014 Jun;67(6):512-9. doi: 10.1136/jclinpath-2013-202122. Epub 2014 Mar 4.
Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have been declining over the last decades to <10%. The aim of this study was to investigate the value of autopsies in the high-tech medicine era by determining the frequency of discrepancies between clinical and autopsy diagnoses.
We classified all adult autopsy cases (n=460), performed at Symbiant, Pathology Expert Centre, in 2007 and 2012/2013, as having major, or minor discrepancy or total concordance. The roles of possible contributory factors were analysed. Finally, we assessed the role of microscopic examination in identifying cause of death.
Major and minor discrepancies were found in 23.5% and 32.6% of the classifiable autopsies, respectively. Most commonly observed major discrepancies were myocardial infarction, pulmonary embolism and pneumonia. Improper imaging and discontinuation of active treatment were significantly associated with a higher and a lower frequency of major discrepancies, respectively. Comparing 2007 and 2012/2013, the frequency of minor discrepancies significantly increased from 26.8% to 39.3%. Final admission length of >2 days was significantly associated with a lower frequency of class III minor discrepancies. Microscopic examination contributed to establishing cause of death in 19.6% of the cases.
Discrepant findings persist at autopsy, even in the era of high-tech medicine. Therefore, autopsies still should serve as a very important part of quality control in clinical diagnosis and treatment. Learning from individual and system-related diagnostic errors can aid in improving patient safety.
尽管尸检仍然是评估临床诊断质量的金标准，但在过去几十年中，尸检率已降至<10%。本研究旨在通过确定临床诊断与尸检诊断之间的差异频率来探讨在高科技医学时代尸检的价值。
我们将 2007 年和 2012/2013 年在 Symbiant、病理专家中心进行的所有成人尸检病例（n=460）分为主要差异、次要差异或完全一致。分析了可能的促成因素的作用。最后，我们评估了显微镜检查在确定死因中的作用。
可分类尸检中分别有 23.5%和 32.6%存在主要和次要差异。最常见的主要差异为心肌梗死、肺栓塞和肺炎。影像学检查不当和停止积极治疗与主要差异的发生频率较高和较低显著相关。与 2007 年相比，2012/2013 年次要差异的发生率从 26.8%显著增加到 39.3%。最终入院时间>2 天与较低的 III 级次要差异发生率显著相关。显微镜检查有助于确定 19.6%病例的死因。
即使在高科技医学时代，尸检仍存在不一致的发现。因此，尸检仍然应该作为临床诊断和治疗质量控制的重要组成部分。从个体和系统相关的诊断错误中吸取教训有助于提高患者安全性。
