Anderson R E, Hill R B, Key C R
Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM 87131.
JAMA. 1989 Mar 17;261(11):1610-7.
Published studies encompassing more than 50,000 autopsies were assessed to determine the sensitivity and specificity of clinical diagnostics (the diagnostic process) in persons dying of 1 of 11 specific diseases during the period 1930 through 1977. The accuracy of clinical diagnostics, as reflected in these two determinations, appeared to improve over this period with respect to some of the diseases studied (rheumatic heart disease and leukemia), while for others it worsened (pulmonary tuberculosis, peritonitis, carcinoma of the lung, gastric carcinoma, and carcinoma of the liver and extrahepatic biliary tract) and for a significant number diagnostic accuracy seemed refractory to sustained change (pulmonary embolism, primary cirrhosis of the liver, gastric/peptic ulcer, and acute coronary thrombosis/myocardial infarction). The findings suggest a new way in which the autopsy can be used to monitor clinical diagnostics to identify possible sources of systematic weaknesses and provide data that can be used to approach the difficult subject of necessary fallibility.
对涵盖超过50000例尸检的已发表研究进行评估，以确定1930年至1977年期间死于11种特定疾病之一的患者的临床诊断（诊断过程）的敏感性和特异性。这两项测定所反映的临床诊断准确性，在这段时间内，对于某些研究的疾病（风湿性心脏病和白血病）似乎有所提高，而对于其他疾病则有所恶化（肺结核、腹膜炎、肺癌、胃癌以及肝癌和肝外胆管癌），并且对于相当数量的疾病，诊断准确性似乎难以持续改变（肺栓塞、原发性肝硬化、胃/消化性溃疡以及急性冠状动脉血栓形成/心肌梗死）。这些发现提示了一种新的方法，通过该方法尸检可用于监测临床诊断，以识别系统性弱点的可能来源，并提供可用于探讨必要的误诊这一难题的数据。
