Schertenleib T I, Pospischil A, Hässig M, Kircher P R, Hilbe M
Institute of Veterinary Pathology, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland.
Department of Farm Animals, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland.
J Comp Pathol. 2017 Feb-Apr;156(2-3):217-234. doi: 10.1016/j.jcpa.2017.01.004. Epub 2017 Feb 21.
The comparison of clinical ante-mortem and pathological post-mortem diagnoses is a prerequisite for quality control, but is rarely done in veterinary medicine. This study reports the occurrence and concurrence of clinical and pathological diagnoses linked to death in 1,000 cats and 1,000 dogs examined and subjected to necropsy examination at the University of Zurich, Switzerland. Potential factors influencing the correlation between diagnoses were examined retrospectively. In 5.8% of cats and 5.2% of dogs no diagnosis was made; in 2.6% and 3.8% of cases only a clinical, and in 17.8% and 11.2%, respectively, only a pathological diagnosis was available. Of the 73.8% of cats and 79.8% of dogs with both diagnoses present, 38.3% and 36.2% were in agreement, while there was disagreement in 17.9% and 16.0%, respectively. The remaining cases (43.8% and 47.8%) had different levels of further diagnostic procedures following necropsy examination. In both species, the manner of death, the clinical discipline submitting the animal for necropsy examination and the quality of the necropsy submission request, as well as the timespan between death and necropsy examination in dogs, proved to influence the concurrence between diagnoses. In contrast, the organ system affected and the type of disease entity were, for both species, the most influential factors in the concurrence of diagnoses. Therefore, in veterinary medicine, even in times of improving diagnostic abilities, necropsy examination still reveals important information for quality control and education.
临床生前诊断与病理死后诊断的比较是质量控制的前提条件，但在兽医学中很少进行。本研究报告了在瑞士苏黎世大学检查并进行尸检的1000只猫和1000只狗中，与死亡相关的临床和病理诊断的发生率及一致性。回顾性研究了影响诊断相关性的潜在因素。5.8%的猫和5.2%的狗未做出诊断；2.6%和3.8%的病例仅有临床诊断，分别有17.8%和11.2%仅有病理诊断。在同时有两种诊断结果的73.8%的猫和79.8%的狗中，38.3%和36.2%诊断结果一致，而分别有17.9%和16.0%不一致。其余病例（43.8%和47.8%）在尸检后有不同程度的进一步诊断程序。在两个物种中，死亡方式、将动物送检尸检的临床学科、尸检送检请求的质量以及狗死亡与尸检之间的时间跨度，都被证明会影响诊断的一致性。相比之下，对于两个物种而言，受影响的器官系统和疾病实体类型是诊断一致性中最具影响力的因素。因此，在兽医学中，即使在诊断能力不断提高的时代，尸检仍能揭示质量控制和教育方面的重要信息。
