Liu Danyang, Gan Rongchang, Zhang Weidi, Wang Wei, Saiyin Hexige, Zeng Wenjiao, Liu Guoyuan
Department of Pathology, School of Basic Medical Sciences, Fudan University, Shanghai, China.
Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.
J Clin Pathol. 2018 Jan;71(1):67-71. doi: 10.1136/jclinpath-2017-204484. Epub 2017 Jul 22.
Emergency medicine is a 'high risk' specialty. Some diseases develop suddenly and progress rapidly, and sudden unexpected deaths in the emergency department (ED) may cause medical disputes. We aimed to assess discrepancies between antemortem clinical diagnoses and postmortem autopsy findings concerning emergency medicine dispute cases and to figure out the most common major missed diagnoses.
Clinical files and autopsy reports were retrospectively analysed and interpreted. Discrepancies between clinical diagnoses and autopsy diagnoses were evaluated using modified Goldman classification as major and minor discrepancy. The difference between diagnosis groups was compared with Pearson χ test.
Of the 117 cases included in this study, 71 of cases (58 class I and 13 class II diagnostic errors) were revealed as major discrepancies (60.7%). The most common major diagnoses were cardiovascular diseases (54 cases), followed by pulmonary diseases, infectious diseases and so on. The difference of major discrepancy between the diagnoses groups was significant (p<0.001). Aortic dissection and myocardial infarction were the most common cause of death (15 cases for each disease) and the most common missed class I diagnoses (80% and 66.7% for each), higher than the average 49.6% of all class I errors of the study patients.
High major disparities between clinical diagnoses and postmortem examinations exist in emergency medical disputes cases; acute aortic dissection and myocardial infarction are the most frequently major missed diagnoses that ED clinicians should pay special attention to in practice. This study reaffirmed the necessity and usefulness of autopsy in auditing death in EDs.
急诊医学是一个“高风险”专业。一些疾病突发且进展迅速，急诊科（ED）的猝死可能引发医疗纠纷。我们旨在评估急诊医学纠纷案件中生前临床诊断与死后尸检结果之间的差异，并找出最常见的主要漏诊情况。
对临床档案和尸检报告进行回顾性分析和解读。使用改良的戈德曼分类法将临床诊断与尸检诊断之间的差异评估为主要差异和次要差异。诊断组之间的差异采用Pearson χ检验进行比较。
本研究纳入的117例病例中，71例（58例I类和13例II类诊断错误）被发现为主要差异（60.7%）。最常见的主要诊断是心血管疾病（54例），其次是肺部疾病、传染病等。诊断组之间主要差异的差异具有统计学意义（p<0.001）。主动脉夹层和心肌梗死是最常见的死亡原因（每种疾病各15例），也是最常见的I类漏诊（每种疾病分别为80%和66.7%），高于研究患者所有I类错误的平均49.6%。
急诊医疗纠纷案件中临床诊断与死后检查之间存在高度的主要差异；急性主动脉夹层和心肌梗死是最常见的主要漏诊情况，急诊临床医生在实践中应特别关注。本研究再次证实了尸检在审核急诊科死亡病例中的必要性和实用性。
