Institute of Pathology, Leipzig University Hospital.
Dtsch Arztebl Int. 2018 Sep 28;115(39):653-658. doi: 10.3238/arztebl.2018.0653.
Autopsies are considered an important quality assurance instrument in medicine, yet autopsy rates in many countries have been declining for many years. The proper role of the post-mortem examination in modern medicine is a matter deserving of study.
This review is based on a selective search of the literature for publications on the role of autopsies as a quality assurance instrument.
Multiple studies have revealed substantial rates of discrepancy between pre- and post-mortem diagnoses, with reported rates lying in the range of 10% to 40%. The frequen- cy of so-called Goldman I erroneous diagnoses, i.e., those that are determined at autopsy and might have influenced the patient's survival, ranges from 2.4% to 10.7%. It can be as- sumed that the rate of serious diagnostic errors revealed by autopsy would fall if autopsy rates were to rise. Independently of the above-mentioned studies, a large-scale study of data from the period 1988-2008 revealed a decline in the rate of Goldman I erroneous diagnoses by more than half. The qualitative effects of autopsies, however, are difficult to measure. At present, imaging studies and minimally invasive or endoscopic diagnostic procedures can be performed post mortem as well, but the available studies show that these methods do not yet suffice to enable a coherent pathogenetic classification of disease processes.
Autopsies should still be performed in the interest of quality assurance in medicine. Uniform standards in the performance and reporting of autopsies could lead to im- provement in the use of the data acquired through them.
尸检被认为是医学中一种重要的质量保证手段,但在许多国家,尸检率多年来一直在下降。因此,有必要对死后检查在现代医学中的适当作用进行研究。
本综述基于对尸检作为质量保证手段的相关文献进行选择性搜索。
多项研究表明,术前和术后诊断之间存在很大的差异率,报道的差异率在 10%到 40%之间。所谓的 Goldman I 错误诊断的频率,即那些在尸检中确定并可能影响患者生存的诊断,范围在 2.4%到 10.7%之间。可以假设,如果尸检率上升,尸检所揭示的严重诊断错误率将会下降。独立于上述研究之外,一项针对 1988 年至 2008 年期间数据的大规模研究表明,Goldman I 错误诊断的比率下降了一半以上。然而,尸检的定性影响很难衡量。目前,死后也可以进行影像学研究以及微创或内镜诊断程序,但现有研究表明,这些方法还不足以对疾病过程进行一致的病因分类。
为了医学质量保证,尸检仍应进行。在尸检的执行和报告方面采用统一标准,可以提高通过尸检获得的数据的使用效率。