Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
PLoS One. 2019 Sep 6;14(9):e0220657. doi: 10.1371/journal.pone.0220657. eCollection 2019.
Clinico-pathological discrepancies are more frequent in settings in which limited diagnostic techniques are available, but there is little information on their actual impact.
We assessed the accuracy of the clinical diagnoses in a tertiary referral hospital in sub-Saharan Africa by comparison with post-mortem findings. We also identified potential risk factors for misdiagnoses.
One hundred and twelve complete autopsy procedures were performed at the Maputo Central Hospital (Mozambique), from November 2013 to March 2015. We reviewed the clinical records. Major clinico-pathological discrepancies were assessed using a modified version of the Goldman and Battle classification.
Major diagnostic discrepancies were detected in 65/112 cases (58%) and were particularly frequent in infection-related deaths (56/80 [70%] major discrepancies). The sensitivity of the clinical diagnosis for toxoplasmosis was 0% (95% CI: 0-37), 18% (95% CI: 2-52) for invasive fungal infections, 25% (95% CI: 5-57) for bacterial sepsis, 34% (95% CI: 16-57), for tuberculosis, and 46% (95% CI: 19-75) for bacterial pneumonia. Major discrepancies were more frequent in HIV-positive than in HIV-negative patients (48/73 [66%] vs. 17/39 [44%]; p = 0.0236).
Major clinico-pathological discrepancies are still frequent in resource constrained settings. Increasing the level of suspicion for infectious diseases and expanding the availability of diagnostic tests could significantly improve the recognition of common life-threatening infections, and thereby reduce the mortality associated with these diseases. The high frequency of clinico-pathological discrepancies questions the validity of mortality reports based on clinical data or verbal autopsy.
在诊断技术有限的情况下，临床病理差异更为常见，但关于其实际影响的信息很少。
我们通过与尸检结果比较，评估撒哈拉以南非洲一家三级转诊医院的临床诊断的准确性。我们还确定了误诊的潜在危险因素。
2013 年 11 月至 2015 年 3 月，在莫桑比克马普托中央医院进行了 112 例完整的尸检程序。我们复习了临床记录。使用 Goldman 和 Battle 分类的改良版本评估主要临床病理差异。
在 112 例病例中发现了 65 例（58%）主要诊断差异，感染相关死亡病例差异尤为频繁（70%的 56 例主要差异）。临床诊断弓形虫病的敏感性为 0%（95%CI：0-37），侵袭性真菌感染为 18%（95%CI：2-52），细菌性败血症为 25%（95%CI：5-57），肺结核为 34%（95%CI：16-57），细菌性肺炎为 46%（95%CI：19-75）。HIV 阳性患者中主要差异比 HIV 阴性患者更常见（48/73[66%]比 17/39[44%]；p = 0.0236）。
在资源有限的情况下，主要的临床病理差异仍然很常见。提高对传染病的怀疑水平并扩大诊断检测的可用性，可能会显著提高对常见危及生命感染的认识，并从而降低这些疾病的死亡率。临床病理差异的高频率质疑了基于临床数据或口述尸检的死亡率报告的有效性。
