Rey-Fanjul Yaiza, Fernández-Vega Iván
Facultad de Medicina de la Universidad de Oviedo, Oviedo, España.
Facultad de Medicina de la Universidad de Oviedo, Oviedo, España; Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, España.
Rev Esp Patol. 2021 Apr-Jun;54(2):92-101. doi: 10.1016/j.patol.2020.02.003. Epub 2020 Mar 31.
To compare and contrast clinical diagnoses with autopsy findings in order to identify unexpected, relevant discrepancies.
A retrospective observational study of the revision of autopsies of adults and their respective medical records in order to classify them according to referral department and Goldman's classification was carried out at the Central University Hospital of Asturias between 2008-2017.
694 (52.6%) of 1320 autopsies were included in the study. Discrepancies were observed in 57.6% of cases, although the majority (39.3%) were minor. Type I discrepancies were identified in 63 autopsies (9.1%); malignant neoplasms being the main pathology observed (57.1%), mainly of gastrointestinal origin (about 28%). The second most common discrepancy was found in cases of infectious diseases (23.8%) followed by pulmonary embolism (15.9%). 64 autopsies were classified as type II discrepancies (9.2%), with myocardial infarct the most common (37.5%), especially acute myocardial infarction (18 cases), followed by bronchoaspirations (18.7%), DIC (15.6%), massive haemorrhages (9.4%) and other conditions. It was considered that both the ICU and the Internal Medicine Service were responsible for the largest number of major discrepancies (type I and II), accounting for about 45% of type I and slightly more than 56% for type II.
Autopsies are an essential means of identifying ante-mortem clinical errors. The incidence of major discrepancies in the Central University Hospital of Asturias (18.3%) is comparable to that of leading hospitals worldwide.
比较和对比临床诊断与尸检结果，以识别意外的、相关的差异。
对阿斯图里亚斯中央大学医院2008年至2017年间成人尸检及其相应病历进行回顾性观察研究，以便根据转诊科室和戈德曼分类法对其进行分类。
1320例尸检中有694例（52.6%）纳入研究。57.6%的病例存在差异，不过大多数（39.3%）为轻微差异。63例尸检（9.1%）被确定为I型差异；观察到的主要病理类型为恶性肿瘤（57.1%），主要起源于胃肠道（约28%）。第二常见的差异见于传染病病例（23.8%），其次是肺栓塞（15.9%）。64例尸检被归类为II型差异（9.2%），最常见的是心肌梗死（37.5%），尤其是急性心肌梗死（18例），其次是支气管吸入（18.7%）、弥散性血管内凝血（15.6%）、大量出血（9.4%）和其他情况。认为重症监护病房和内科服务部门导致的主要差异（I型和II型）数量最多，I型约占45%，II型略多于56%。
尸检是识别生前临床错误的重要手段。阿斯图里亚斯中央大学医院的主要差异发生率（18.3%）与全球领先医院相当。
