Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands.
Department of Biomolecular Health Sciences, Utrecht University, Utrecht, The Netherlands.
Vet Q. 2023 Dec;43(1):1-8. doi: 10.1080/01652176.2023.2233584.
The postmortem examination can be used as a means of quality control for clinical diagnoses. A retrospective study on 300 dogs and cats that had been admitted to a small animal intensive care unit was performed comparing the clinical and postmortem findings, using the Modified Goldman criteria. All patient files were reevaluated for clinical diagnoses and all postmortem material was reevaluated for pathological diagnoses. After this, the Modified Goldman criteria were applied to score the discrepancies between them, and factors associated with the occurrence of an undiagnosed major unexpected finding were analyzed. The postmortem examination revealed additional findings in 65% of the cases. Major discrepancies, defined as those affecting treatment and possibly outcome of the patient, were present in 21.3% of the cases. The most frequently missed diagnoses detected at necropsy were pneumonia of various etiologies, meningitis/meningoencephalitis, myocarditis and generalized vasculitis. A shorter ICU stay was associated with increased odds of a major discrepancy. Conditions affecting the urinary or gastrointestinal system were negatively associated with major discrepancy.
尸检可作为临床诊断质量控制的一种手段。对在小型动物重症监护病房住院的 300 只犬猫进行了一项回顾性研究，使用改良 Goldman 标准比较临床和尸检结果。对所有患者的病历进行重新评估，以确定临床诊断，对所有尸检材料进行重新评估，以确定病理诊断。然后，应用改良 Goldman 标准对它们之间的差异进行评分，并分析与未诊断出主要意外发现的发生相关的因素。尸检结果显示 65%的病例有其他发现。主要差异是指那些影响患者的治疗和预后的差异，在 21.3%的病例中存在。在尸检中最常被遗漏的诊断是各种病因的肺炎、脑膜炎/脑膜脑炎、心肌炎和全身性血管炎。重症监护病房停留时间较短与主要差异的发生几率增加相关。影响泌尿系统或胃肠道系统的疾病与主要差异呈负相关。
