Van Den Bogaert Wouter, Alders Lotte, Wuestenbergs Joke, Dequeker Elisabeth, Van de Voorde Wim
Forensic Biomedical Sciences, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
Department of Forensic Medicine, University Hospitals Leuven, Leuven, Belgium.
Forensic Sci Med Pathol. 2024 Dec 4. doi: 10.1007/s12024-024-00919-z.
Diagnostic uncertainty is a well-recognized concept in clinical practice, encompassing both technical perspectives and the subjective perceptions of physicians. Post-mortem diagnostics (PMD), which involves all post-mortem investigations to assess diseases and injuries and determine the cause of death, shares this inherent uncertainty due to the complexity and multidisciplinary nature of autopsies.
A comprehensive literature review was conducted to uncover relevant publications focusing on diagnostic uncertainty in PMD. An expert panel evaluated expressions and sources of diagnostic uncertainty to identify factors influencing PMD uncertainty.
Literature specifically addressing PMD uncertainty is sparse, though implicit and explicit references exist. This article illustrates the presence of uncertainty in PMD by drawing upon both literature and pathology practice. We introduce the definition of PMD uncertainty as "the inability to determine the exact cause of death and/or the precise significance of certain autopsy findings". PMD uncertainty can stem from a pathologist's subjective perception, but often results from several objective factors. Six factors inherent to the PMD setting were identified as contributing to this uncertainty. To systematically express the certainty of cause-of-death determinations, we developed a new Post-Mortem Diagnostic Certainty Scale (PMDCS) featuring eight categories, distinguishing between assignable and non-assignable causes of death.
Understanding and applying the concept of PMD uncertainty will enhance comprehension of the importance of certain post-mortem findings and improve the accuracy of autopsy result interpretation. While eliminating PMD uncertainty entirely is not feasible, standardizing investigations can reduce uncertainty, and using the PMDCS can improve the clarity of autopsy reports.
诊断不确定性是临床实践中一个广为人知的概念，涵盖技术层面和医生的主观认知。尸检诊断（PMD）涉及所有用于评估疾病和损伤并确定死因的尸检调查，由于尸检的复杂性和多学科性质，也存在这种内在的不确定性。
进行了全面的文献综述，以找出关注尸检诊断中诊断不确定性的相关出版物。一个专家小组评估了诊断不确定性的表现形式和来源，以确定影响尸检诊断不确定性的因素。
专门论述尸检诊断不确定性的文献稀少，不过存在一些隐含和明确的参考文献。本文通过借鉴文献和病理学实践来说明尸检诊断中不确定性的存在。我们将尸检诊断不确定性定义为“无法确定确切死因和/或某些尸检结果的确切意义”。尸检诊断不确定性可能源于病理学家的主观认知，但通常是由几个客观因素导致的。已确定尸检诊断环境中固有的六个因素导致了这种不确定性。为了系统地表达死因判定的确定性，我们开发了一种新的尸检诊断确定性量表（PMDCS），该量表有八个类别，区分可归因和不可归因的死因。
理解和应用尸检诊断不确定性的概念将增强对某些尸检结果重要性的理解，并提高尸检结果解释的准确性。虽然完全消除尸检诊断不确定性是不可行的，但规范调查可以减少不确定性，使用尸检诊断确定性量表可以提高尸检报告的清晰度。
