Dismuke S E, VanderZwaag R
J Chronic Dis. 1984;37(1):67-73. doi: 10.1016/0021-9681(84)90127-9.
The death certificate (DC) diagnosis of pulmonary embolism (PE) has been compared to autopsy findings in 2398 patients dying between 1966 and 1976. Accuracy of the death certificate and the effect of diagnostic misclassification errors on the association between PE and potential risk factors were analyzed in this study. Sensitivity of the DC diagnosis of PE was less than 40% and the predictive value of a positive diagnosis was less than 50%. The epidemiological associations derived using the DC diagnosis of PE were very unreliable for myocardial infarction and malignant neoplasm because errors of diagnostic misclassification were not randomly distributed. Associations with risk factors derived using massive embolism were conservative estimates of the associations derived by using any embolism found at autopsy. We conclude that the death certificate diagnosis of PE is extremely inaccurate and should be used with great caution to study the epidemiology of PE.
在1966年至1976年间死亡的2398例患者中，对肺栓塞（PE）的死亡证明（DC）诊断结果与尸检结果进行了比较。本研究分析了死亡证明的准确性以及诊断错误分类误差对PE与潜在风险因素之间关联的影响。DC诊断PE的敏感性低于40%，阳性诊断的预测价值低于50%。由于诊断错误分类并非随机分布，因此使用DC诊断PE得出的心肌梗死和恶性肿瘤的流行病学关联非常不可靠。使用大面积栓塞得出的与风险因素的关联是对尸检发现的任何栓塞得出的关联的保守估计。我们得出结论，PE的死亡证明诊断极其不准确，在研究PE的流行病学中应极其谨慎地使用。
