Cameron H M, McGoogan E
J Pathol. 1981 Apr;133(4):273-83. doi: 10.1002/path.1711330402.
Comparison of certified clinical diagnoses with autopsy findings showed that, while the major cause of death was confirmed in 61 per cent. of cases, many diagnoses--both major and contributory--were wrong; many clinical diagnoses were either disproved or relegated to a less important role, and many autopsy findings had not apparently been anticipated. Accuracy was particularly poor in some clinical categories: notably cerebrovascular disease and infections. In these, the diagnosis was more often wrong than right. Thus, death certificates are unreliable as a source of diagnostic data. The clinician's confidence in his major diagnosis bore a fairly close relationship to the frequency of its confirmation. Nevertheless, even when certified as "fairly certain", the major diagnosis was wrong in about one-quarter of these cases. An attempt was made to assess the significance of incorrect diagnoses; one half of these might be clinically significant. Diagnostic accuracy did not improve with the time spent in hospital, and it bore an inverse relationship to the patient's age.
经认证的临床诊断与尸检结果的对比显示，虽然61%的病例中主要死因得到了确认，但许多诊断——包括主要诊断和辅助诊断——都是错误的；许多临床诊断要么被证伪，要么被降为次要地位，而且许多尸检结果显然未被预料到。在某些临床类别中，准确性尤其差：特别是脑血管疾病和感染。在这些类别中，诊断错误的情况比正确的情况更常见。因此，死亡证明作为诊断数据的来源并不可靠。临床医生对其主要诊断的信心与其被确认的频率密切相关。然而，即使被认证为“相当确定”，这些病例中约四分之一的主要诊断仍是错误的。有人试图评估错误诊断的重要性；其中一半可能具有临床意义。诊断准确性并不会随着住院时间的延长而提高，并且与患者年龄呈反比关系。
