Hjorth L, Jensen H S, Noer H, Rasmussen K S, Sørensen I M
Patologisk Anatomisk Institut, Hjørring Sygehus.
Ugeskr Laeger. 1995 May 22;157(21):3055-8.
The sensitivity, specificity and clinical accuracy of clinical diagnoses were determined and compared for two periods of time: 1.7.1980-30.6.1981 and 1.7.1990-30.6.1993 based on the analysis of 286 and 138 autopsies respectively. The autopsy rate decreased from 82.7% in the first period to 11.2% in the second. The first period shows a generally higher sensitivity and accuracy for positive diagnosis. Both periods reveal the lowest sensitivity for pulmonary embolism and the lowest accuracy for positive clinical diagnosis of pneumonia/bronchopneumonia. For malignancies and arteriosclerotic heart diseases significant discrepancy between the periods was demonstrated using the chi 2-test. The results are influenced by low autopsy rates causing fewer true-positive diagnoses and a declining sensitivity. This type of study is a useful tool for demonstrating changes in the diagnostic procedure. The present investigation demonstrates a need for further analysis of malignancies to explain the simultaneous decrease in sensitivity, specificity and accuracy in spite of an increasing number of malignancies in autopsy findings.
基于分别对286例和138例尸检的分析，确定并比较了两个时间段（1980年7月1日至1981年6月30日和1990年7月1日至1993年6月30日）临床诊断的敏感性、特异性和临床准确性。尸检率从第一个时间段的82.7%降至第二个时间段的11.2%。第一个时间段对阳性诊断总体显示出较高的敏感性和准确性。两个时间段对肺栓塞的敏感性最低，对肺炎/支气管肺炎的阳性临床诊断准确性最低。使用卡方检验显示，两个时间段在恶性肿瘤和动脉硬化性心脏病方面存在显著差异。结果受到低尸检率的影响，导致真阳性诊断减少且敏感性下降。这类研究是展示诊断程序变化的有用工具。本研究表明需要对恶性肿瘤进行进一步分析，以解释尽管尸检结果中恶性肿瘤数量增加，但敏感性、特异性和准确性却同时下降的现象。
