Kajiwara J K, Zucoloto S, Manço A R, Muccillo G, Barbieri M A
Department of Morphology, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
J Intern Med. 1993 Aug;234(2):181-7. doi: 10.1111/j.1365-2796.1993.tb00728.x.
To analyse the concordance between clinical and autopsy diagnoses.
Nine-hundred-and-ninety-seven autopsies were studied comparing the diagnoses of the autopsy requests with those of the death certificates and autopsy reports. The cases were grouped according to the 17 categories of diseases of the International Classification of Diseases (ICD) and the concordance was analysed with the kappa (kappa) coefficient of concordance.
The Hospital da Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRPUSP), Ribeirão Preto, SP, Brazil.
The patients autopsied at HCFMRPUSP during the period between 1978 and 1980.
kappa statistics offer an alternative approach to measuring the concordance between clinical and autopsy diagnoses.
The kappa-value obtained was equal to 0.601 with a variance of 1.545 x 10(-4) when comparing the clinical diagnoses and the autopsy diagnoses, and equal to 0.661 with a variance of 1.531 x 10(-4) comparing the clinical diagnoses with those obtained after the gross examination. These values are significant at the level of 5%, i.e. there is an overall statistical concordance between clinical and autopsy diagnoses although the value is not absolute (kappa = 1.00).
If autopsies are heeded without bias, they will continue to give important feedback concerning medical diagnosis.
分析临床诊断与尸检诊断之间的一致性。
对997例尸检进行研究，将尸检申请的诊断与死亡证明及尸检报告的诊断进行比较。根据国际疾病分类（ICD）的17类疾病对病例进行分组，并使用一致性kappa（κ）系数分析一致性。
巴西圣保罗大学医学院里贝朗普雷图临床医院（HCFMRPUSP），里贝朗普雷图，圣保罗州。
1978年至1980年期间在HCFMRPUSP进行尸检的患者。
kappa统计提供了一种测量临床诊断与尸检诊断之间一致性的替代方法。
比较临床诊断与尸检诊断时，获得的kappa值等于0.601，方差为1.545×10⁻⁴；比较临床诊断与大体检查后获得的诊断时，kappa值等于0.661，方差为1.531×10⁻⁴。这些值在5%的水平上具有显著性，即临床诊断与尸检诊断之间总体上存在统计学一致性，尽管该值并非绝对（kappa = 1.00）。
如果无偏见地重视尸检，它们将继续提供有关医学诊断的重要反馈。
