Discrepancies between clinical diagnosis and hospital autopsy: A comparative retrospective analysis of 1,112 cases.

Stephan D. Kurz,Viyan Sido,Bernhard Ulm,Hermann Herbst,Claas T. Buschmann,Thomas M. Ruschinski,Erma Salkic,Michael Tsokos,Ritesh G. Menezes

doi:10.1371/journal.pone.0255490

Abstract

AimsThe aim of this study was to compare discrepancies between diagnosed and autopsied causes of death in 1,112 hospital autopsies and to determine the factors causing this discrepancies.Methods1,112 hospital autopsies between 2010 and 2013 were retrospectively studied. Ante-mortem diagnoses were compared to causes of death as determined by autopsy. Clinical diagnoses were extracted from the autopsy request form, and post-mortem diagnoses were assessed from respective autopsy reports. Variables, such as sex, age, Body Mass Index, category of disease, duration of hospital stay and new-borns were studied in comparison to discrepancy. P-values were derived from the Mann-Whitney U test for the constant features and chi-2 test, p-values < 0,05 were considered significant.Results73.9% (n = 822) patients showed no discrepancy between autopsy and clinical diagnosis. The duration of hospitalisation (6 vs. 9 days) and diseases of the cardiovascular system (61.7%) had a significant impact on discrepancies.ConclusionAge, cardiovascular diseases and duration of hospital stay significantly affect discrepancies in ante- and post-mortem diagnoses.

Highlights

Autopsies are indispensable in medicine and are important for medical education, quality assurance and to confirm the clinical diagnosis [1,2,3,4]
The Vivantes Hospital Neukolln is a maximum care hospital and with > 1,200 beds and > 15,000 surgical interventions per year one of the largest hospitals in Berlin, Germany., Clinical diagnoses were extracted from the clinical information written on the autopsy request form, and the post-mortem diagnoses were assessed from the autopsy report
We compared the immediate cause of death, i. e. the main result of the autopsy, and the main clinical diagnosis prior to death for discrepancies, a discrepancy was defined as different ante-/postmortem diagnosis with respect to the cause of death

Summary

Methods

1,112 hospital autopsies between 2010 and 2013 were retrospectively studied. Ante-mortem diagnoses were compared to causes of death as determined by autopsy. Clinical diagnoses were extracted from the autopsy request form, and post-mortem diagnoses were assessed from respective autopsy reports. Variables, such as sex, age, Body Mass Index, category of disease, duration of hospital stay and new-borns were studied in comparison to discrepancy. P-values were derived from the Mann-Whitney U test for the constant features and chi-2 test, p-values < 0,05 were considered significant

Introduction

Material and methods

Discussion

Findings

Limitation of the study