Hospital autopsy remains a vital instrument for quality assurance of clinical diagnosis

Abstract

Hospital autopsies are infrequently performed in Australian public hospitals but remain an informative tool for quality assurance of clinical diagnosis. At our institution, a major centre for trauma and cardiopulmonary transplantation, autopsies were performed on 86 patients between August 2011 and August 2013. We audited all cases to address concordance of clinical and autopsy findings. Using death certificates, hospital records and autopsy reports, clinical cause of death and co-morbid diagnoses were compared with autopsy findings and assessed as either correct, over- or missed diagnoses. Full autopsy was performed in 70% (60/86) and partial in 30% (26/86); cause of death was assessable in all but one partial autopsy. Correct cause of death was found in 79% (67/85) while over- or missed diagnoses accounted for 21% (18/85). In 11% of cases (9/85), the cause of death was a major change from one body system to another. The most common missed cause of death was an infective aetiology (pulmonary angioinvasive Aspergillus spp.), occurring in 6% (5/85). Even when cause of death was correct, a further 31% (26/85) yielded significant over- or missed co-morbid diagnoses. Hospital autopsies provide treating clinicians with significant and frequently unexpected findings highlighting their effectiveness in auditing clinical diagnoses.