scholarly journals ANALYSIS OF CLINICAL DIAGNOSES IN FATAL HEAD INJURY CASES

2019 ◽  
Vol 26 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Vladimir A. Klevno ◽  
Alexander V. Maksimov
Keyword(s):  
Head Injury ◽  
Clinical Diagnosis ◽  
Head Trauma ◽  
Underlying Disease ◽  
Clinical Diagnostics ◽  
Postmortem Diagnosis ◽  
Clinical Diagnoses ◽  
Icd 10 ◽  
Autopsy Diagnosis

Aim. In this research, we compare the antemortem and postmortem diagnosis in fatal head injury cases with the purpose of establishing the structure and causes of incorrect diagnoses.Material and methods. 1223 cases of fatal outcomes with the clinical diagnosis of death from head trauma were examined. In each case, we carried out a comparison of the clinical and autopsy diagnosis in terms of all report headings in order to establish reasons for divergence in the antemortem and postmortem diagnoses and the role of incorrect clinical diagnostics in the onset of death.Results. In 35% of cases, the clinical head trauma diagnoses were incorrectly categorized. In 22.6% cases, the antemortem diagnoses were formulated not in correspondence with the modern classifi cation and terms of ICD-10. In 11.7% cases, the violation of the etiopathogenesis principle was observed. Clinical diagnoses were not supported by objective data and examination results in 4.5% cases. The discrepancy between the clinical and autopsy diagnoses in terms of the ‘underlying disease’, ‘complications’ and ‘concomitant’ headings was 15.6%, 10.1% and 14.0% from all the studied cases, respectively. Subjective reasons are found to statistically predominate among the identifi ed reasons for the divergence of diagnoses.Conclusion. It is established that fi nal clinical diagnoses in fatal head injury cases fail to fully meet the criteria of structure, nosology, etiopathogenesis and reliability. Erroneous diagnoses are found to result from underestimation of clinical data, insuffi cient observation and instrumental examination of patients, incorrect formulation of the fi nal clinical diagnosis. 

The Role of the Autopsy in Medical Malpractice Cases, I

2002 ◽  
Vol 126 (9) ◽  
pp. 1023-1031 ◽  
Author(s):  
Kevin E. Bove ◽  
Clare Iery
Keyword(s):  
Clinical Diagnosis ◽  
Medical Malpractice ◽  
Standard Of Care ◽  
State Court ◽  
Medical Negligence ◽  
Trial Court ◽  
Autopsy Findings ◽  
Original Trial ◽  
Autopsy Diagnosis

Abstract Context.—Fear that damaging information from autopsy may be introduced as evidence in lawsuits alleging medical malpractice is often cited as one factor contributing to the decline in autopsy rates. Objective.—To determine how autopsy information influences the outcome of medical malpractice litigation. Design.—We studied state court records in 99 cases of medical malpractice adjudicated from 1970 to the present to assess the role of information from autopsies in the outcomes. Results.—The 3 largest groups defined by cause of death at autopsy were acute pulmonary embolism, acute cardiovascular disease, and drug overdose/interaction. Findings for defendant physicians outnumbered medical negligence in the original trial proceedings by a 3:1 margin. The appellate courts affirmed 51 acquittals and 19 findings of negligence, and reversed the original trial court decision in 29 cases for technical reasons. We found no significant relationship between accuracy of clinical diagnosis (using the autopsy standard) and outcome of a suit charging medical negligence. Even when a major discrepancy existed between the autopsy diagnosis and the clinical diagnosis, and the unrecognized condition was deemed treatable, defendant physicians were usually exonerated. Moreover, major diagnostic discrepancies were relatively uncommon in suits in which a physician was found to be negligent. Conversely, in about 20% of cases, autopsy findings were helpful to defendant physicians. Conclusions.—Our study confirms that a finding of medical negligence is based on standard-of-care issues rather than accuracy of clinical diagnosis. Autopsy findings may appear to be neutral or favorable to either the plaintiff or the defendant, but are typically not the crux of a successful legal argument for either side in a malpractice action. We conclude that fear of autopsy findings has no rational basis and is an important obstacle to uninhibited outcomes analysis.

scholarly journals Concordance between clinical diagnosis of pulmonary thromboembolism at hospital discharge and anatomopathological diagnosis

2020 ◽  
Vol 34 ◽  
pp. 205873842094239
Author(s):  
Benjamín Rubio-Jurado ◽  
Rocío Concepción Albores-Arguijo ◽  
Antonio Guerra-Soto ◽  
Teresita Plasencia-Ortiz ◽  
Gerónimo Tavarez-Macías ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Clinical Diagnosis ◽  
Pulmonary Thromboembolism ◽  
Developed Countries ◽  
Hospital Discharges ◽  
Postmortem Diagnosis ◽  
Autopsy Diagnosis ◽  
The Mean ◽  
D Dimer ◽  
Similar Incidence

Half of the cases of pulmonary thromboembolism (PTE) are not diagnosed because of its unspecific clinical presentation; in Mexico, autopsy data reveal a similar incidence to that of developed countries. The objective of this work was to know the concordance between the clinical diagnosis of PTE at hospital discharge and its autopsy diagnosis. The method used was a retrospective cohort study of cases with PTE diagnosis who attended from January 2005 to December 2013. Information was obtained from the autopsies registry and clinical charts. From 177,368 hospital discharges, there were 412 (6.74%) with PTE diagnosis. There were 13,559 deaths, with PTE diagnosis in 139 (1%) patients. There were 479 autopsies, and in 66 (14%) of whom PTE diagnosis was documented, the mean age was 55 years (range, 18–89 years). The premortem diagnosis of PTE at discharge was confirmed in 412 cases. Postmortem diagnosis of principal disease was medical in 49 (74%) and medical-surgical in 17 (26%) patients. We found that nine patients had the clinical diagnosis of PTE, unlike the postmortem diagnosis, which was reported in 66 autopsies. The above allows establishing a 1:7 ratio that represents 14%. D-dimer was determined in 11 cases (16%) and was positive in 8 (73%). Thromboprophylaxis was applied in 15 cases (23%). The study of necropsies and identification of discrepancies is needed to improve the diagnostic accuracy and healthcare quality. The evaluation of hemostasis biomarkers besides D-dimer can better describe the pro-thrombotic state, the risk of thrombosis, and its association with morbidity and mortality.

scholarly journals Autopsy validation of 123I-FP-CIT dopaminergic neuroimaging for the diagnosis of DLB

Neurology ◽  
2016 ◽  
Vol 88 (3) ◽  
pp. 276-283 ◽  
Author(s):  
Alan J. Thomas ◽  
Johannes Attems ◽  
Sean J. Colloby ◽  
John T. O'Brien ◽  
Ian McKeith ◽  
...  
Keyword(s):  
Brain Tissue ◽  
Clinical Diagnosis ◽  
Lewy Body ◽  
Lewy Bodies ◽  
Lewy Body Disease ◽  
High Specificity ◽  
Clinical Diagnoses ◽  
Diagnosis Of Dementia ◽  
Autopsy Diagnosis

Objective:To conduct a validation study of 123I-N-fluoropropyl-2b-carbomethoxy-3b-(4-iodophenyl) nortropane (123I-FP-CIT) SPECT dopaminergic imaging in the clinical diagnosis of dementia with Lewy bodies (DLB) with autopsy as the gold standard.Methods:Patients >60 years of age with dementia who had undergone 123I-FP-CIT imaging in research studies and who had donated their brain tissue to the Newcastle Brain Tissue Resource were included. All had structured clinical research assessments, and clinical diagnoses were applied by consensus panels using international diagnostic criteria. All underwent 123I-FP-CIT imaging at baseline, and scans were rated as normal or abnormal by blinded raters. Patients were reviewed in prospective studies and after death underwent detailed autopsy assessment, and neuropathologic diagnoses were applied with the use of standard international criteria.Results:Fifty-five patients (33 with DLB and 22 with Alzheimer disease) were included. Against autopsy diagnosis, 123I-FP-CIT had a balanced diagnostic accuracy of 86% (sensitivity 80%, specificity 92%) compared with clinical diagnosis, which had an accuracy of 79% (sensitivity 87%, specificity 72%). Among patients with DLB, 10% (3 patients) met pathologic criteria for Lewy body disease but had normal 123I-FP-CIT imaging.Conclusions:This large autopsy analysis of 123I-FP-CIT imaging in dementia demonstrates that it is a valid and accurate biomarker for DLB, and the high specificity compared with clinical diagnosis (20% higher) is clinically important. The results need to be replicated with patients recruited from a wider range of settings, including movement disorder clinics and general practice. While an abnormal 123I-FP-CIT scan strongly supports Lewy body disease, a normal scan does not exclude DLB with minimal brainstem involvement.Classification of evidence:This study provides Class I evidence that 123I-FP-CIT dopaminergic neuroimaging accurately identifies patients with DLB.

scholarly journals Clinical diagnosis versus autopsy diagnosis in head trauma

2017 ◽  
Vol 31 (4) ◽  
pp. 455-464
Author(s):  
Andreea-Alexandra Velnic ◽  
Bianca Hanganu ◽  
Valentin Petre Ciudin ◽  
Dragoș Crauciuc ◽  
Irina Smaranda Manoilescu ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Head Trauma ◽  
Clinical Care ◽  
Demographic Data ◽  
Head Injuries ◽  
Laboratory Data ◽  
Clinical Death ◽  
Intracerebral Hematoma ◽  
Cord Injury ◽  
Autopsy Diagnosis

Abstract The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1) to total discordance (C4) and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis- missing injuries in the autopsy reports) and C3 (partial discordance in favor of the necroptic diagnosis- missing injuries in the medical files). Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral hematoma and ventricular hemorrhage (21.6%). In C3 cases the most frequently omitted injuries were subarachnoidian hemorrhage and skull base fractures (17.9%). Conclusions: The clinical cause of death is not always concordant with the autopsy diagnosis. Autopsy may identify the inconsistencies in diagnosis, the injuries frequently skipped and the factors favoring the discordance rate between the clinical death diagnosis and the autopsy diagnosis, making it a valuable tool for improving the clinical care of the patients with head trauma.

scholarly journals Value of autopsy in Internal Medicine: discrepancies between clinical and postmortem diagnosis

2012 ◽  
Author(s):  
Fabrizio Tiratterra ◽  
Valeria Pignatelli ◽  
Alberto Placido ◽  
Agostino Valenti ◽  
Umberto Recine
Keyword(s):  
Internal Medicine ◽  
Clinical Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Techniques ◽  
Postmortem Diagnosis ◽  
Substantial Discrepancy ◽  
Time Period

Introduction The number of autoptic controls is progressively dropping worldwide during the last decades. Several social, cultural and normative causes may underlie this phenomenon. However, a hidden cause may be represented by the scepticism of physicians about the gain in information given by this practice. There is in fact a general thinking that available diagnostic techniques may be adequate for a correct diagnosis, even in the case of a mortal outcome. Nevertheless, several studies have shown quite relevant discrepancies between premortem and postmortem diagnosis. In this study, the authors evaluate the accuracy of clinical diagnosis in diseases leading the patient to death.Materials and methods Retrospective analysis including all patients died in the Department of Internal Medicine of a General Hospital in Rome during a three year time period (1st January 2007–31 December 2009). Age, sex, period of hospitalization, clinical diagnosis, autoptic diagnosis, cause of death, and level of discrepancy between clinical diagnosis and autoptic control have been collected. Main diagnoses have been classified as follows: (1) discrepancy with a possible influence on survival; (2) discrepancy with no or questionable influence on survival.Results Ninety-two cases (42 males, 50 females; mean age 79.3 years) have been included. Thirty-four main diagnoses (36.9%) have been classified as discrepant (15.2% classified as type 1 discrepancy and 21.7 as type 2).DiscussionA substantial discrepancy between clinical diagnosis and autoptic control is confirmed by the current study, which supports the role of autopsy as a tool for the improvement of medical practice.

Kleine-Levin Syndrome: Report of Two Cases with Onset of Symptoms Precipitated by Head Trauma

1988 ◽  
Vol 152 (3) ◽  
pp. 410-412 ◽  
Author(s):  
R. G. Will ◽  
J. P. R. Young ◽  
D. J. Thomas
Keyword(s):  
Head Injury ◽  
Head Trauma ◽  
Lithium Carbonate ◽  
Response To Treatment ◽  
Syndrome Report

Two cases of Kleine-Levin syndrome are described in which the onset of symptoms was temporally related to head injury. The possible aetiological role of trauma and an apparent response to treatment with lithium carbonate are discussed.

Clinical Diagnoses and Autopsy Findings: A Retrospective Analysis of 252 Cases in Greece

2005 ◽  
Vol 129 (2) ◽  
pp. 210-214
Author(s):  
Chaido Spiliopoulou ◽  
Stavroula Papadodima ◽  
Nikolaos Kotakidis ◽  
Antonios Koutselinis
Keyword(s):  
Retrospective Analysis ◽  
Clinical Diagnosis ◽  
Cause Of Death ◽  
Diagnostic Errors ◽  
Postmortem Diagnosis ◽  
Autopsy Findings ◽  
Quality Of Patient Care ◽  
Clinical Diagnoses ◽  
Unexpected Findings

Abstract Context.—Despite medical and technologic advances, clinicians may misdiagnose a patient's situation and the cause of death. Autopsy may be valuable in uncovering the most frequent diagnostic pitfalls and helping clinicians to learn and to develop the medical art and science. Objective.—To compare the clinical diagnoses with postmortem findings and evaluate the frequency of diagnostic errors assessed by autopsies. Design.—Retrospective analysis of the protocols of 252 consecutive cases of adult patients autopsied in the Department of Forensic Medicine and Toxicology of Athens Medical School during the period 1999–2003. The outcome measures included concordance between diagnosis before death and at autopsy, sex, age, and length of hospitalization of the patient. Results.—In 73 cases (29%), the autopsy findings confirmed the clinical diagnosis and the cause of death suggested by the clinicians. In 45 cases (19%), the clinical diagnosis and the cause of death suggested by the clinicians were discordant with the autopsy findings. In 105 cases (42%), the autopsy requests did not include any suggestion about the cause of the patient's death. In 7 cases (3%), several diagnoses were suggested by the clinicians, and in 16 cases (6%), the comparison between clinical and postmortem diagnosis was not possible. The most frequently misdiagnosed diseases were coronary disease and pulmonary embolism. Conclusions.—It is concluded from this study that autopsies may reveal unexpected findings that are of critical importance and that a continued emphasis on autopsy evaluation is necessary to improve the quality of patient care.

Substance Abuse in Older Psychiatric Inpatients

2017 ◽  
Vol 63 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Tilman Wetterling ◽  
Klaus Junghanns
Keyword(s):  
Substance Abuse ◽  
Substance Abusers ◽  
Psychiatric Inpatient ◽  
Psychiatric Inpatients ◽  
Severe Withdrawal ◽  
Psychiatric Inpatient Treatment ◽  
Clinical Diagnoses ◽  
Multiple Substance ◽  
Icd 10 ◽  
Substance Abuse Disorders

Abstract. Aim: This study investigates the characteristics of older patients with substance abuse disorders admitted to a psychiatric department serving about 250.000 inhabitants. Methods: The clinical diagnoses were made according to ICD-10. The data of the patients with substance abuse were compared to a matched sample of psychiatric inpatients without substance abuse as well as to a group of former substance abusers with long-term abstinence. Results: 19.3 % of the 941 patients aged > 65 years showed current substance abuse, 9.4 % consumed alcohol, 7.9 % took benzodiazepines or z-drugs (zolpidem and zopiclone), and 7.0 % smoked tobacco. Multiple substance abuse was rather common (30.8 %). About 85 % of the substance abusers had psychiatric comorbidity, and about 30 % showed severe withdrawal symptoms. As with the rest of the patients, somatic multimorbidity was present in about 70 % of the substance abusers. Remarkable was the lower rate of dementia in current substance abusers. Conclusion: These results underscore that substance abuse is still a challenge in the psychiatric inpatient treatment of older people.

Challenges of Fear Conditioning Research in the Age of RDoC

2017 ◽  
Vol 225 (3) ◽  
pp. 189-199 ◽  
Author(s):  
Tina B. Lonsdorf ◽  
Jan Richter
Keyword(s):  
Fear Conditioning ◽  
Clinical Diagnosis ◽  
Research Domain Criteria ◽  
Major Focus ◽  
The Future ◽  
Definition Of ◽  
Methodological Considerations ◽  
Research Domain

Abstract. As the criticism of the definition of the phenotype (i.e., clinical diagnosis) represents the major focus of the Research Domain Criteria (RDoC) initiative, it is somewhat surprising that discussions have not yet focused more on specific conceptual and procedural considerations of the suggested RDoC constructs, sub-constructs, and associated paradigms. We argue that we need more precise thinking as well as a conceptual and methodological discussion of RDoC domains and constructs, their interrelationships as well as their experimental operationalization and nomenclature. The present work is intended to start such a debate using fear conditioning as an example. Thereby, we aim to provide thought-provoking impulses on the role of fear conditioning in the age of RDoC as well as conceptual and methodological considerations and suggestions to guide RDoC-based fear conditioning research in the future.

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