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

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.

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Application of the Drowning Index to Opioid & Multidrug Intoxication Deaths: A Retrospective Analysis

Academic Forensic Pathology ◽

10.1177/1925362119851115 ◽

2019 ◽

Vol 9 (1-2) ◽

pp. 44-50

Author(s):

Lindsey T Ellis ◽

Madeleine Opsahl ◽

Deiter J. Duff ◽

Carl C. Stacy

Keyword(s):

Pleural Effusion ◽

Retrospective Analysis ◽

Cause Of Death ◽

Weight Ratio ◽

Spleen Weight ◽

Organ Weights ◽

Autopsy Findings ◽

Effusion Fluid

Introduction: Drowning deaths present a challenge for forensic pathologists, because the autopsy findings may occur in many nondrowning scenarios. Previous studies have attempted to identify patterns in organ weights that may be specific for drowning. The drowning index (DI) has been defined as the weight ratio of the lungs and pleural effusion fluid to the spleen. Studies have suggested DI may be useful in confirming drowning as the cause of death. No studies have yet compared autopsy findings in drownings to those in drug-related deaths, in spite of their qualitative similarities. Materials and Methods: We compared the lung and pleural effusion weight, spleen weight, and DI from 536 autopsies ruled drowning, opioid, or multidrug intoxication, or hanging in Columbia, Missouri, from 2011 to 2016. Results: Opioid overdoses result in heavier lungs and spleens than drownings, multidrug overdoses, or hangings. There is no DI value at which a death can be definitively ascribed to drowning. The median DI was significantly higher in drownings than in opioid intoxications, multidrug intoxications, or hangings ( P < .0001; P = .001; P = .005). However, very few drowning cases (13.33%) had a DI >14.1. Additionally, many opioid and multidrug overdoses had a DI >14.1. The highest calculated DI value (DI = 33) was associated with multidrug intoxication. Conclusion: In our opinion, the DI has little, if any, utility in distinguishing between drowning and drug-related deaths.

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ANALYSIS OF CLINICAL DIAGNOSES IN FATAL HEAD INJURY CASES

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2019-26-2-115-121 ◽

2019 ◽

Vol 26 (2) ◽

pp. 115-121 ◽

Cited By ~ 1

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.

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19. Prevalence of diagnostic discordance: A retrospective analysis of autopsy findings and clinical diagnoses

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2779 ◽

2007 ◽

Vol 30 (4) ◽

pp. 37

Author(s):

S. Suryavanshi ◽

J. D. Gomez ◽

A. Mulla ◽

J. Kalra

Keyword(s):

Health Care ◽

Medical Error ◽

Care Delivery ◽

Diagnostic Errors ◽

University Hospital ◽

Strong Impact ◽

City Hospital ◽

Autopsy Findings ◽

Discordance Rate ◽

Clinical Diagnoses

The prevalence of medical error in health care systems has compromised the quality of health care delivery. The research on medical errors in hospitalized population has consistently revealed high rates of misdiagnosis. Autopsy examination has been an established tool for quality assurance programs. The objective of this study was to determine the discrepancy rates between clinical and autopsy findings in patients admitted to various hospitals (Royal University hospital, RUH; St. Paul’s hospital, SPH; Saskatoon city hospital, SCH) of Saskatoon Health Region. A retrospective record review of the medical and autopsy charts was carried out for all the deceased adult in-patients admitted during the years 2002, 2003, and 2004. All autopsies were carried out either in the morgue of RUH or at SPH hospital. A total of 3416 in-patient deaths were registered during the study period. Autopsies were performed on 206 of the deceased resulting in an autopsy rate of 6%. In accordance with selection criteria, 158 cases were included for this study. The mean age of subjects was 66.6 ± 15.2 years with a range of 16 – 94 years. The total concordance rate in this study between clinical and autopsy diagnoses was 75.3%. The discordance rate was 20.9% and in 3.8% of the study population a conclusive clinical or autopsy diagnoses was not finalized. The concordance and discordance rate between clinical diagnoses and autopsy findings when compared between the patients of two hospitals (RUH and SPH) were not significantly different. These results suggest that despite the technical advances in medical and diagnostic modalities, there still persists a significant discordance in clinical and autopsy diagnoses. Our study confirms the wide prevalence of diagnostic discrepancies in the health care system and emphasizes the value of autopsy as an effective quality improvement and educational tool with a strong impact on quality management. Roosen J, Frans E, Wilmer A, Knockaert DC, Bobbaers H. Comparison of premortem clinical diagnoses in critically ill patients and subsequent autopsy findings. Mayo Clin Proc 2000; 75:562-67. Sonderegger-Iseli K, Burger S, Muntwyler J, Salomon F. Diagnostic errors in three medical eras: a necropsy study. Lancet 2000; 10355:2027-31. Kalra J. Medical Error: An Introduction to Concepts. Clinical Biochemistry 2004;37:1043-51.

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Postmortem Computed Tomography Imaging in the Investigation of Nontraumatic Death in Infants and Children

BioMed Research International ◽

10.1155/2013/327903 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

Yukihiro Noda ◽

Ken Yoshimura ◽

Shoji Tsuji ◽

Atsushi Ohashi ◽

Hirohide Kawasaki ◽

...

Keyword(s):

Computed Tomography ◽

Clinical Diagnosis ◽

Cause Of Death ◽

Concordance Rate ◽

Infants And Children ◽

Postmortem Computed Tomography ◽

Promising Technique ◽

Computed Tomography Imaging ◽

Multicenter Trials ◽

Clinical Diagnoses

Objective. To determine the accuracy of postmortem computed tomography (PMCT) for the assessment of causes in nontraumatic deaths in children.Study Design. We enrolled cases of nontraumatic deaths of infants and children who underwent PMCT at a single center. The presumed cause of death determined by PMCT was prospectively compared with the clinical and pathological diagnoses of deaths.Results. Thirty-eight cases were enrolled for analysis. Among them, seven cases also underwent conventional medical autopsy. PMCT revealed an identifiable cause of death in accordance with the clinical diagnosis of death in 16 cases of the 38 cases (the concordance rate was 42%) and in accordance with the autopsy cause of death in four of the seven autopsy cases (the concordance rate was 57%). Among eight cases with unknown cause of death by clinical diagnosis, four cases (50%) were identified with cardiac tamponade as a cause of death (one case) and intracranial hemorrhage suggesting abuse (3 cases).Conclusions. PMCT seems to be a promising technique that might serve as a substitute for conventional medical autopsy and give us the complementary information to clinical diagnoses particularly in cases of child abuse. Larger multicenter trials are worthwhile to validate the general feasibility of PMCT.

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Comparison of Clinical Diagnoses and Autopsy Findings: Six-Year Retrospective Study

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2016-0488-oa ◽

2017 ◽

Vol 141 (9) ◽

pp. 1262-1266 ◽

Cited By ~ 14

Author(s):

Hyejong Song Marshall ◽

Clara Milikowski

Keyword(s):

Diagnostic Errors ◽

Developed Countries ◽

Body Cavity ◽

Class I ◽

Clinical Investigations ◽

Time Period ◽

Clinical Diagnoses ◽

Impact On Survival ◽

Unexpected Findings ◽

The Given

Context.— The frequency of autopsies has declined in most developed countries beginning in the latter half of the 20th century. During this time period the technology of medicine made significant advances; however, it is important to regularly reevaluate the role of the autopsy to confirm suspected diagnoses and identify unsuspected findings. Objective.— To determine what portion of autopsies reveal clinically meaningful unexpected findings. Design.— Reports that included clinical histories of autopsies performed at Jackson Memorial Hospital during the 6 years between 2009 and 2014 were reviewed by 2 pathologists. Each case was classified using the Goldman Classification. Results.— In the given time period, 923 autopsies were performed; 512 patients (55.5%) were adults. A total of 334 cases were subject to review after excluding those with a short (<1 day) hospital stay, restriction to a single organ or body cavity, and cases referred from other facilities. A total of 33 of 334 cases (9.9%) were identified as class I discrepancy, where the autopsy revealed a discrepant diagnosis with a potential impact on survival or treatment. Critical findings, such as untreated infection (15 of 33 cases; 45.5%), pulmonary embolism (8 of 33 cases; 24.2%), and undiagnosed malignancy (6 of 33 cases; 18.2%), were found in these cases. Major significant findings that had not been clinically detected, whether clinically manageable or not (class I and II), were found in 65 of 334 cases (19.5%). Conclusion.— Despite intensive modern clinical investigations, autopsies continue to reveal major antemortem diagnostic errors in a significant number of cases.

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Discrepancies between clinical and autopsy diagnosis of cause of death among psychiatric patients who died due to natural causes. A retrospective autopsy study

Vojnosanitetski pregled ◽

10.2298/vsp170304132m ◽

2019 ◽

Vol 76 (3) ◽

pp. 278-283

Author(s):

Dragan Mitrovic ◽

Ivana Savic ◽

Radmila Jankovic

Keyword(s):

Cardiovascular Diseases ◽

Clinical Diagnosis ◽

Cause Of Death ◽

Causes Of Death ◽

Psychiatric Patients ◽

Psychiatric Hospitals ◽

Control Group ◽

Natural Death ◽

Autopsy Findings ◽

Somatic Diseases

Background/Aim. Autopsy studies rarely investigate the causes of natural death in psychiatric population. The aim of this study was to examine the causes of death among the subjects with various psychiatric disorders in whom a clinical (pathoanatomical) autopsy was requested. Methods. The study group included 118 patients (65% men, 35% women, mean age 58.2 ? 13.6 years) with a psychiatric diagnosis, in whom a clinical autopsy was performed. We compared the distribution of causes of natural death among psychiatric patients and other patients, representatives of the general population who died of natural causes. We also analyzed the difference between clinical diagnoses of cause of death and the autopsy findings in psychiatric patients. Results. Psychiatric patients died earlier than the control group (58 vs. 69 years), usually due to the respiratory (46%) and cardiovascular diseases (37%). The most common diagnoses in psychiatric patients were organic psychoses and dementias (F00-F09) and schizophrenia and schizoaffective disorders (F20-F29). Majority of the patients (55%) died in general hospitals vs. specialized psychiatric hospitals (45%) due to somatic diseases. There was a significant difference in the distribution of causes of death compared to the control group in which the cardiovascular diseases dominated. Even in 64% of psychiatric patients there was a discrepancy between the clinical diagnosis of the cause of death and definite autopsy findings. Conclusion. The assessment of somatic diseases in psychiatric patients is insufficient, especially in specialized psychiatric hospitals. That leads to a significant discrepancy between clinical diagnosis of the cause of death and autopsy findings. Therefore, it is necessary to pay additional attention in diagnostics and treatment of somatic diseases in these patients to improve their health care.

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A retrospective analysis of clinical diagnoses and autopsy findings in 3,042 cases during two different time periods

Human Pathology ◽

10.1016/0046-8177(94)90269-0 ◽

1994 ◽

Vol 25 (2) ◽

pp. 140-145 ◽

Cited By ~ 58

Author(s):

Béla Veress ◽

Irina Alafuzoff

Keyword(s):

Retrospective Analysis ◽

Autopsy Findings ◽

Clinical Diagnoses ◽

Time Periods

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Cause of death during the first 24 hours after hospitalization: An autopsy study

Naucni casopis urgentne medicine - Halo 194 ◽

10.5937/halo26-28743 ◽

2020 ◽

Vol 26 (3) ◽

pp. 113-118

Author(s):

Radmila Janković ◽

Elena Jordanova ◽

Jovan Jevtić ◽

Ljubica Simić ◽

Marko Baralić

Keyword(s):

Clinical Diagnosis ◽

Cause Of Death ◽

Clinical Data ◽

Fatal Outcome ◽

Postmortem Examination ◽

Autopsy Study ◽

Ischemic Lesion ◽

Bowel Infarction ◽

Emergency Hospitalization

Introduction/Objective Postmortem examination has a significant role in evaluating the quality of health care. The objective of the paper is to analyze the cause of death as determined by postmortem examination in patients who had undergone emergency hospitalization and had subsequently died within 24h, as well as the factors that contributed to the fatal outcome and correlation with available clinical data. Methods the analysis included autopsy reports and protocols, as well as clinical data from medical records and autopsy referrals during the three year period (2018-2020) for patients who had undergone a postmortem examination at the Insitute of Pathology, Medical Faculty, University of Belgrade. The correlation between the clinical diagnosis and postmortem findings was evaluated using Goldman criteria. Results the patients analysed were predominantly male (52/90; 58%). Women were statistically significantly older than men (p=0.024). The most common clinical diagnosis was cardiovascular disease (32.2%). The majority of the patients reported experiencing the first symptoms a few hours before seeking medical help (80%). The majority of the patients were being treated for chronic disease (80%) before hospitalization. The immediate cause of death determined by postmortem examination was most commonly heart failure (38/90, 42.2%). The most common clinically unrecognised causes of death include: bronchopneumonia (8/90), myocarditis (3/90), acute ischemic lesion/acute myocardial infarction (3/90) and bowel infarction (3/90). Conclusion the correlation between clinical and postmortem findings is very important because it enables the discovery of diagnostic and treatment errors and promotes new knowledge crucial for medical advancement.

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