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Quality Assessment and Management: An Overview of Concordance and Discordance Rates Between Clinical and Autopsy Diagnoses

  • Jawahar (Jay) KalraEmail author
  • Daniel Markewich
  • Patrick Seitzinger
Conference paper
Part of the Advances in Intelligent Systems and Computing book series (AISC, volume 957)

Abstract

Autopsy diagnoses have traditionally been used as the “Gold Standard” for determining the cause of death. The purpose of this study was to use autopsy to determine the rate of concordance and discordance between clinical diagnoses and post-mortem findings in patients admitted to the hospitals of the Saskatoon Health Region. A retrospective record review of the medical and autopsy charts was carried out by three independent observers for all the deceased adult in-patients admitted during 2006 to 2008. In accordance with selection criteria, 102 (59 males; 43 females) cases were assessed. The concordance rate between clinical and autopsy diagnosis was found to be 86.3%. The discordance rate was 12.7% and in 1.0% was inconclusive. We encourage residents and physicians to continue using autopsy as an important tool to extend our understanding of disease processes.

Keywords

Concordance Discordance Medical error Autopsy Clinical diagnosis Post-mortem diagnosis 

References

  1. 1.
    Graber, M.L.: The incidence of diagnostic error in medicine. BMJ Qual. Saf. 22, 21–27 (2013)CrossRefGoogle Scholar
  2. 2.
    McGlynn, E.A., McDonald, K.M., Cassel, C.K.: Measurement is essential for improving diagnosis and reducing diagnostic error. JAMA 314, 2501 (2015)CrossRefGoogle Scholar
  3. 3.
    Singh, H.: Diagnostic errors: moving beyond “no respect” and getting ready for prime time. BMJ Qual. Saf. 22, 789–792 (2013)CrossRefGoogle Scholar
  4. 4.
    Newman-Toker, D.E., Pronovost, P.J.: Diagnostic errors—the next frontier for patient safety. JAMA 301, 1060 (2009)CrossRefGoogle Scholar
  5. 5.
    Cresswell, K.M., Panesar, S.S., Salvilla, S.A., Carson-Stevens, A., Larizgoitia, I., Donaldson, L.J., Bates, D., Sheikh, A.: Group, on behalf of the W.H.O. (WHO) S.P.C.E.W.: Global research priorities to better understand the burden of iatrogenic harm in primary care: an international Delphi exercise. PLoS Med. 10, e1001554 (2013)CrossRefGoogle Scholar
  6. 6.
    Graber, M., Gordon, R., Franklin, N.: Reducing diagnostic errors in medicine. Acad. Med. 77, 981–992 (2002)CrossRefGoogle Scholar
  7. 7.
    Olson, A.P.J., Graber, M.L., Singh, H.: Tracking progress in improving diagnosis: a framework for defining undesirable diagnostic events. J. Gen. Intern. Med. 33, 1187–1191 (2018) CrossRefGoogle Scholar
  8. 8.
    Berner, E.S., Graber, M.L.: Overconfidence as a cause of diagnostic error in medicine. Am. J. Med. 121, S2–S23 (2008)CrossRefGoogle Scholar
  9. 9.
    Bunting, R.F., Groszkruger, D.P.: From To Err Is Human to Improving Diagnosis in Health Care: the risk management perspective. J. Healthc. Risk Manag. 35, 10–23 (2016)CrossRefGoogle Scholar
  10. 10.
    Singh, H., Schiff, G.D., Graber, M.L., Onakpoya, I., Thompson, M.J.: The global burden of diagnostic errors in primary care. BMJ Qual. Saf. 26, 484–494 (2017)CrossRefGoogle Scholar
  11. 11.
    Aalten, C.M., Samson, M.M., Jansen, P.A.F.: Diagnostic errors; the need to have autopsies. Neth. J. Med. 64, 186–190 (2006)Google Scholar
  12. 12.
    Marshall, H.S., Milikowski, C.: Comparison of clinical diagnoses and autopsy findings: six-year retrospective study. Arch. Pathol. Lab. Med. 141, 1262–1266 (2017)CrossRefGoogle Scholar
  13. 13.
    Graber, M.: Diagnostic errors in medicine: a case of neglect forum. Jt. Comm. J. Qual. Patient Saf. 31, 106–113 (2005)CrossRefGoogle Scholar
  14. 14.
    Kalra, J., Entwistle, L., Suryavanshi, S., Chadha, R.: Quality assessment using concordance and discordance rates in medical findings. Clin. Gov. An Int. J. 15, 128–133 (2010)CrossRefGoogle Scholar
  15. 15.
    Roulson, J., Benbow, E.W., Hasleton, P.S.: Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. Histopathology 47, 551–559 (2005) CrossRefGoogle Scholar
  16. 16.
    Scordi-Bello, I.A., Kalb, T.H., Lento, P.A.: Clinical setting and extent of premortem evaluation do not predict autopsy discrepancy rates. Mod. Pathol. 23, 1225 (2010)CrossRefGoogle Scholar
  17. 17.
    Tavora, F., Crowder, C.D., Sun, C.-C., Burke, A.P.: Discrepancies between clinical and autopsy diagnoses. Am. J. Clin. Pathol. 129, 102–109 (2008)CrossRefGoogle Scholar
  18. 18.
    Tai, D.Y.H., El-Bilbeisi, H., Tewari, S., Mascha, E.J., Wiedemann, H.P., Arroliga, A.C.: A study of consecutive autopsies in a medical ICU: a comparison of clinical cause of death and autopsy diagnosis. Chest 119, 530–536 (2001)CrossRefGoogle Scholar
  19. 19.
    Moorchung, N., Singh, V., Mishra, A., Patrikar, S., Kakkar, S., Dutta, V.: Is necropsy obsolete - an audit of the clinical autopsy over six decades: a study from Indian sub continent. Indian J. Pathol. Microbiol. 56, 372 (2013)CrossRefGoogle Scholar
  20. 20.
    Spiliopoulou, C., Papadodima, S., Kotakidis, N., Koutselinis, A.: Clinical diagnoses and autopsy findings: a retrospective analysis of 252 cases in Greece. Arch. Pathol. Lab. Med. 129, 210–214 (2005)Google Scholar
  21. 21.
    Maris, C., Martin, B., Creteur, J., Remmelink, M., Piagnerelli, M., Salmon, I., Vincent, J.-L., Demetter, P.: Comparison of clinical and post-mortem findings in intensive care unit patients. Virchows Arch. 450, 329–333 (2007)CrossRefGoogle Scholar
  22. 22.
    Combes, A., Mokhtari, M., Couvelard, A., Trouillet, J.-L., Baudot, J., Hénin, D., Gibert, C., Chastre, J.: Clinical and autopsy diagnoses in the intensive care unit. Arch. Intern. Med. 164, 389 (2004)CrossRefGoogle Scholar
  23. 23.
    Gibson, T.N., Shirley, S.E., Escoffery, C.T., Reid, M.: Discrepancies between clinical and postmortem diagnoses in Jamaica: a study from the University Hospital of the West Indies. J. Clin. Pathol. 57, 980–985 (2004) CrossRefGoogle Scholar
  24. 24.
    Shojania, K.G., Burton, E.C., McDonald, K.M., Goldman, L.: Changes in rates of autopsy-detected diagnostic errors over time. JAMA 289, 2849 (2003)CrossRefGoogle Scholar
  25. 25.
    Tudela, P., Carreres, A., Ballester, M.: Diagnostic errors in emergency departments. Med. Clínica (English Ed.) 149, 170–175 (2017)CrossRefGoogle Scholar
  26. 26.
    Schiff, G.D., Hasan, O., Kim, S., Abrams, R., Cosby, K., Lambert, B.L., Elstein, A.S., Hasler, S., Kabongo, M.L., Krosnjar, N., Odwazny, R., Wisniewski, M.F., McNutt, R.A.: Diagnostic error in medicine. Arch. Intern. Med. 169, 1881 (2009)CrossRefGoogle Scholar
  27. 27.
    Goldman, L., Sayson, R., Robbins, S., Cohn, L.H., Bettmann, M., Weisberg, M.: The value of the autopsy in three medical eras. N. Engl. J. Med. 308, 1000–1005 (1983)CrossRefGoogle Scholar
  28. 28.
    Veress, B.: A retrospective analysis of clinical diagnoses and autopsy findings in 3,042 cases during two different time periods. Hum. Pathol. 25, 140–145 (1988)CrossRefGoogle Scholar
  29. 29.
    Winters, B., Custer, J., Galvagno, S.M., Colantuoni, E., Kapoor, S.G., Lee, H., Goode, V., Robinson, K., Nakhasi, A., Pronovost, P., Newman-Toker, D.: Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual. Saf. 21, 894–902 (2012)CrossRefGoogle Scholar
  30. 30.
    Thurnheer, R., Hoess, C., Doenecke, C., Moll, C., Muntwyler, J., Krause, M.: Diagnostic performance in a primary referral hospital assessed by autopsy: evolution over a ten-year period. Eur. J. Intern. Med. 20, 784–787 (2009)CrossRefGoogle Scholar
  31. 31.
    Fares, A.F., Fares, J., Fares, G.F., Cordeiro, J.A., Nakazone, M.A., Cury, P.M.: Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies. Arq. Bras. Cardiol. 97, 449–455 (2011)CrossRefGoogle Scholar
  32. 32.
    Kuijpers, C.C., Fronczek, J., Van De Goot, F.R.W., Niessen, H.W.M., Van Diest, P.J., Jiwa, M.: The value of autopsies in the era of high-tech medicine: discrepant findings persist. J. Clin. Pathol. 67, 512–519 (2014)CrossRefGoogle Scholar
  33. 33.
    Pastores, S.M., Dulu, A., Voigt, L., Raoof, N., Alicea, M., Halpern, N.A.: Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients. Crit. Care 11, R48 (2007)CrossRefGoogle Scholar
  34. 34.
    De Vlieger, G., Mahieu, E., Meersseman, W.: Clinical review: what is the role for autopsy in the ICU? Crit. Care 14, 221 (2010)CrossRefGoogle Scholar
  35. 35.
    Cameron, H.M., McGoogan, E., Watson, H.: Necropsy: a yardstick for clinical diagnoses. Br. Med. J. 281, 985–988 (1980)CrossRefGoogle Scholar
  36. 36.
    Sington, J.D., Cottrell, B.J.: Analysis of the sensitivity of death certificates in 440 hospital deaths: a comparison with necropsy findings. J. Clin. Pathol. 55, 499–502 (2002)CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Jawahar (Jay) Kalra
    • 1
    • 2
    Email author
  • Daniel Markewich
    • 2
  • Patrick Seitzinger
    • 3
  1. 1.Royal University Hospital, Saskatoon Health RegionSaskatoonCanada
  2. 2.Department of Pathology and Laboratory Medicine, College of MedicineUniversity of SaskatchewanSaskatoonCanada
  3. 3.Northern Medical Program, Faculty of MedicineUniversity of British ColumbiaVancouverCanada

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