Abstract
Objective:To determine whether autopsies improve the detection of major clinical errors.
Design:Retrospective chart review of all deaths for a 30-month period to detect major clinical errors when a correct diagnosis and institution of proper therapy would have prolonged the patient’s life, with comparison of autopsied patients with those without an autopsy.
Setting:Small government hospital inpatient medical service.
Patients:335 consecutive deaths with 141 [42%] autopsies.
Main results:Review of the clinical records of cases without autopsy led to the discovery of only two major clinical errors [1%], whereas 19 major clinical errors [13%] were detected in autopsy cases. Three of the 19 errors in autopsy patients would have been detected by chart review alone. Thirteen of the 19 clinical errors in autopsied patients were related to infections that were missed or were not treated appropriately because of misdiagnosis.
Conclusion:Autopsies continue to reveal unanticipated and important information that is essential for internal medicine residency training and for the evaluation of the quality of medical care.
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References
Center for Environmental Health and Injury Control. Autopsy frequency—United States, 1980–85. MMWR 1988;37:191–4.
Travers H. Mortui vivos docent. Kansas Med 1986;329-33.
Ahronheim JC, Bernholc AS, Clark WD. Age trends in autopsy rates: striking decline in late life. JAMA 1983;250:1182–6.
Campion EW, Reder VA, Mulley AG, Thibault GE. Age and the declining rate of autopsy. J Am Geriatr Soc 1986;34:865–8.
Roberts WC. The autopsy: its decline and suggestion for its revival. N Engl J Med 1978;299:332–8.
Thurlbeck WM. Accuracy of clinical diagnosis in a Canadian teaching hospital. Can Med Assoc J 1981;125:443–7.
Pounder DJ, Horowitz M, Rowland R, Reid DP. The value of the autopsy in medical audit—a combined clinical and pathological assessment of 100 cases. Aust NZ J Med 1983;13:478–82.
Puxty JAH, Horan MA, Fox RA. Necropsies in the elderly. Lancet 1983;1:1262–4.
Scottolini AG, Weinstein SR. The autopsy in clinical quality control. JAMA 1983;250:1192–4.
McPhee SJ, Bottles K. Autopsy: moribund art or vital science? Am J Med 1985;78:107–13.
Cocchi A, Vecchio FM, Pahor M, et al. Autopsy rate in young and older hospitalized patients. Eur J Epidemiol 1986;2:151–7.
Stevanovic G, Tucakovic G, Dotlic R, Kanjuh V. Correlation of clinical diagnoses with autopsy findings: a retrospective study of 2,145 consecutive autopsies. Hum Pathol 1986;17:1225–30.
Battle RM, Pathak D, Humble CG, et al. Factors influencing discrepancies between premortem and postmortem diagnoses. JAMA 1987;258:339–44.
Landefeld CS, Chren MM, Myers A, Geller R, Robbins S, Goldman L. Diagnostic yield of the autopsy in a university hospital and a community hospital. N Engl J Med 1988;318:1249–54.
Gross JS, Neufeld RR, Libow LS, Gerber I, Rodstein M. Autopsy study of the elderly institutionalized patient: review of 234 autopsies. Arch Intern Med 1988;148:173–6.
Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weisberg M. The value of the autopsy in three medical eras. N Engl J Med 1983;308:1000–5.
Kircher T, Anderson RE. Cause of death: proper completion of the death certificate. JAMA 1987;258:349–52.
Kircher T, Nelson J, Burdo H. The autopsy as a measure of accuracy of the death certificate. N Engl J Med 1985;313:1263–9.
Council on Scientific Affairs: Autopsy: a comprehensive review of current issues. JAMA 1987;258:364–9.
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Pelletier, L.L., Klutzow, F. & Lancaster, H. The Autopsy. J Gen Intern Med 4, 300–303 (1989). https://doi.org/10.1007/BF02597401
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DOI: https://doi.org/10.1007/BF02597401