title: Correlation of clinical diagnosis with autopsy findings.
abstract: We investigated 110 cases, selected at random out of the total of 1876 autopsies performed in the Institute of Pathological Anatomy and Histology at the University of Ferrara-Arcispedale Santa Anna on patients who had died at the hospital during 1983-87. Clinical data were taken from 'necropsy request forms' filled in by clinicians and from medical records. We then evaluated the extent of agreement and disagreement, expressed as underdiagnosis (false-negative) and overdiagnosis (false-positive), between the clinical and pathological records with regard to primary disease and to cause of death. Agreement between the diagnoses was 81% for primary disease and 58% for cause of death. The diagnoses of neoplastic, cerebrovascular and cardiovascular diseases showed the closest agreement. Among the neoplasms, those of the liver, gall-bladder, pancreas, retroperitoneal space and prostate were most often overlooked in clinical diagnoses. We had conflicting results for cancer of the lung and of the colon-rectum, for which there was a high level of agreement, but also a large number of false-positive cases and cases in which they were found by chance at autopsy. For cerebrovascular diseases, false-negative and false-positive diagnoses were seen most often for cause of death. With regard to cardiovascular diseases, a relatively uniform distribution was found for myocardial infarction among the three categories, and a high rate of agreement was found for pulmonary embolism. Of all diseases, bronchopneumonia was associated with the highest percentage of false-negative diagnoses for cause of death. Our data on digestive diseases show the strongest agreement on diagnosis of primary disease in relation to cirrhosis of the liver; a high rate of agreement on cause of death was confirmed for alimentary bleeding. Active tuberculosis was detected only at autopsy. We conclude that autopsy is a valid tool for investigation, despite the availability of sophisticated diagnostic techniques.
authors.affiliation: Institute of Pathological Anatomy and Histology, University of Ferrara, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Rossi
authors.forename: D
authors.initials: D
authors.lastname: Reale
authors.forename: E
authors.initials: E
authors.lastname: Grandi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality; D002423:Cause of Death; D003933:Diagnosis; D003951:Diagnostic Errors; D005260:Female; D006748:Hospital Departments; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality