A comparison of the antemortem clinical diagnosis and autopsy findings for patients who die in the emergency department.
OBJECTIVE
In spite of advances in medical technology, there remains a high discrepancy rate between the antemortem clinical diagnosis and postmortem examination diagnosis for patients who die in hospitals. The aim of this study was to compare the clinical and postmortem examination diagnoses of patients who died in the emergency department (ED) of a tertiary hospital, and to analyze any discrepancy between them.


METHODS
The study was a retrospective chart review of patients who died in the ED of a tertiary referral teaching hospital and a comparison of the antemortem diagnosis with the autopsy diagnosis. Any missed diagnosis was classified, according to the Goldman criteria, into major and minor missed diagnoses.


RESULTS
A total of 59 patients were eligible for inclusion in the study. There was complete agreement between the antemortem diagnosis and the autopsy result in 51% of cases. The incidence of major missed diagnoses-where if the diagnosis had been known before the patient died, treatment may have been altered or survival may have been prolonged-was 7%.


CONCLUSIONS
There is a significant discrepancy rate between the antemortem diagnosis and the autopsy diagnosis. However, in this study, serious missed diagnoses in which outcome may have been significantly altered are unusual among those who die in the ED of a tertiary referral hospital.
Department of Emergency Medicine, The Canberra Hospital, ACT, Australia. alan.oconnor@bigpond.com
Alan E
AE
O'Connor
Jeremy T
JT
Parry
Drew B
DB
Richardson
Sanjiv
S
Jain
Peter B
PB
Herdson
D020958:Australian Capital Territory / Q000453:epidemiology; D001344:Autopsy / Q000592:standards*; D002423:Cause of Death; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards*; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D008485:Medical Audit; D012017:Referral and Consultation; D012189:Retrospective Studies; D016019:Survival Analysis