Clinical diagnoses and autopsy findings: a retrospective analysis of 252 cases in Greece.
BACKGROUND
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.


METHODS
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.
Spiliopoulou
Chaido
C
Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens, Athens, Greece. cspiliop@cc.uoa.gr
Papadodima
Stavroula
S
Kotakidis
Nikolaos
N
Koutselinis
Antonios
A
D000368:Aged; D017542:Aneurysm, Ruptured / Q000473:pathology; D001012:Aorta, Abdominal / Q000473:pathology; D001013:Aorta, Thoracic / Q000473:pathology; D001344:Autopsy / Q000706:statistics & numerical data; D002423:Cause of Death; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis; D011655:Pulmonary Embolism / Q000473:pathology; D012189:Retrospective Studies