Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies.
BACKGROUND
Discrepancies between clinical and autopsy diagnoses persists worldwide.


OBJECTIVE
We evaluated autopsies in a university hospital in order to assess the accuracy of clinical cardiovascular diagnosis compared to postmortem findings.


METHODS
Four hundred nine consecutive autopsies between 2003 and 2006 were analyzed in a tertiary-care hospital in São José do Rio Preto, SP, Brazil. The comparison of clinic-pathological cardiovascular findings was performed using Goldman's discrepancies classification.


RESULTS
Autopsy rate at the hospital was 8%. Cardiovascular causes of death represented 42.8% (175 out of 409 patients) of autopsy diagnoses. In 98 (56%) patients, there were major discrepancies (class I and II), representing a large proportion of misdiagnoses for mesenteric infarction (84.6%), acute myocardial infarction (64.7%), aorta dissection (64.2%), and pulmonary embolism (62.5%). Highest concordance rates were observed in congestive heart failure (59%) and acute ischemic stroke (58.8%). Age, sex, length of stay and the last admission unit at the hospital were not associated with Goldman criteria.


CONCLUSIONS
Clinic-autopsy discrepancies concerning cardiovascular death remain high in Brazil, despite technological resources available. Moreover, our findings reinforce the importance of postmortem examination in contributing to medical care improvement.
Hospital de Base, Faculdade de Medicina de São José do Rio Preto, Av. Brigadeiro Faria Lima 5544, São José do Rio Preto, SP, Brazil.
Aline Fusco
AF
Fares
Jorge
J
Fares
Gislaine Fusco
GF
Fares
José Antônio
JA
Cordeiro
Marcelo Arruda
MA
Nakazone
Patrícia Maluf
PM
Cury
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000592:standards*; D001938:Brazil; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000473:pathology; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult