title: The value of autopsies in the era of high-tech medicine: discrepant findings persist.
abstract: OBJECTIVE
  Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have been declining over the last decades to <10%. The aim of this study was to investigate the value of autopsies in the high-tech medicine era by determining the frequency of discrepancies between clinical and autopsy diagnoses.
  
  
  METHODS
  We classified all adult autopsy cases (n=460), performed at Symbiant, Pathology Expert Centre, in 2007 and 2012/2013, as having major, or minor discrepancy or total concordance. The roles of possible contributory factors were analysed. Finally, we assessed the role of microscopic examination in identifying cause of death.
  
  
  RESULTS
  Major and minor discrepancies were found in 23.5% and 32.6% of the classifiable autopsies, respectively. Most commonly observed major discrepancies were myocardial infarction, pulmonary embolism and pneumonia. Improper imaging and discontinuation of active treatment were significantly associated with a higher and a lower frequency of major discrepancies, respectively. Comparing 2007 and 2012/2013, the frequency of minor discrepancies significantly increased from 26.8% to 39.3%. Final admission length of >2 days was significantly associated with a lower frequency of class III minor discrepancies. Microscopic examination contributed to establishing cause of death in 19.6% of the cases.
  
  
  CONCLUSIONS
  Discrepant findings persist at autopsy, even in the era of high-tech medicine. Therefore, autopsies still should serve as a very important part of quality control in clinical diagnosis and treatment. Learning from individual and system-related diagnostic errors can aid in improving patient safety.
authors.affiliation: Symbiant Pathology Expert Centre, Alkmaar, The Netherlands.
authors.forename: Chantal C H J
authors.initials: CC
authors.lastname: Kuijpers
authors.affiliation: Symbiant Pathology Expert Centre, Alkmaar, The Netherlands Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Fronczek
authors.affiliation: Symbiant Pathology Expert Centre, Alkmaar, The Netherlands.
authors.forename: Frank R W
authors.initials: FR
authors.lastname: van de Goot
authors.affiliation: Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands Department of Cardiac Surgery, VU Medical Centre, Amsterdam, The Netherlands ICaR-VU, VU Medical Centre, Amsterdam, the Netherlands.
authors.forename: Hans W M
authors.initials: HW
authors.lastname: Niessen
authors.affiliation: Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van Diest
authors.affiliation: Symbiant Pathology Expert Centre, Alkmaar, The Netherlands.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Jiwa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000706:statistics & numerical data / Q000639:trends; D020811:Biomedical Technology / Q000639:trends; D002423:Cause of Death; D003951:Diagnostic Errors; D003952:Diagnostic Imaging; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: AUTOPSY PATHOLOGY; HISTOPATHOLOGY; POSTMORTEM; QUALITY CONTROL; SAFETY