Discrepancies between clinical and autoptic diagnoses in Italy: evaluation of 879 consecutive cases at the "Policlinico of Bari" teaching hospital in the period 1990-2009

作者：Sblano Sara^*; Arpaio Alessandra; Zotti Fiorenza; Marzullo Andrea; Bonsignore Alessandro; Dell'Erba Alessandro

来源：Annali dell'Istituto Superiore di Sanita, 2014, 50(1): 44-48.

DOI：10.4415/ANN_14_01_07

• clinical diagnoses
• autopsy findings
• rate of discrepancy
• quality control
• risk-management

Introduction. In spite of the benefits of autopsies, there has been in recent years a drastic decline in the number of autopsies performed, mainly due to an apparent unattractive cost-benefit ratio and fears of the medico-legal consequences.
Material and Methods. A retrospective study was conducted on the reports of all the 879 consecutive autopsies performed at "Policlinico of Bari" from 1990 to 2009.
Results. All clinical diagnoses were compared with autopsy findings showing 558 concordant diagnoses (most of all neoplasms); 123 certain discordant diagnoses (69 of them with potential impact on survival, such as acute myocardial infarctions, pulmonary thromboembolisms, internal haemorrhages, surgery complications, aortic aneurism ruptures, and so on); 116 uncertain discrepant diagnoses; 82 unclear diagnoses.
Conclusions. The rate of discrepancy allows the authors to hypothesize that a better diagnostic assessment could lead to a different outcome. In terms of risk-management this negative performance needs to be carefully analysed and requires a comprehensive audit of all services provided. In this sense, the authors underline the crucial importance of autopsy as an essential tool to address unresolved clinical questions and highlight previously undiagnosed medical conditions.

• 出版日期2014