Trends of accuracy of clinical diagnoses of the basic cause of death in a university hospital

Aims: To determine the agreement between clinical and necropsy diagnoses of the basic cause of death, and to compare the results with those obtained in a previous study carried out at the same university hospital. Methods: In total, 4828 necropsies, performed between 1990 and 1995 in the University...

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Bibliographic Details
Published in:	Journal of clinical pathology Vol. 57; no. 4; pp. 369 - 373
Main Authors:	Grade, M H C, Zucoloto, S, Kajiwara, J K, Fernandes, M T P, Couto, L G F, Garcia, S B
Format:	Journal Article
Language:	English
Published:	London BMJ Publishing Group Ltd and Association of Clinical Pathologists 01-04-2004 BMJ BMJ Publishing Group LTD Copyright 2004 Journal of Clinical Pathology
Subjects:	Accuracy Agreements autopsy Autopsy - methods Biological and medical sciences Cause of Death clinical diagnoses Diagnosis Diagnostic tests Disease error General aspects HCFMRP-USP Health services Hospitals Hospitals, University Humans ICD International Classification of Diseases Laboratories Legal medicine Medical imaging Medical sciences Metabolic disorders Mortality necropsy Original Pathology Quality Sensitivity and Specificity Statistics as Topic Studies Trends University Hospital of the Faculty of Medicine of Ribeirão Preto University of São Paulo Medicine Accuracy University Cause Trend Death Diagnosis Hospital
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Summary:	Aims: To determine the agreement between clinical and necropsy diagnoses of the basic cause of death, and to compare the results with those obtained in a previous study carried out at the same university hospital. Methods: In total, 4828 necropsies, performed between 1990 and 1995 in the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil, were reviewed. Examinations were concluded at the macroscopic part of the necropsy in nearly 35% of the cases. Statistical analysis was carried out using the κ coefficient comparing the clinical diagnosis and the diagnosis obtained after necropsy. The jackknife method was used to identify comparable κ values for the comparison of the two periods. Results: Compared with the 1978–80 period, a significant increase in diagnostic agreement was seen for the group submitted to complete necropsy, whereas no similar increase was detected when only the macroscopic step was analysed. Conclusions: There was a discrete tendency to an improved correlation between clinical and postmortem data stated by full necropsy analysis. The findings show that microscopic analysis remains important to confirm the cause of death in many cases. Diagnostic discrepancies remained high, and therefore complete necropsy continues to be an essential instrument for the assessment of clinical diagnosis.
Bibliography:	href:jclinpath-57-369.pdf istex:8813D49B416C31B128D0834459725CFBDD0ABE26 Correspondence to:  Dr M H C Grade  Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Campus FMRP, USP, 14.049-000, Ribeirão Preto, Brazil; marcio@rpa.fmrp.usp.br local:0570369 ark:/67375/NVC-71QJCJ0G-B PMID:15047739 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Correspondence to: Dr M H C Grade Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Campus FMRP, USP, 14.049-000, Ribeirão Preto, Brazil; marcio@rpa.fmrp.usp.br
ISSN:	0021-9746 1472-4146
DOI:	10.1136/jcp.2003.013235