Friday 3 February 2012

Emedinews:Insights on Medicolegal issues: Autopsies is important for further improvement in medical practice


Autopsies is important for further improvement in medical practice

  • systematic review of studies calculated that in about 25% of autopsies a major diagnostic error would be revealed. However, this rate has decreased over time and the study projects that in a contemporary US institution, 8.4% to 24.4% of autopsies will detect major diagnostic errors.
  • An analysis has suggested that approximately one-third of death certificates are incorrect and that half of the autopsies performed produced findings that were not suspected before the person died. Also, it is thought that over one-fifth of unexpected findings can only be diagnosed histological, i.e. by biopsy or autopsy, and that approximately one-quarter of unexpected findings, or 5% of all findings, are major and can similarly only be diagnosed from tissue.
  • According to another study, autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli, and 9 endocarditic, among others.
  • Focusing on intubated patients, one study found that abdominal pathologic conditions - abscesses, bowel perforations, or infarction - were as frequent as pulmonary emboli as a cause of class I errors. While patients with abdominal pathologic conditions generally complained of abdominal pain, results of examination of the abdomen were considered unremarkable in most patients, and the symptom was not pursued. 

(Ref: Changes in rates of autopsy-detected diagnostic errors over time: a systematic review.  JAMA 2003;289(21):2849–56)

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