Changes in rates of autopsy-detected diagnostic errors over time: a systematic review.

摘要: ContextSubstantial discrepanies exist between clinical diagnoses and findings at autopsy. Autopsy may be used as a tool for quality management to analyze diagnostic discrepanies.ObjectiveTo determine the rate at which autopsies detect important, clinically missed diagnoses, extent this has changed over time.Data SourcesA systematic literature search English-language articles available on MEDLINE from 1966 April 2002, using terms autopsy, postmortem changes, post-mortem, postmortem, necropsy, posthumous, identified 45 studies reporting 53 distinct autopsy series meeting prospectively defined criteria. Reference lists were reviewed identify additional studies, final bibliography was distributed experts in field missing or unpublished studies.Study SelectionIncluded studies reported clinically missed involving primary cause of death (major errors), with most serious being those likely to have affected patient outcome (class I errors).Data ExtractionLogistic regression performed data autopsy series 40-year period adjusting effects changes autopsy rates, country, case mix (general autopsies; adult medical; intensive care; or pediatric surgery; general pediatrics inpatients; neonatal intensive care; other autopsy), important methodological features primary studies.Data SynthesisOf identified, 42 major errors 37 reported class errors. Twenty-six both class I error rates. The median error 23.5% (range, 4.1%-49.8%) major errors 9.0% 0%-20.7%) Analyses diagnostic error rates mix, rate yielded relative decreases per decade 19.4% (95% confidence interval [CI], 1.8%-33.8%) 33.4% [CI], 8.4%-51.6%) I errors. Despite these decreases, we estimated that contemporary US institution (based on ranging 100% [the extrapolated extreme which clinical selection is eliminated] 5% [roughly national average]), could observe 8.4% 24.4% from 4.1% 6.7%.ConclusionThe possibility given will reveal unsuspected diagnoses decreased time, but remains sufficiently high encouraging ongoing use appears warranted.