Issue: 2006 > June > original article

Diagnostic errors; the need to have autopsies

C.M. Aalten, M.M. Samsom, P.A.F. Jansen


Introduction: In geriatric patients, atypical presentation
and limitations in diagnostic scope may lead to underdiagnosis. The aim of this study was to establish
the frequency, nature and causes of clinical diagnostic
errors in a geriatric population.
Design: A retrospective study.
Methods: We assessed the accuracy of clinical diagnosis
using autopsy results as our gold standard. Factors likely
to influence accuracy of clinical diagnosis were identified.
We used the (modified) classification of Goldman <i>et al.</i> to define discrepancy.
Results: We analysed 93 autopsies of a total of 331 deaths (28%). Discrepancies in major diagnoses were seen in 36 cases (39%). In 17 of these, clinical management might have been different if the diagnosis had been made premortem. These were: pulmonary embolism (4); unrecognised infection (4); intestinal ischaemia (3); ruptured aortic aneurysm (2); malignancy (1); tracheal obstruction (1); intestinal obstruction (1) and acute pancreatitis (1). Discrepancies in minor diagnoses were seen in 46 cases (50%). About one third of these were clinically relevant. Discrepancies occurred more frequently if there was a degree of uncertainty about clinical diagnosis (p<0.001).
Conclusion: Major discrepancies between clinical
diagnosis and autopsy findings were seen in 39% of our
study population. They occur more often in the case of
uncertain clinical diagnosis. Our findings stress the
continuing and important role of autopsy in improving
clinical practice in geriatric medicine.