Comparison of the clinical and post mortem diagnoses of the causes of death

The fast moving progress in medical technology causes someone to ask if the progress is not only in diagnostic abilities but also in diagnostic precision. Despite the improved quality of diagnostic technology, the frequency of misdiagnosis has not decreased appreciably. The goal of autopsy is not only to uncover clinicians mistakes or judge them but rather to instruct clinicians to learn by their own mistakes. We reviewed the autopsy records from the Archive of the Institute of Forensic Medicine in Ljubljana of 1792 deceased persons in 1997 and 1998 and compared the clinical and post mortem diagnoses. We eliminated from study all autopsies performed on deceased persons not admitted to the Clinical Medical Centre. From the remaining 911 autopsy reports we compared the post mortem diagnoses with the clinical diagnoses. We classified findings into five groups according to the level of agreement between the clinical and the post mortem diagnoses. Group 1 included cases of complete agreement between clinical and post mortem diagnoses. Group 2 cases of disagreement about the basic illness, group 3 cases of partial disagreement about the direct causes of death, group 4 cases of total disagreement between the clinical diagnosis and the post mortem, named, also misdiagnosis and group 5 clinical diagnosis which could not be calssified. The diagnoses were in total agreement in 49.30% of cases, in partial agreement (disagreement about direct causes of death) in 20.68% and in disagreement about the basic illness in 6.87%. The diagnoses were in total disagreement in 9.87%. 13.30% of cases were not possible to classify owing to incomplete death certificates or reports of the causes of death.