Clinical diagnosis: a post-mortem assessment of accuracy in the 1980s

The clinical diagnoses of a series of 400 patients dying in hospital were compared with the pathological findings at autopsy. The clinical diagnoses were precisely confirmed in only 46.75% of cases (average age 65.3 y). Potentially treatable disease was missed in 13% of patients (average age 72.7 y). The most frequent errors, both of under-diagnosis and over-diagnosis, were for pulmonary embolus, pneumonia and myocardial infarction. Over-diagnosis increased with length of hospital stay. Peritonitis and other deep-seated sepsis were surprisingly frequently missed in life. The findings closely parallel those from other units both in Britain and overseas, and suggest that there is currently a high diagnostic error rate, which varies remarkably little from one institution to another.