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Published on: December 18, 2016
The reliability of autopsy diagnostics: inter-observer variation between pathologists, a preliminary report
B Veress1, V Gadaleanu, I Nennesmo
1Department of Pathology, Karolinska Institute, Huddinge University Hospital, Sweden.
Abstract:
The aim of the study was to analyse the agreement between pathologists regarding macroscopic autopsy diagnostics. Four pathologists examined 35 autopsies and determined the principal disease and its complications, the immediate cause of death, other major diseases and their complications, and minor diseases. The participants were paired and their diagnoses were analysed by using kappa statistics for interobserver variation. The agreement on the principal disease was almost perfect between the participants (kappa values between 0.83 and 0.97), whereas that on the immediate cause of death was moderate/substantial (kappa values between 0.43-0.75). The list of all other major diseases and their complications was almost complete for each observer, but that of the minor diseases showed a more considerable variation. In spite of the high level of agreement it is recommended that the autopsy findings be discussed among pathologists if the clinical picture cannot be explained satisfactorily, and that the cause of death be determined by the clinicians after the demonstration of the autopsy.
Insights
Pathologists showed high agreement on principal diseases during autopsy diagnostics, but moderate agreement on the immediate cause of death. Minor disease diagnosis varied more significantly among observers.
Area of Science:
- Forensic Pathology
- Medical Diagnostics
Background:
- Autopsy diagnostics are crucial for determining cause of death and disease.
- Interobserver variation in pathological diagnoses can impact accuracy.
Purpose of the Study:
- To analyze the agreement among pathologists in macroscopic autopsy diagnostics.
- To assess interobserver variation in identifying principal diseases, complications, cause of death, and other diseases.
Main Methods:
- Four pathologists reviewed 35 autopsies.
- Diagnoses included principal disease, complications, immediate cause of death, major diseases, and minor diseases.
- Kappa statistics were used to measure interobserver agreement.
Main Results:
- Near-perfect agreement (kappa 0.83-0.97) was observed for the principal disease.
- Moderate to substantial agreement (kappa 0.43-0.75) was found for the immediate cause of death.
- High completeness for major diseases/complications, but considerable variation in minor disease reporting.
Conclusions:
- High agreement exists for principal disease identification in autopsies.
- Discussion among pathologists is recommended for unexplained clinical findings.
- Clinicians should determine the cause of death post-autopsy demonstration.
