A study of coroner's cases from hospitals: a comparison of autopsy and clinical diagnosis

This study compares the clinical cause of death and the autopsy cause of death. The study population of 623 cases consists of all coroner's cases for the year 1990 subjected to autopsy, which were hospital cases, and which were not dead on arrival. The clinical cause of death was confirmed by autopsy in 72% of cases. For unnatural deaths (260 cases), the agreement between the clinical cause of death and autopsy diagnosis was 96%. However, in natural deaths and in deaths related to surgical or therapeutic procedures (363 cases), the agreement was much lower, being 54%. The percentage agreement was lower in some categories than others, notably respiratory conditions (51%) and circulatory conditions (42%). Agreement was particularly poor in the clinical diagnosis of myocarditis (0% agreement), pulmonary thrombo-embolism (33%), cerebro-vascular accidents (36%) and pneumonia (45%). Thus death certification in these categories would have been a particularly unreliable source of diagnostic data.