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Are autopsies obsolete?
1Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Insights
Autopsies frequently reveal missed diagnoses, with nearly half of cases showing undiagnosed causes of death. Many of these treatable conditions highlight the autopsy
Area of Science:
- Pathology
- Medical Diagnosis
Background:
- Autopsy plays a crucial role in verifying clinical diagnoses.
- Assessing the diagnostic yield of autopsies is essential for quality improvement in healthcare.
Observation:
- A retrospective study analyzed 176 autopsies from 1994 at a tertiary care center.
- Diagnoses from complete autopsies were compared with antemortem clinical diagnoses.
Findings:
- Nearly half (44.9%) of autopsies revealed at least one undiagnosed cause of death.
- Infections, infarctions, and malignant neoplasms were common missed diagnoses.
- Approximately two-thirds of undiagnosed causes were treatable conditions.
Implications:
- Autopsies uncover significant missed diagnoses, even in the era of advanced medical technology.
- The autopsy's value persists in identifying treatable conditions overlooked during patient care.
- Findings underscore the importance of maintaining autopsy services for medical education and patient safety.
Abstract:
To determine the current frequency of discovering important diagnoses at autopsy, the diagnoses made in all complete or "no head" autopsies during 1994 at a major tertiary care transplantation referral center were retrospectively compared with the diagnoses made antemortem. Of 176 autopsies, 79 (44.9%) revealed 1 or more undiagnosed causes of death. Of the 123 undiagnosed causes of death, 13 were sole immediate causes of death, 72 were one of multiple immediate causes, 22 were intervening causes, and 16 were underlying causes. The causes of death were as follows: infections, 34; infarctions, 11; malignant neoplasms, 8; pulmonary emboli, 7; gastrointestinal ulcers, 7; hemorrhages, 6; thromboses, 3; amyloidosis, 1; genetic hemochromatosis, 1; and cardiac tamponade, 1. Of 35 autopsies of transplant recipients, 16 (46%) disclosed undiagnosed causes of death, compared with 63 (44.7%) of 141 autopsies of patients who had not received transplants. Approximately two thirds of the undiagnosed causes of death were judged to be treatable conditions. This and similar studies suggest that old-fashioned low-technology autopsies can uncover many important diagnoses missed by modern high-technology medicine.