解剖で検出された診断誤差の割合の時間的変化:体系的なレビュー

Kaveh G Shojania¹, Elizabeth C Burton, Kathryn M McDonald

¹Department of Medicine, University of California, San Francisco, CA 94143, USA. shojania@medicine.ucsf.edu

JAMA

|June 5, 2003

まとめ

解剖では,時間の経過とともに,メジャーおよびクラスIの診断エラーがますます少なくなっています. しかし,診断成果は依然として有意であり,品質管理のための解剖の継続的な使用を正当化しています.

科学分野:

病理学パトロジー
医療の質の向上医療の質の向上
診断の精度診断の精度

背景:

臨床診断は,解剖の結果としばしば異なる.
解剖は,診断の不一致を評価し,医療の質を改善するための重要なツールとして機能します.

研究の目的:

解剖によって特定された臨床的に誤診された診断の割合を定量化するために.
解剖で検出された診断エラーの傾向を時間とともに分析する.

主な方法:

MEDLINEやその他の情報源からの英語記事 (1966-2002) の体系的な文献レビュー.
重症およびクラスIの診断エラーを報告した53件の解剖シリーズを含む.
ロジスティック回帰分析は,症例の組み合わせ,国,そして40年以上にわたる解剖率を調整します.

主要な成果:

平均誤差率は,主要な誤差で23.5%,クラスIの誤差で9.0%でした.
十年ごとにエラー率が著しく低下した:重大なエラーでは19.4%,クラスIエラーでは33.4%.
現代の米国の機関は,依然として8.4%~24.4%の主要なエラー率と4.1%~6.7%のクラスIエラー率を有している可能性があります.

結論:

予期せぬ診断に対する解剖の診断成果は低下しています.
減少にもかかわらず,解剖は重要な誤診を特定し,その継続的な利用を支えるために価値があります.

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