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随着时间的推移,尸检检测的诊断错误率的变化:系统性审查
Kaveh G Shojania1, Elizabeth C Burton, Kathryn M McDonald
1Department of Medicine, University of California, San Francisco, CA 94143, USA. shojania@medicine.ucsf.edu
随着时间的推移,尸检越来越少发现重大和I类诊断错误. 然而,诊断产量仍然很大,这证明了为质量管理继续使用尸检的必要性.
科学领域:
- 病理学 病理学 病理学
- 改善医疗质量 改善医疗质量
- 诊断的准确性 诊断的准确性
背景情况:
- 临床诊断往往不同于尸检结果.
- 尸检是评估诊断差异和改善医疗保健质量的关键工具.
研究的目的:
- 量化通过尸检发现的临床错误诊断率.
- 分析随着时间的推移,尸检检测的诊断错误的趋势.
主要方法:
- 来自MEDLINE和其他来源的英语文章 (1966-2002) 的系统文献综述.
- 包括53个尸体解剖系列报告重大和I类诊断错误.
- 后勤回归分析对40年来病例组合,国家和尸检率进行调整.
主要成果:
- 大错误的中位数为23.5%,I类错误的中位数为9.0%.
- 错误率每十年显著下降:重大错误为19.4%,I类错误为33.4%.
- 当代的美国机构仍然可能具有8.4%-24.4%的重大错误率和4.1%-6.7%的I类错误率.
结论:
- 对未经怀疑的诊断进行尸检的诊断收益率已经下降.
- 尽管尸检的数量下降,但尸检仍然很有价值,用于识别重要的错过诊断,支持它们的持续使用.
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