Boletín médico del Hospital Infantil de México
versión impresa ISSN 1665-1146
RICHARDSON-LOPEZ COLLADA, Vesta y CORONEL-MARTINEZ, Diana Leticia. Discrepancy between clinical diagnoses versus autopsy findings in a third-level pediatric hospital. Bol. Med. Hosp. Infant. Mex. [online]. 2006, vol.63, n.4, pp.232-240. ISSN 1665-1146.
Introduction. The autopsy has been recognized as a useful tool for medical education and for quality improvement, evaluating therapeutic and diagnostic measures. In the last 50 years, the autopsy rates have constantly declined. Interestingly, between 1972 and 2002, the discrepancies between clinical diagnoses and autopsy findings haven't diminished, even with all the technological improvements now available. This research enables us to determine the discrepancy rate between our clinical diagnosis and autopsy results, as well as the main diseases that need diagnostic or therapeutic improvements in our hospital. Our objectives were: 1. To obtain the discrepancy rate between clinical diagnoses and autopsy findings. 2. To determine the most frequent type of discrepancy, according with the Goldman criteria, modified by Battle, and 3. To evaluate the possible association of these discrepancies with the number of admissions, length of stay, patient's age and physician's age. Material and methods. A retrospective, observational, comparative and transversal study. Sample: all cases that had an autopsy between January 1st and December 31th 2004. Cases with an incomplete record were excluded. The main variables analyzed were: age, gender, number of admissions and their length of stay, main clinical service, type of autopsy, main clinical and autopsy diagnoses and probable cause of death. Results. In the year 2004 there were 209 deaths registered with 62 autopsies (29.7% rate). We found a discrepancy in the main clinical diagnosis in 15 cases (24.6%); and, according with the Goldman criteria, modified by Battle, we found a class I discrepancy in 5 cases (8.2%) and a class II discrepancy in 4 cases (6.6%). We didn't find significant statistical differences in patients older than a year compared with patients less than 1 year old. There were no significant differences regarding the number of admissions and their length of stay, or variations the artendiag with the attending physician's age. Conclusions. Our main discrepancies were in infectious diseases, similar to other studies. Our discrepancy numbers are similar to others reported in the world. It is important to analyze these cases with the physicians involved, and together learn from our mistakes, working to improve diagnostic and therapeutic measures, and overall, quality of care.
Palabras llave : Autopsy; clinical diagnostic; discrepancy.