Emedinews - Insight on medicolegal issues: Autopsies are important in medicine for continuous improvement in medical practice

 A study that focused on heart attacks i.e. myocardial infarction as a cause of death found significant errors of omission and commission, i.e. a sizable number cases ascribed to myocardial infarctions were not MIs and a significant number of non-MIs were actually MIs.

·         A systematic review of studies of the autopsy calculated that in about 25% of autopsies a major diagnostic error will be revealed. However, this rate has decreased over time and the study projects that in a contemporary US institution, 8.4% to 24.4% of autopsies will detect major diagnostic errors.

·         An analysis suggested that approximately one-third of death certificates are incorrect and that half of the autopsies performed produced findings that were not suspected before the person died. Also, it is thought that over one-fifth of unexpected findings can only be diagnosed histological, i.e. by biopsy or autopsy, and that approximately one -quarter of unexpected findings, or 5% of all findings, are major and can similarly only be diagnosed from tissue.

·         One study found that "Autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli, and 9 endocarditis, among others”.

·         Focusing on intubated patients, one study found "abdominal pathologic conditions--abscesses, bowel perforations, or infarction--were as frequent as pulmonary emboli as a cause of class I errors. While patients with abdominal pathologic conditions generally complained of abdominal pain, results of examination of the abdomen were considered unremarkable in most patients, and the symptom was not pursued". 

References

1.       Ravakhah K. Death certificates are not reliable: revivification of the autopsy. South Med J 2006;99(7):728-33.

2.      Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA 2003;289(21): 2849-56.

[      (Contributed by Dr Sudhir Gupta)