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Accuracy of clinical diagnoses in a teaching hospital: a review of 997 autopsies
Author(s) -
KAJIWARA J. K.,
ZUCOLOTO S.,
MANÇO A. R. X.,
MUCCILLO G.,
BARBIERI M. A.
Publication year - 1993
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.1993.tb00728.x
Subject(s) - concordance , medical diagnosis , autopsy , medicine , kappa , cohen's kappa , clinical diagnosis , pediatrics , pathology , statistics , mathematics , geometry
. Objectives . To analyse the concordance between clinical and autopsy diagnoses. Design . Nine‐hundred‐and‐ninety‐seven autopsies were studied comparing the diagnoses of the autopsy requests with those of the death certificates and autopsy reports. The cases were grouped according to the 17 categories of diseases of the International Classification of Diseases (ICD) and the concordance was analysed with the k (kappa) coefficient of concordance. Setting . The Hospital da Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRPUSP), Ribeirão Preto, SP, Brazil. Subjects . The patients autopsied at HCFMRPUSP during the period between 1978 and 1980. Main outcome measures. k statistics offer an alternative approach to measuring the concordance between clinical and autopsy diagnoses. Results . The k ‐value obtained was equal to 0.601 with a variance of 1.545 times 10 −4 when comparing the clinical diagnoses and the autopsy diagnoses, and equal to 0.661 with a variance of 1.531 times 10 −4 comparing the clinical diagnoses with those obtained after the gross examination. These values are significant at the level of 5%, i.e. there is an overall statistical concordance between clinical and autopsy diagnoses although the value is not absolute (k= 1.00). Conclusions . If autopsies are heeded without bias, they will continue to give important feedback concerning medical diagnosis.