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A Comparison of the Antemortem Clinical Diagnosis and Autopsy Findings for Patients Who Die in the Emergency Department
Author(s) -
O'Connor Alan E.,
Parry Jeremy T.,
Richardson Drew B.,
Jain Sanjiv,
Herdson Peter B.
Publication year - 2002
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1197/aemj.9.9.957
Subject(s) - medicine , medical diagnosis , autopsy , emergency department , referral , tertiary referral hospital , clinical diagnosis , retrospective cohort study , incidence (geometry) , emergency medicine , pediatrics , tertiary care , general surgery , surgery , radiology , family medicine , psychiatry , physics , optics
Objectives: In spite of advances in medical technology, there remains a high discrepancy rate between the antemortem clinical diagnosis and postmortem examination diagnosis for patients who die in hospitals. The aim of this study was to compare the clinical and postmortem examination diagnoses of patients who died in the emergency department (ED) of a tertiary hospital, and to analyze any discrepancy between them. Methods: The study was a retrospective chart review of patients who died in the ED of a tertiary referral teaching hospital and a comparison of the antemortem diagnosis with the autopsy diagnosis. Any missed diagnosis was classified, according to the Goldman criteria, into major and minor missed diagnoses. Results: A total of 59 patients were eligible for inclusion in the study. There was complete agreement between the antemortem diagnosis and the autopsy result in 51% of cases. The incidence of major missed diagnoses—where if the diagnosis had been known before the patient died, treatment may have been altered or survival may have been prolonged—was 7%. Conclusions: There is a significant discrepancy rate between the antemortem diagnosis and the autopsy diagnosis. However, in this study, serious missed diagnoses in which outcome may have been significantly altered are unusual among those who die in the ED of a tertiary referral hospital.