Abstract：
AIMS:Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have been declining over the last decades to <10%. The aim of this study was to investigate the value of autopsies in the high-tech medicine era by determining the frequency of discrepancies between clinical and autopsy diagnoses. METHODS:We classified all adult autopsy cases (n=460), performed at Symbiant, Pathology Expert Centre, in 2007 and 2012/2013, as having major, or minor discrepancy or total concordance. The roles of possible contributory factors were analysed. Finally, we assessed the role of microscopic examination in identifying cause of death. RESULTS:Major and minor discrepancies were found in 23.5% and 32.6% of the classifiable autopsies, respectively. Most commonly observed major discrepancies were myocardial infarction, pulmonary embolism and pneumonia. Improper imaging and discontinuation of active treatment were significantly associated with a higher and a lower frequency of major discrepancies, respectively. Comparing 2007 and 2012/2013, the frequency of minor discrepancies significantly increased from 26.8% to 39.3%. Final admission length of >2 days was significantly associated with a lower frequency of class III minor discrepancies. Microscopic examination contributed to establishing cause of death in 19.6% of the cases. CONCLUSIONS:Discrepant findings persist at autopsy, even in the era of high-tech medicine. Therefore, autopsies still should serve as a very important part of quality control in clinical diagnosis and treatment. Learning from individual and system-related diagnostic errors can aid in improving patient safety.
journal_name
J Clin Patholjournal_title
Journal of clinical pathologyauthors
Kuijpers CC,Fronczek J,van de Goot FR,Niessen HW,van Diest PJ,Jiwa Mdoi
10.1136/jclinpath-2013-202122subject
Has Abstractpub_date
2014-06-01 00:00:00pages
512-9issue
6eissn
0021-9746issn
1472-4146pii
jclinpath-2013-202122journal_volume
67pub_type
杂志文章abstract：:Cervical biopsies from 97 women with malignant cells in cervical scrape smears have been studied. Forty-eight patients had invasive squamous carcinoma, and 49 had intraepithelial lesions. Of these, six had dedifferentiated carcinoma in situ, nine had the differentiated lesions generally known as ;severe dysplasia', an...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.20.1.7
更新日期：1967-01-01 00:00:00
abstract：:This memorandum proposes a standardized system of reporting the histology of human lymph nodes based on commonly used simple staining techniques. The purpose is to provide a uniform, internationally acceptable system by which the histological structure of lymph nodes can be correlated with other parameters of immunolo...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.26.5.317
更新日期：1973-05-01 00:00:00
abstract：:A case is reported of a patient with plasmacytoma which assumed different clinicopathological features over seven years. The tumour first presented as a subcutaneous mass which was misdiagnosed as anaplastic carcinoma. Complete response to radiotherapy ensued but recurrence took the form of an intracerebral tumour. Fu...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.47.10.951
更新日期：1994-10-01 00:00:00
abstract：:Two unusual ovarian tumours thought to be of Wolffian identity, one of them malignant, are described. They showed packed combinations of adenopapillary, tubular, trabecular and diffuse patterns, a sharp and generalised periodic acid-Schiff (PAS)-positive basement membrane and areas of elastic network. A review of publ...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.35.5.526
更新日期：1982-05-01 00:00:00
abstract：BACKGROUND:The "classical" antineutrophil cytoplasmic antibody (C-ANCA) pattern seen on indirect immunofluorescence (IIF) is characterised by granular cytoplasmic staining showing central or interlobular accentuation, and is strongly associated with antiproteinase-3 antibodies (PR3-ANCA) and Wegener's granulomatosis. H...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.52.2.124
更新日期：1999-02-01 00:00:00
abstract：:A rapidly fatal case of enteritis necroticans in a 24 year old man with diabetes was caused by Clostridium perfringens type C. The role of beta toxin in the disease is discussed. This type has not been previously described as a causative agent in necrotising bowel disease of man outside endemic areas. ...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.37.8.942
更新日期：1984-08-01 00:00:00
abstract：:The applicability of a recently developed non-radioactive DNA labelling and detection method, which uses the digoxigenin (DIG) enzyme linked immunosorbent assay (ELISA) system, for the detection of viral infections in pathology specimens by in situ hybridisation, was examined. Its efficacy was compared with that of bi...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.43.10.806
更新日期：1990-10-01 00:00:00
abstract：:Two hundred and forty-seven strains of micro-organisms were isolated from the urinary tract of 121 patients with neurological complaints leading to paraplegia. The commonest infecting organism was E. coli and the commonest type of Proteus was P. mirabilis. Infections with more than one type of organism were present in...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.13.1.54
更新日期：1960-01-01 00:00:00
abstract：:Primary low grade marginal zone B cell lymphoma (MZL) of the breast and localised mammary amyloidosis are exceedingly rare entities. This report describes the case of a woman with long standing Sjögren's syndrome presenting with asymptomatic MZL of the breast showing plasmacytic differentiation, associated with local ...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.56.1.74
更新日期：2003-01-01 00:00:00
abstract：:Three patients with aplastic anaemia had a history of substantial previous exposure to organochlorine pesticides. The temporal association between chemical exposure and the onset of first symptoms of anaemia was strongly supportive. Organochlorines have the property of lipid affinity and accumulation in adipose tissue...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.43.2.98
更新日期：1990-02-01 00:00:00
abstract：:Urine specimens were collected from 26 normal subjects, 10 patients with proven primary hyperparathyroidism, and eight patients with hypercalcaemia due to other causes. After overnight urine concentration, an oral water load was given to induce a diuresis and provide urine specimens with a relatively wide range of cre...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.22.3.287
更新日期：1969-05-01 00:00:00
abstract：:Automation in clinical chemistry is a powerful tool. Like most innovations it is posing many questions as well as resolving some. Its use in population screening has led to questioning the validity of the old system of ;normal values' and to the search for better methods of indicating the significance of laboratory te...
journal_title：Journal of clinical pathology
pub_type： 杂志文章,评审
doi：10.1136/jcp.26.8.555
更新日期：1973-08-01 00:00:00
abstract：:An alternative method for detecting the production of slime by coagulase negative staphylococci was compared with the routinely used Christensen method on 124 isolates of coagulase negative staphylococci from carriage sites, blood cultures, and infected peritoneal dialysis fluids. The alternative method requires the u...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.42.8.872
更新日期：1989-08-01 00:00:00
abstract：:In a population of 432 apparently healthy men aged 50 years and over 19-2% had one or more erythrocytes per high-power field in the urine while 8-1% had more than 10. Erythrocyturia seemed to be strongly correlated with tobacco consumption. No significant association with occupation could be demonstrated but the data ...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.30.4.341
更新日期：1977-04-01 00:00:00
abstract：AIMS:To study whether differences in eradication rates of antibiotics may be explained by differences in secretion of antibiotics in gastric juice. METHODS:A single intravenous dose of either ampicillin 500 mg, erythromycin 500 mg, or metronidazole 500 mg was administered to four healthy Helicobacter pylori negative v...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.45.3.225
更新日期：1992-03-01 00:00:00
abstract：:Concentration of factor VIII from fresh plasma by cryoprecipitation remains the basis for preparation of products used to treat haemophilia A. This paper describes the preparation of a factor VIII concentrate from small plasma pools in transfusion centres with drying facilities. The dried concentrate from one litre of...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.34.10.1091
更新日期：1981-10-01 00:00:00
abstract：:Liver diseases are associated with complex haemostasis defects, in which platelets, coagulation, and fibrinolysis may all be affected. The low plasma concentrations of clotting factors often found can be the result of many changes such as impaired synthesis, increased catabolism due to intravascular coagulation, or al...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.37.5.523
更新日期：1984-05-01 00:00:00
abstract：:Preoperative (neoadjuvant) chemoradiation therapy/treatment (NCRT) is emerging as an important treatment modality in borderline resectable pancreatic ductal adenocarcinoma (PDAC). The constellation of histopathological changes secondary to chemoradiation is diverse and has been well documented, particularly in other g...
journal_title：Journal of clinical pathology
pub_type： 杂志文章,评审
doi：10.1136/jclinpath-2016-203604
更新日期：2016-06-01 00:00:00
abstract：:A method is described for the quantitative separation of radioactive bile acids and neutral sterols in human faeces on a potassium hydroxide-treated silicic acid column. Results obtained with faecal extracts containing metabolites derived from radioactive cholesterol, cholic acid, and chenodeoxycholic acid show that t...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.18.1.105
更新日期：1965-01-01 00:00:00
abstract：AIMS:As part of the UK antimicrobial resistance strategy and action plan, the Public Health Laboratory Service (PHLS) is required to collect antibiotic susceptibility data so that resistance trends and patterns can be monitored. Most laboratories report urine Gram negative isolates, as "coliforms" according to morpholo...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.55.7.524
更新日期：2002-07-01 00:00:00
abstract：BACKGROUND:Oncogenicity of human papillomavirus (HPV) DNA in premalignant and malignant uterine cervical diseases is mainly induced by E6/E7 open reading frame (ORF). The presence of an oncogenic HPV DNA may be a diagnostic marker for the detection of cytologically negative smears. AIMS:To evaluate an original polymer...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.51.1.38
更新日期：1998-01-01 00:00:00
abstract：:Sections from 100 cervical biopsy specimens were studied by 12 consultant histopathologists to determine the robustness of the existing pathology terminology and classification. Analysis by kappa statistics showed good agreement in the diagnosis of CIN 3 and squamous carcinoma but an inability to distinguish accuratel...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.42.3.231
更新日期：1989-03-01 00:00:00
abstract：:One hundred and two bone marrow samples were analysed by histological and immunohistochemical methods for neurone specific enolase (NSE). The biopsies were performed to determine the extent of bone marrow disease in 84 neuroblastomas, nine embryonal rhabdomyosarcomas, five Ewing's sarcomas, two cases of Hodgkin's dise...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.44.4.309
更新日期：1991-04-01 00:00:00
abstract：:Bone marrow aspirates and biopsy specimens were taken at diagnosis from 51 patients with acute myeloid leukaemia (AML). The diagnosis was based on morphological and cytochemical analyses, and the leukaemias were classified by FAB criteria. A considerable difference was observed between the results of bone marrow aspir...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.42.3.300
更新日期：1989-03-01 00:00:00
abstract：:Aztreonam blood agar, a new selective medium for Gram positive aerobic bacteria, was evaluated in comparison with conventional media for skin swabs. Aztreonam agar increased the number of isolates of Staphylococcus aureus by 17%. By producing purer growths on primary isolation, it significantly speeded up the identifi...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.46.8.769
更新日期：1993-08-01 00:00:00
abstract：AIMS:To determine whether the presence of disseminated bone marrow tumour cells at diagnosis is a prognostic factor for breast cancer patients at high risk of recurrence or bone metastasis, and to assess their presence as a criterion for evaluation of the potential benefits of adjuvant chemotherapy. METHODS:Multiple b...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.50.3.206
更新日期：1997-03-01 00:00:00
abstract：:A 60 year old woman affected by Hashimoto's thyroiditis presented with a history of recurring episodes of urticaria and angio-oedema. Clinical and laboratory evaluation of the patient excluded allergy to external agents, hereditary angio-oedema, and occult infections. A pathogenic relation between Hashimoto's thyroidi...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.50.3.254
更新日期：1997-03-01 00:00:00
abstract：:DNA typing was requested to investigate a presumptive cancer diagnosis error by confirming whether benign and cancerous prostatic tissue in the same presurgical haematoxylin and eosin stained slide belonged to the same person. After independent histological re-examination of the slide by a pathologist, manual slide di...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.2004.017673
更新日期：2005-01-01 00:00:00
abstract：AIMS:To determine the suitability of primary gel separation tubes for the storage of frozen sera intended for serological testing. METHODS:Blood samples from 102 patients were collected into gel separation tubes. The sera from these samples were split between the primary gel separation tubes and conventional plastic s...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.57.1.104
更新日期：2004-01-01 00:00:00
abstract：AIM:To determine the size of a cervical biopsy specimen with human papillomavirus (HPV) infection required to enable in situ hybridisation to be carried out with a guarantee of a reliable result. METHODS:In situ hybridisation was carried out in 142 cervical uterine biopsy specimens classified histologically as low gra...
journal_title：Journal of clinical pathology
pub_type： 杂志文章
doi：10.1136/jcp.48.1.57
更新日期：1995-01-01 00:00:00
