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Autopsy Study Reveals Missed Diagnoses

French researchers find they catch diagnostic errors in ICU units

MONDAY, Feb. 23, 2004 (HealthDayNews) -- A French study of autopsy results revealed missed diagnoses in a number of patients who died in intensive care units (ICUs).

The three-year study included 1,492 ICU patients. Of those patients, 315 died and 167 of those were autopsied. The researchers compared autopsy findings with the patients' clinical diagnoses while they were in ICUs.

Among the 694 clinical diagnoses, 33 (4.8) percent were refuted and 13 (1.9 percent) were judged incomplete by the autopsy findings. The autopsies also revealed 171 missed diagnoses. These included 21 missed cancers, 12 strokes, 11 heart attacks, 10 pulmonary emboli (clot in the lungs), and nine endocarditis (inflammation of the heart valves).

"With an autopsy rate of 53 percent, major diagnostic errors were identified for 31.7 percent of the autopsied patients, and the correct diagnosis would have changed management and possibly resulted in cure or prolonged survival for up to 10 percent of patients," the study authors write.

"Even in the era of modern diagnostic technology, regular comparisons of clinical and autopsy diagnoses provide pertinent information that might improve future management of ICU patients," the authors write.

The study appears in the Feb. 23 issue of the Archives of Internal Medicine.

The authors note autopsy rates have decreased worldwide. They say the reasons for the decline include a fear of potential legal consequences if autopsies reveal misdiagnoses, the reluctance of families to give permission for autopsy, and doubt about the usefulness of autopsies.

More information

The Agency for Healthcare Research and Quality has more about how autopsies help uncover diagnostic discrepancies.

SOURCE: JAMA/Archives journals, news release, Feb. 23, 2004
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