Do we still need the autopsy? Clinical diagnosis versus autopsy diagnosis

B. Ioan, T. Alexa, I. Alexa

Abstract: The autopsy is one of the main tools for the evolution of medicine. Nevertheless, the autopsy rate declined worldwide in the last decades due to several reasons: progress in diagnosis of diseases, fear of legal consequences if a wrong diagnosis is proved, refusal of the deceased s family, reluctance of forensic pathologists and pathologists because of infectious risk and time consumption. However, despite the huge progress of medical science, discrepancies between the death diagnosis established by the clinician and the diagnosis established by the pathologist after performing the autopsy still exist and have remained relatively constant over the last 50 years. Our study aimed to identify the concordance rate between the cause of death established in the hospital and the cause of death established after performing the forensic autopsy and to determine the factors that could influence the concordance rate. The study group included 100 patients who died in hospital and underwent autopsy. We found a concordance rate of 45% which could be influenced by certain factors, such as: duration of hospitalization, interclinic consultation, mechanism of death, postmortem microscopic examination and the biochemical analysis performed during hospitalization. Our results support the fact that autopsy remains an essential tool for assessing the quality of care, for improving medical education process and for highlighting those diseases that represent "diagnostic challenges".
Keywords: autopsy, cause of death, diagnosis, concordance