Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies

Abstract

Background: Discrepancies between clinical and autopsy diagnoses persists worldwide. Objective: We evaluated autopsies in a university hospital in order to assess the accuracy of clinical cardiovascular diagnosis compared to postmortem findings. Methods: Four hundred nine consecutive autopsies between 2003 and 2006 were analyzed in a tertiary-care hospital in São José do Rio Preto, SP, Brazil. The comparison of clinic-pathological cardiovascular findings was performed using Goldman's discrepancies classification. Results: Autopsy rate at the hospital was 8%. Cardiovascular causes of death represented 42.8% (175 out of 409 patients) of autopsy diagnoses. In 98 (56%) patients, there were major discrepancies (class I and II), representing a large proportion of misdiagnoses for mesenteric infarction (84.6%), acute myocardial infarction (64.7%), aorta dissection (64.2%), and pulmonary embolism (62.5%). Highest concordance rates were observed in congestive heart failure (59%) and acute ischemic stroke (58.8%). Age, sex, length of stay and the last admission unit at the hospital were not associated with Goldman criteria. Conclusions: Clinic-autopsy discrepancies concerning cardiovascular death remain high in Brazil, despite technological resources available. Moreover, our findings reinforce the importance of postmortem examination in contributing to medical care improvement.