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Comparison between clinical and autopsy diagnoses in a cardiology hospital
  1. Rafael Saad (rafael.saad{at}terra.com.br)
  1. Heart Institute (InCor), University of São Paulo Medical School, Brazil
    1. Alice T Yamada (alice.yamada{at}incor.usp.br)
    1. Heart Institute (InCor), University of São Paulo Medical School, Brazil
      1. Fernando H F P da Rosa (consulting{at}feferraz.net)
      1. Heart Institute (InCor), University of São Paulo Medical School, Brazil
        1. Paulo S Gutierrez (anppaulo{at}incor.usp.br)
        1. Heart Institute (InCor), University of São Paulo Medical School, Brazil
          1. Alfredo J Mansur (ajmansur{at}incor.usp.br)
          1. Heart Institute (InCor), University of São Paulo Medical School, Brazil

            Abstract

            Background Few recent studies evaluated diagnostic accuracy by comparison between clinical and autopsy diagnoses in a hospital specialized in cardiology.

            Methods 406 consecutive autopsy cases during 2 years were studied. Patients aged 47.4 ± 28.4 years; 236 (58.1%) were men and 170 (41.9%) women. Diagnostic comparison was categorized in classes I to V (I, II, III and IV: discrepancy in decreasing order of importance regarding therapy and prognosis; V: concordance). Categorization was ranked on the basis of the highest degree of discrepancy. Statistical analysis was performed with χ2 test and stepwise logistic regression.

            Results Each age increase of 10 years added 16.2% to the risk of the diagnostic comparison be categorized in classes I and II (major discrepancy) in comparison to classes III, IV and V (odds ratio 1.16, 95% confidence interval 1.07-1.27, p<0.001). By contrast, admission to intensive care units decreased 47% the risk of categorization in classes I and II (odds ratio 0.53, 95% confidence interval 0.32-0.85, p=0.009). The most frequent diagnostic discrepancy occurred for pulmonary embolism - 30 out of 88 (34.1%) diagnoses in classes I and II. Concordance rate was 71.1% for acute myocardial infarction, 75% for aorta dissection, 73.1% for infective endocarditis and 35.2% for pulmonary embolism.

            Conclusion Age and hospital ward influenced the distribution of diagnostic discrepancy or concordance between clinical and autopsy diagnoses. Lower discrepancy rate for myocardial infarction and infective endocarditis may be related to the fact of being a specialty hospital.

            • autopsy diagnosis
            • clinical diagnosis
            • diagnostic accuracy
            • heart diseases
            • myocardial infarction

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