This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (75)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Oncology  • Alert me on articles by topic

How Often Are Clinical Diagnoses Incorrect?

Elizabeth C. Burton, MD; Dana A. Troxclair, MS; William P. Newman III, MD

JAMA. 1998;280:1245-1248.

Context.— Autopsy often reveals new diagnoses of malignant neoplasms, but as technological advances to improve diagnosis during life have improved, autopsy rates have declined dramatically.

Objective.— To determine if there is still a high discordance rate between clinical and autopsy diagnoses of malignant neoplasms despite increasing technological advances in diagnostic methods.

Design and Setting.— A 10-year retrospective study (1986-1995) of all autopsies performed at the Medical Center of Louisiana at New Orleans.

Participants.— All patients autopsied, excluding preterm fetuses, at the Medical Center of Louisiana at New Orleans, by both Tulane and Louisiana State University Schools of Medicine in which consent was obtained or authorization given from the Orleans Parish Coroner's Office.

Main Outcome Measures.— Discordance between clinical and autopsy diagnoses of malignant neoplasms.

Results.— A total of 1625 cases were reviewed of which 520 preterm fetuses were excluded. Of the remaining 1105 cases, 654 were male and 451 were female. The mean age was 48.3 years (range, 1-98 years). A total of 433 neoplasms were diagnosed, 250 of which were malignant. One hundred eleven malignant neoplasms in 100 patients had been either undiagnosed or misdiagnosed, and in 57 patients, the immediate cause of death could be attributed to the malignant neoplasm. The discordance between clinical and autopsy diagnoses of malignant neoplasms in this study is 44%, which is similar to previously reported studies.

Conclusion.— The discordance rate between clinical and autopsy diagnoses of malignant neoplasms is large and confirms the importance of the postmortem examination.

From the Louisiana State University Medical Center, New Orleans.

RELATED ARTICLE

Low-Tech Autopsies in the Era of High-Tech Medicine: Continued Value for Quality Assurance and Patient Safety
George D. Lundberg
JAMA. 1998;280(14):1273-1274.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Can cause of death be predicted from the pre-necropsy information provided in coroners' cases?
Biggs et al.
J. Clin. Pathol. 2008;61:124-126.
ABSTRACT | FULL TEXT  

Errors in Cancer Diagnosis: Current Understanding and Future Directions
Singh et al.
JCO 2007;25:5009-5018.
ABSTRACT | FULL TEXT  

Death of the teaching autopsy: Advances in technology have not reduced the value of the autopsy
Fruhbeck
BMJ 2004;328:165-166.
FULL TEXT  

Fundamental Measures of Diagnostic Examination Performance: Usefulness for Clinical Decision Making and Research
Langlotz
Radiology 2003;228:3-9.
ABSTRACT | FULL TEXT  

A Dose of Our Own Medicine: Alternative Medicine, Conventional Medicine, and the Standards of Science
Morreim
J Law Med Ethics 2003;31:222-235.
 

The Autopsy: A Professional Responsibility in Assuring Quality of Care
Burton
American Journal of Medical Quality 2002;17:56-60.
ABSTRACT  

Are coroners' necropsies necessary? A prospective study examining whether a "view and grant" system of death certification could be introduced into England and Wales
Rutty et al.
J. Clin. Pathol. 2001;54:279-284.
ABSTRACT | FULL TEXT  

Diagnosis of Renal Cancer by Molecular Urinalysis
Eisenberger et al.
JNCI J Natl Cancer Inst 1999;91:2028-2032.
ABSTRACT | FULL TEXT  

Case of the Month: The Autopsy and the Living
Collins et al.
Arch Intern Med 1999;159:2391-2392.
FULL TEXT  

Study Design and Analysis in Neuroradiology: A Practical Approach
Medina
Am. J. Neuroradiol. 1999;20:1584-1596.
FULL TEXT  

Case of the Month: Outcome Analysis and Quality Assessment
Bennett et al.
Arch Intern Med 1999;159:1399-1400.
FULL TEXT  

Autopsy Rates and Diagnosis
Lynn et al.
JAMA 1999;281:2181-2181.
FULL TEXT  

Is the Discordance Rate of Malignancy Still High?
Inoue et al.
Arch Intern Med 1999;159:1013-1013.
FULL TEXT  

Low-Tech Autopsies in the Era of High-Tech Medicine: Continued Value for Quality Assurance and Patient Safety
Lundberg
JAMA 1998;280:1273-1274.
FULL TEXT