ACCURACY OF CLINICAL DIAGNOSES IN A TEACHING HOSPITAL - A REVIEW OF 997 AUTOPSIES

Objectives. To analyse the concordance between clinical and autopsy di agnoses.Design. Nine-hundred-and-ninety-seven autopsies were studied c omparing the diagnoses of the autopsy requests with those of the death certificates and autopsy reports. The cases were grouped according to the 1 7 categories of diseases of the International Classification of Diseases (ICD) and the concordance was analysed with the kappa (kappa ) coefficient of concordance. Setting. The Hospital da Clinicas da Fac uldade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (HCF MRPUSP), Ribeirao Preto, SP, Brazil. Subjects. The patients autopsied at HCFMRPUSP during the period between 1978 and 1980. Main outcome mea sures. Kappa statistics offer an alternative approach to measuring the concordance between clinical and autopsy diagnoses. Results. The kapp a-value obtained was equal to 0.601 with a variance of 1. 54 5 x 10(-4 ) when comparing the clinical diagnoses and the autopsy diagnoses, and equal to 0.661 with a variance of 1.531 x 10(-4) comparing the clinic al diagnoses with those obtained after the gross examination. These va lues are significant at the level of 5 %, i.e. there is an overall sta tistical concordance between clinical and autopsy diagnoses although t he value is not absolute (kappa = 1.00). Conclusions. If autopsies are heeded without bias, they will continue to give important feedback co ncerning medical diagnosis.