Autopsy findings and clinical diagnoses: Retrospective study of 3,117 autopsies

Aim. To determine the extent of agreement between clinical and autopsy find ings. Methods. A 14-year retrospective study (1982-1995) of autopsies from the De partments of Internal Medicine and Surgery was performed at the Zagreb Univ ersity Hospital Center, Croatia. The autopsy findings were compared with th e clinical diagnoses, Results. The autopsy rate among hospital deaths ranged between 23% and 33%, The overall rate of major discrepancies was 11.6% for all autopsy reports. The most common cause of death were cardiovascular diseases (40.9%), follo wed by malignancies (25.2%) and infections (12.9%). Among all cardiovascula r diseases, myocardial infarction was the most frequently diagnosed (17.9%) and was misdiagnosed by clinicians in 16.5% of the cases. Incorrectly diag nosed malignancies were found in only 5.7% of the cases; hematological and lymphoid malignancies (48.8%) were the most common neoplasms and were usual ly confirmed before death. Infections were found in 46.9% of all autopsies. Bacterial pneumonias and peritonitis were overlooked in 67.5% and 23.5% of the cases, respectively, in which they existed together with another serio us condition. Conclusion. Modern technology has not improved the overall accuracy of clin ical diagnoses. When an autopsy should be performed is still a matter of di scussion.