The value of autopsies in the era of high-tech medicine: Discrepant findings persist

Chantal C.H.J. Kuijpers, Judith Fronczek, Frank R.W. Van De Goot, Hans W.M. Niessen, Paulus Joannes van Diest, Mehdi Jiwa

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


Aims: Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have been declining over the last decades to <10%. The aim of this study was to investigate the value of autopsies in the high-tech medicine era by determining the frequency of discrepancies between clinical and autopsy diagnoses. Methods: We classified all adult autopsy cases (n=460), performed at Symbiant, Pathology Expert Centre, in 2007 and 2012/2013, as having major, or minor discrepancy or total concordance. The roles of possible contributory factors were analysed. Finally, we assessed the role of microscopic examination in identifying cause of death. Results: Major and minor discrepancies were found in 23.5% and 32.6% of the classifiable autopsies, respectively. Most commonly observed major discrepancies were myocardial infarction, pulmonary embolism and pneumonia. Improper imaging and discontinuation of active treatment were significantly associated with a higher and a lower frequency of major discrepancies, respectively. Comparing 2007 and 2012/2013, the frequency of minor discrepancies significantly increased from 26.8% to 39.3%. Final admission length of >2 days was significantly associated with a lower frequency of class III minor discrepancies. Microscopic examination contributed to establishing cause of death in 19.6% of the cases. Conclusions: Discrepant findings persist at autopsy, even in the era of high-tech medicine. Therefore, autopsies still should serve as a very important part of quality control in clinical diagnosis and treatment. Learning from individual and system-related diagnostic errors can aid in improving patient safety.

Original languageEnglish (US)
Pages (from-to)512-519
Number of pages8
JournalJournal of clinical pathology
Issue number6
StatePublished - Jun 2014
Externally publishedYes

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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