(精选)Autopsies still a gold standard教学课件.pptVIP

Autopsies: still a gold standard ?;Background;We excluded incomplete autopsy cases and also pediatric autopsies ( 16 years old). We confronted the clinical diagnoses listed on the autopsy request form with pathological diagnoses in the autopsy report. Clinically important discrepancies were defined as: -major :missed diagnoses for which detection and treatment before death might have resulted in cure or prolongation of survival or for which detection before death would probably have led to a change in management. -minor: missed diagnoses without clinical implication. Sudden death was defined as death occurring less than 12 hours after the first symptoms.;Mean medical autopsy rate for adult patients (16 years) death was 10.7 % (2005-2008) and mean total autopsy rate (medical autopsies and forensic autopsies of patients deceaded in the hospital) was 15.8 %. Data from 2004 are not avalaible. For paediatric patients deceaded during the same period (2005-2008) the mean autopsy rate in our hospital was 48%.; Among 717 autopsy cases: 35.6% (255) were qualified as sudden death 59.8 % (429) concerned men Provenance (place of death) of the 717 cases of autopsy:;Reasons for requesting an autopsy 63.6 %: cause of death without a specific medical problem 69.3 %: specific questions: confirmation of diagnosis elucidation of complications of medical interventions elucidation of etiology or pathogenesis;Cause of death was established in 526 cases (73.3%): In 164 of 255 sudden death cases (64.3 %) a cause of death was established In 362 of 462 non sudden death cases (78.3%) a cause of death was established In 456 of 717 (63,6%) with specific question of the cause of death, a cause was established in 66.2% (302 cases);103 (14.4%) clinically important diagnoses (major) were established that were missed by the attending clinicians 166 (23.2%) missed diagnoses without important clinical implications (minor) were encountered;Meningiomas 12 Gastro-intestinal adenomas