Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.

<h4>Background</h4>Autopsy rates in Western countries consistently decline to an average of <5%, although clinical autopsies represent a reasonable tool for quality control in hospitals, medically and economically. Comparing pre- and postmortal diagnoses, diagnostic discrepancies as u...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Daniel Wittschieber, Frederick Klauschen, Anna-Christin Kimmritz, Moritz von Winterfeld, Carsten Kamphues, Hans-Joachim Scholman, Andreas Erbersdobler, Heidi Pfeiffer, Carsten Denkert, Manfred Dietel, Wilko Weichert, Jan Budczies, Albrecht Stenzinger
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1cc8a23d7f5144a6a655311a665d58d6
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:1cc8a23d7f5144a6a655311a665d58d6
record_format	dspace
spelling	oai:doaj.org-article:1cc8a23d7f5144a6a655311a665d58d62021-11-18T07:17:50ZWho is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.1932-620310.1371/journal.pone.0037460https://doaj.org/article/1cc8a23d7f5144a6a655311a665d58d62012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22629399/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Autopsy rates in Western countries consistently decline to an average of <5%, although clinical autopsies represent a reasonable tool for quality control in hospitals, medically and economically. Comparing pre- and postmortal diagnoses, diagnostic discrepancies as uncovered by clinical autopsies supply crucial information on how to improve clinical treatment. The study aimed at analyzing current diagnostic discrepancy rates, investigating their influencing factors and identifying risk profiles of patients that could be affected by a diagnostic discrepancy.<h4>Methods and findings</h4>Of all adult autopsy cases of the Charité Institute of Pathology from the years 1988, 1993, 1998, 2003 and 2008, the pre- and postmortal diagnoses and all demographic data were analyzed retrospectively. Based on power analysis, 1,800 cases were randomly selected to perform discrepancy classification (class I-VI) according to modified Goldman criteria. The rate of discrepancies in major diagnoses (class I) was 10.7% (95% CI: 7.7%-14.7%) in 2008 representing a reduction by 15.1%. Subgroup analysis revealed several influencing factors to significantly correlate with the discrepancy rate. Cardiovascular diseases had the highest frequency among class-I-discrepancies. Comparing the 1988-data of East- and West-Berlin, no significant differences were found in diagnostic discrepancies despite an autopsy rate differing by nearly 50%. A risk profile analysis visualized by intuitive heatmaps revealed a significantly high discrepancy rate in patients treated in low or intermediate care units at community hospitals. In this collective, patients with genitourinary/renal or infectious diseases were at particularly high risk.<h4>Conclusions</h4>This is the current largest and most comprehensive study on diagnostic discrepancies worldwide. Our well-powered analysis revealed a significant rate of class-I-discrepancies indicating that autopsies are still of value. The identified risk profiles may aid both pathologists and clinicians to identify patients at increased risk for a discrepant diagnosis and possibly suboptimal treatment intra vitam.Daniel WittschieberFrederick KlauschenAnna-Christin KimmritzMoritz von WinterfeldCarsten KamphuesHans-Joachim ScholmanAndreas ErbersdoblerHeidi PfeifferCarsten DenkertManfred DietelWilko WeichertJan BudcziesAlbrecht StenzingerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 5, p e37460 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Daniel Wittschieber Frederick Klauschen Anna-Christin Kimmritz Moritz von Winterfeld Carsten Kamphues Hans-Joachim Scholman Andreas Erbersdobler Heidi Pfeiffer Carsten Denkert Manfred Dietel Wilko Weichert Jan Budczies Albrecht Stenzinger Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.
description	<h4>Background</h4>Autopsy rates in Western countries consistently decline to an average of <5%, although clinical autopsies represent a reasonable tool for quality control in hospitals, medically and economically. Comparing pre- and postmortal diagnoses, diagnostic discrepancies as uncovered by clinical autopsies supply crucial information on how to improve clinical treatment. The study aimed at analyzing current diagnostic discrepancy rates, investigating their influencing factors and identifying risk profiles of patients that could be affected by a diagnostic discrepancy.<h4>Methods and findings</h4>Of all adult autopsy cases of the Charité Institute of Pathology from the years 1988, 1993, 1998, 2003 and 2008, the pre- and postmortal diagnoses and all demographic data were analyzed retrospectively. Based on power analysis, 1,800 cases were randomly selected to perform discrepancy classification (class I-VI) according to modified Goldman criteria. The rate of discrepancies in major diagnoses (class I) was 10.7% (95% CI: 7.7%-14.7%) in 2008 representing a reduction by 15.1%. Subgroup analysis revealed several influencing factors to significantly correlate with the discrepancy rate. Cardiovascular diseases had the highest frequency among class-I-discrepancies. Comparing the 1988-data of East- and West-Berlin, no significant differences were found in diagnostic discrepancies despite an autopsy rate differing by nearly 50%. A risk profile analysis visualized by intuitive heatmaps revealed a significantly high discrepancy rate in patients treated in low or intermediate care units at community hospitals. In this collective, patients with genitourinary/renal or infectious diseases were at particularly high risk.<h4>Conclusions</h4>This is the current largest and most comprehensive study on diagnostic discrepancies worldwide. Our well-powered analysis revealed a significant rate of class-I-discrepancies indicating that autopsies are still of value. The identified risk profiles may aid both pathologists and clinicians to identify patients at increased risk for a discrepant diagnosis and possibly suboptimal treatment intra vitam.
format	article
author	Daniel Wittschieber Frederick Klauschen Anna-Christin Kimmritz Moritz von Winterfeld Carsten Kamphues Hans-Joachim Scholman Andreas Erbersdobler Heidi Pfeiffer Carsten Denkert Manfred Dietel Wilko Weichert Jan Budczies Albrecht Stenzinger
author_facet	Daniel Wittschieber Frederick Klauschen Anna-Christin Kimmritz Moritz von Winterfeld Carsten Kamphues Hans-Joachim Scholman Andreas Erbersdobler Heidi Pfeiffer Carsten Denkert Manfred Dietel Wilko Weichert Jan Budczies Albrecht Stenzinger
author_sort	Daniel Wittschieber
title	Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.
title_short	Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.
title_full	Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.
title_fullStr	Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.
title_full_unstemmed	Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.
title_sort	who is at risk for diagnostic discrepancies? comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in east and west berlin.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/1cc8a23d7f5144a6a655311a665d58d6
work_keys_str_mv	AT danielwittschieber whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT frederickklauschen whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT annachristinkimmritz whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT moritzvonwinterfeld whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT carstenkamphues whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT hansjoachimscholman whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT andreaserbersdobler whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT heidipfeiffer whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT carstendenkert whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT manfreddietel whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT wilkoweichert whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT janbudczies whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin AT albrechtstenzinger whoisatriskfordiagnosticdiscrepanciescomparisonofpreandpostmortaldiagnosesin1800patientsof3medicaldecadesineastandwestberlin
_version_	1718423647804194816

Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.

Ejemplares similares