Diagnostic Errors Discovered at Autopsy

Abstract. It has been questioned whether routine autopsies are needed any longer for control and correction of causes of death, specially in clear‐cut cases. This question was therefore studied in connection with deaths in a department of internal medicine. Among 400 consecutive deaths autopsy was performed in 383 (96%). Causes of death diagnosed before autopsy were compared with those established by the same clinicians after autopsy. As main cause of death the clinical diagnosis was thereby confirmed as correct in 57% of cases, and as erroneous in 30%. In the remaining 13% it had not been possible to make a definite diagnosis ante mortem. Fewer diagnostic errors were encountered among patients below than above 70 years of age. There were also fewer errors when clinical diagnoses had been considered fairly certain than when estimated only as probable. However, even in the case of deceased patients below 70 years of age with fairly certain diagnoses, 15% were revealed to be erroneous at autopsy. The main cause of death was a circulatory disorder in 67% of cases, and a neoplastic in 17%. All other groups of diseases together accounted for the remaining 16% of deaths. Clinical diagnoses of neoplasms were more seldom found to be erroneous than diagnoses of other groups of diseases. Contributory causes of death were clinically underestimated. Of the disorders established as contributory after post‐mortem 46% had been unrecognized before death. It is concluded that autopsies are still needed for control and correction of causes of death, also in “clear‐cut” cases.