Comparison of Ante-Mortem Clinical Diagnosis and Final Autopsy Diagnosis: Experience from a Single Academic Centre in Pretoria, South Africa

Abstract

Background/Objectives: There seems to be a global reduction in the number of clinical post-mortems requested and performed worldwide, suggesting a decreasing need for post-mortem examinations. Despite advances in medical technology, autopsies remain a relevant tool to determine cause of death. Methods: A total of 276 post-mortem results were extracted from the NHLS lab track database, of which only 152 were included in this study. Discrepancies between ante and post-mortem diagnoses were evaluated using the Goldman classification. Data were analysed using STATA-18. Results: The sample consisted largely of females (n = 101, 66.45%) aged 30 and above (n = 58, 33.80%), with a mean age of 28.3. Of the 152 samples analysed, 60% (n = 92) of all postmortems showed a correlation between ante- and post-mortem diagnoses. However, 29.1% (n = 45) of cases showed major discrepancies which could have been prevented if correct diagnoses were made. Metabolic diseases were most frequently misdiagnosed (p = 0.020), with more cases of Class I discrepancies than Class V discrepancies (15.5% (n = 7) vs. 2.1% (n = 2), respectively. Additionally, infections (n = 59; 39%) were the most common cause of death. Conclusions: Even with marked improvements in diagnostic technology, a post-mortem examination is a necessary quality control tool that can be used to verify cause of death, and thus improve clinical practice.

Keywords

• autopsy
• ante-mortem diagnosis
• discrepancies
• clinical audit