Contents: Introduction to clinical autopsy

5. Clinical-pathological discordance in the autopsies

The book To Err is Human. Building a Safer Health system published by the American National Institute of Health in 1999, and among other things, it stated:

· Medical errors kill between 44,000 and 98,000 in the US every year.

· Medical errors are one of the leading causes of death in the US.

· Prescription errors kill more Americans than accidents at work.

During medical practice there are at least three types of errors: Action, omission, and diagnostic judgment. A meta-analysis revealed that up to 30% of all death certificates may be wrong (compared to autopsy data) and up to 13% of autopsied patients should not have died yet (Goldman’s Error class I). Therefore, pathologists can save lives just from the autopsy table detecting errors!

Table 2: Goldman’s classification

	DESCRIPTION
CLASS I	Discrepancy in major diagnosis. Knowledge before death would have led to a different management that could have prolonged survival or cured the patient.
CLASS II	Discrepancy in major diagnosis. Knowledge before death would not have led to longer survival, even with correct treatment
CLASS III	Discrepancy in minor diagnosis not directly related to cause of death, but with symptoms that should have been treated or would have eventually affected prognosis.
CLASS IV	Discrepancy in minor diagnosis with possible epidemiological or genetic importance.
CLASS V	No discrepancies.