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Shojania KG, Burton EC, McDonald KM, et al. The Autopsy as an Outcome and Performance Measure. Rockville (MD): Agency for Healthcare Research and Quality (US); 2002 Oct. (Evidence Reports/Technology Assessments, No. 58.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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The Autopsy as an Outcome and Performance Measure.

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Appendix C: Index of Study Topics

One of the fields in the reference database was used to index articles according to the study topics addressed and the specific type of information provided.


  1. Diagnostic Errors(“Dx errors”)-studies of clinical-autopsy diagnostic discrepancies
    Because of the complexity of this topic, articles tended to be indexed with one or more of the following sub-headings.
    Spec Dz's - studies reporting diagnostic discrepancies for specific diseases or diagnoses.
    Bobrowitz ID. Active tuberculosis undiagnosed until autopsy. Am J Med. 1982;72:650–8.
    Zarling EJ, et al. Failure to diagnose acute myocardial infarction: the clinicopathologic experience at a large community hospital. JAMA. 1983;250:1177–81.
    Goldhaber SZ, et al. Factors associated with correct antemortem diagnosis of major pulmonary embolism. Am J Med. 1982;73:822–6.
    Population - studies providing data relevant to clinical diagnostic performance in a general population, not just at among deaths or autopsies (e.g., by providing discharge diagnoses for the same time period, or de facto, by achieving an autopsy rate close to 100%.)
    DeRiemer K, et al. The epidemiology of tuberculosis diagnosed after death in San Francisco, 1986-1995. Int J Tuberc Lung Dis. 1999;3(6):488–93.)
    McCarthy BD, et al. Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med. 1993;22:579–82.
    Flum DR, et al. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001;286:1748–53.
    Selection - studies assessing clinical selection bias of cases for autopsy (e.g., by prospectively asking clinicians about their expectation of new information at autopsy
    Cameron HM, McGoogan E. A prospective study of 1152 hospital autopsies: I. Inaccuracies in death certification. J Pathol 1981; 133: 273–83).
    Predictors - studies reporting factors other than clinical selection (above) and time of study (below) that predict the occurrence of diagnostic errors. Examples include demographics (age, gender, race, socioeconomic status, religion), hospital length of stay (LOS), clinical service (service), clinical diagnosis (Dx), and presence of a DNR order.
    Landefeld CS, et al. Diagnostic yield of the autopsy in a university hospital and a community hospital. N Engl J Med 1988; 318: 1249–54.
    McFarlane MJ. Clinical diagnosis is not a source of bias in selection for necropsy. Arch Pathol Lab Med. 1989;113:64–7.
    Setting indicates that diagnostic error rates were compared in different settings (e.g., teaching vs. non-teaching hospital, nursing home vs. hospital)
    Landefeld CS, et al. Diagnostic yield of the autopsy in a university hospital and a community hospital. N Engl J Med. 1988;318:1249–54.
    Time indicates that diagnostic error rates were assessed compared in different time periods
    Goldman L, et al. The value of the autopsy in three medical eras. N Engl J Med. 1983;308:1000–5.
    Kirch W, Schafii C. Misdiagnosis at a university hospital in 4 medical eras. Medicine (Baltimore). 1996;75:29–40.
    Sonderegger-Iseli K, et al. Diagnostic errors in three medical eras: a necropsy study. Lancet. 2000;355:2027–31.
    Error analysis - studies including some sort of analysis of why misdiagnoses were made (anecdotal discussion of selected cases did not count as sufficient)
    Middleton K, et al. An autopsy-based study of diagnostic errors in geriatric and nongeriatric adult patients. Arch Intern Med. 1989;149(8):1809–12.
    Dx tests - studies examining the impact of antemortem diagnostic testing on autopsy-detected errors
    Goldman L, et al. The value of the autopsy in three medical eras. N Engl J Med. 1983;308(17):1000–5.
    Kirch W, Schafii C: Misdiagnosis at a university hospital in 4 medical eras. Medicine (Baltimore) 1996; 75: 29–40.
    Complications - studies of the role of the autopsy in detecting complications of care, including many of the general autopsy series that happen to mention complications as a specific type of missed diagnosis, but also other studies focused specifically on this issue.
    Ebbesen J, et al. Drug-related deaths in a department of internal medicine. Arch Intern Med. 2001;161:2317–23.
    Gotti EW. Adverse drug reactions and the autopsy. Prevalence and perspective. Arch Pathol. 1974;97:201–4.
    Medicolegal - studies including any information on the impact of autopsy-detected errors on legal actions
    Juvin P, et al. Postoperative death and malpractice suits: is autopsy useful? Anesth Analg. 2000;91:344–6.
    Nichols L, et al Are autopsies obsolete? Am J Clin Pathol. 1998;110:210–8.
    Performance - studies containing information on the “test characteristics” of the autopsy itself (e.g., quality of the autopsy, number of cases in which a diagnosis could not be established despite adequate autopsy)
    Veress B, et al. The reliability of autopsy diagnostics: inter-observer variation between pathologists, a preliminary report. Qual Assur Health Care. 1993;5:333–7.
    Schned AR, et al A comprehensive quality assessment program on the autopsy service. Am J Clin Pathol. 1986;86:133–8.
    Fowler EF, et al. Evaluation of a teaching hospital necropsy service. J Clin Pathol. 1977;30:575–8.
  2. Attitudes - articles describing attitudes towards the autopsy on the parts of patients, their family members, or the general public clinicians (including students, post-graduate trainees and practicing physicians), and pathologists.
    McPhee SJ, et al. To redeem them from death. Reactions of family members to autopsy. Am J Med. 1986;80(4):665–71.
    Wilke A, French F. Attitudes toward autopsy refusal by young adults. Psychological Reports. 1990;67(1):81–2.
    Sanner M. A comparison of public attitudes toward autopsy, organ donation, and anatomic dissection. A Swedish survey. JAMA. 1994;271(4):284–8.
    Rosenbaum GE, et al. Autopsy consent practice at US teaching hospitals: results of a national survey. Arch Intern Med. 2000;160(3):374–80.
    Stolman CJ, et al. Attitudes of pediatricians and pediatric residents toward obtaining permission for autopsy. Arch Pediatr Adolesc Med. 1994;148(8):843–7.
    Trelstad RL, et al. The role for regional autopsy centers in the evaluation of covered deaths. Survey of opinions of U.S. and Canadian chairs of pathology and major health insurers in the United States. Arch Pathol Lab Med. 1996;120(8):753–8.
  3. Autopsy rates - observational studies of trends in autopsy rates over time or intervention studies attempting to increase the autopsy rate
    Cameron HM, McGoogan E, Clarke J, Wilson BA. Trends in hospital necropsy rates: Scotland 1961-74. BMJ. 1977;1:1577–80.
    Sinard JH. Factors affecting autopsy rates, autopsy request rates, and autopsy findings at a large academic medical center. Exp Mol Pathol. 2001;70:333–43.
  4. Epidemiology - studies describing the role of the autopsy in tracking the epidemiology of target conditions
    Welch HG, Black WC. Using autopsy series to estimate the disease “reservoir” for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med; 1997. p. 1023–8.
    Rakar S, Sinagra G, Di LA, Poletti A, Bussani R, Silvestri F, et al. Epidemiology of dilated cardiomyopathy. A prospective post-mortem study of 5252 necropsies. The Heart Muscle Disease Study Group. Eur Heart J. 1997;18:117–23.
    McFarlane MJ, Feinstein AR, Wells CK, Chan CK. The ‘epidemiologic necropsy’. Unexpected detections, demographic selections, and changing rates of lung cancer. JAMA. 1987;258:331–8.
  5. Death Certificates - studies addressing the correlation between diagnoses on death certificates and autopsies and/or formal chart review
    Kircher T, Nelson J, Burdo H. The autopsy as a measure of accuracy of the death certificate. N Engl J Med. 1985;313:1263–9.
    Jordan JM, Bass MJ. Errors in death certificate completion in a teaching hospital. Clin Invest Med. 1993;16:249–55.


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