Document Detail

Is necropsy a valid monitor of clinical diagnosis performance?
MedLine Citation:
PMID:  1933005     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To improve the validity of comparisons between clinical and postmortem diagnoses when postmortem diagnosis is used to monitor clinical diagnosis performance. DESIGN: Analysis of elementary examples. MAIN OUTCOME MEASURES: Sensitivity and specificity of clinical and postmortem diagnoses and confirmation and agreement rates. Sensitivity and specificity permit valid comparisons of clinical and postmortem diagnoses among different procedures, sites, or times whereas agreement and confirmation rates may be misleading. Estimates of sensitivity and specificity, however, can be severely distorted by factors such as non-random selection of cases for necropsy or by unrecognised errors in postmortem diagnosis. Such distortion may be minimised by (a) estimating the likely magnitude of errors in postmortem diagnosis, (b) specifying standard conditions for performing necropsies, and (c) ensuring an unbiased sample of moderate size rather than a large biased sample. CONCLUSION: Sensitivity and specificity should be used as measures of agreement between clinical and postmortem diagnoses. IMPLICATION: Monitoring of clinical diagnosis performance by necropsy surveys requires ensuring accuracy of pathological examinations and validity of study design and analysis.
R Saracci
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  303     ISSN:  0959-8138     ISO Abbreviation:  BMJ     Publication Date:  1991 Oct 
Date Detail:
Created Date:  1991-12-17     Completed Date:  1991-12-17     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  898-900     Citation Subset:  AIM; IM    
Unit of Analytical Epidemiology, International Agency for Research on Cancer, Lyons, France.
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MeSH Terms
Diagnostic Errors
Medical Audit / methods*
Myocardial Infarction / diagnosis
Neoplasms / diagnosis
Sensitivity and Specificity
Comment In:
BMJ. 1991 Nov 16;303(6812):1270-1   [PMID:  1747661 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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