High diagnostic discrepancy in infectious diseases detected by autopsy
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Keywords
Autopsy, Diagnostic Errors, Communicable Diseases, Immunocompromised Host
Abstract
Background: Autopsies are considered the gold standard for determining the cause of death. Infections are among the leading causes of death, and many are only identified through autopsy. Such studies are lacking in Mexico.
Objective: To compare the frequency of diagnostic discrepancies, particularly those related to infections identified premortem, in patients from the Hospital de Especialidades del Centro Médico Nacional de Occidente, during the period from 2014 to 2021.
Materials and methods: A retrospective study was conducted. Autopsy reports from 2014 to 2021 were reviewed to identify cases with infectious diagnoses determined postmortem. Premortem diagnoses were obtained from clinical records. Two clinical reviewers classified the diagnostic discrepancies. Inter-rater agreement was assessed using Cohen’s Kappa coefficient and comparison were performed using the Chi-square test.
Results: Of 164 autopsies, 70 cases (43%) revealed at least one infection as either the primary or a contributing cause of death. Diagnostic discrepancies were identified in 52% of patients with infections and in 70% of patients living with HIV. The most frequent infectious disease was pneumonia, while cytomegalovirus (CMV) and Candida were the most commonly underdiagnosed infections.
Conclusions: Diagnostic discrepancies are present in more than half of the patients with infectious diseases. The HIV-positive population has the highest rate of diagnostic discrepancies.
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