The value of the autopsy in medical audit--a combined clinical and pathological assessment of 100 cases.

We retrospectively reviewed 100 consecutive autopsies performed at the Royal Adelaide Hospital in 1979. The review was made jointly by a clinician, surgical pathologist and forensic pathologist. The mean patient age was 64.5 years. Sixteen percent of premortem anatomical diagnoses were not confirmed at autopsy. Autopsy revealed 171 new anatomical diagnoses. Of these, 33 diagnoses in 27 patients were important in relation to the cause of death and if known premortem would have altered therapy and possibly outcome in two patients. In 11 cases the missed major diagnoses should have been entertained on the basis of available clinical data. Of the 19 sudden deaths, the cause of death was not included in the clinical differential diagnosis in seven cases. Autopsy resulted in a substantial change in the death certification of 43 cases. The data indicate that the autopsy has a great deal to offer in correcting clinical diagnoses and effecting scientific discipline for clinicians.