Résumé
<p><b>OBJECTIVE</b>To analyze the discrepancies between clinical and autopsy diagnoses in hospitals of different grades and with respect to duration of hospitalization.</p><p><b>METHODS</b>A total of 188 autopsy cases collected from hospitals of different grades were retrospectively reviewed and the discrepancies between clinical and autopsy diagnoses were analyzed.</p><p><b>RESULTS</b>The overall rate of misdiagnosis was 48.9% (92/188). The misdiagnosis rate in grade I hospitals (75.8%, 25/33) was significantly higher than that in grade III (39.6%, 38/96; chi(2) = 12.861, P = 0.000) and grade II hospitals (49.2%, 29/59; chi(2) = 6.179, P = 0.016 ). The misdiagnosis rate of patients beyond 24 hours of admission was lower than that admitted within 24 hours (chi(2) = 20.991, P = 0.000). The overall rate of missed diagnosis was 34.6% (65/188). The rate of missed diagnosis in grade I hospitals was remarkably higher than that of the grade III hospitals (chi(2) = 8.241, P = 0.006). There was no difference between grades I and III hospitals on the rate of missed diagnosis within 24 hours of admission, however, this rate was lower in grade III hospitals in comparing with that of grade I hospitals in patients admitted beyond 24 hours (chi(2) = 5.181, P = 0.047). The distribution of disease entities commonly encountered in patients of both misdiagnosis and missed diagnosis were heart problems, infections, arterial diseases and pulmonary embolism.</p><p><b>CONCLUSIONS</b>The rate of discrepancies between clinical and autopsy diagnoses is relatively high. The misdiagnosis and missed diagnosis rate in grade I hospitals was significantly higher than that in grade III hospitals and was closely related with the duration of hospitalization. Autopsy study thus still remains an important measure in clinical audit.</p>
Sujets)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Anévrysme de l'aorte , Diagnostic , Anatomopathologie , Autopsie , Cause de décès , Erreurs de diagnostic , Hôpitaux communautaires , Hôpitaux généraux , Hôpitaux d'enseignement , Infections , Diagnostic , Anatomopathologie , Durée du séjour , Infarctus du myocarde , Diagnostic , Anatomopathologie , Myocardite , Diagnostic , Anatomopathologie , Embolie pulmonaire , Diagnostic , Anatomopathologie , Études rétrospectivesRésumé
Objective To design a bone marrow histological scoring system for myelodysplastic syndrome(MDS) in order to provide an objective evaluation of clinical diagnosis,disease development and outcome prediction. Methods HE and Gomori staining were used to observe the morphological alterations in 149 bone marrow biopsies.Immunohistochemical staining for MPO,CD235,F8,CD42b,CD61 and CD34 was performed.The scores of distinct morphological changes of MDS were valued. Results The bone marrow histological scoring system for MDS was established and validated.The scoring system comprised 8 distinct histological features of MDS in bone marrow biopsy.When the score was ≥5,there was significant difference between normal bone marrow biopsy and bone marrow biopsy with MDS(P