ABSTRACT

Objectives: To determine the cause of death diagnoses and the discrepancy rate between clinical and autopsy diagnoses in the Emergency Department (ED) of the University Hospital of the West Indies (UHWI).

Methods: Clinical and post-mortem records were reviewed for all the patients dying in the ED of the UHWI within 24 hours of their admission, during the period January 2007 to December 2010. The patients’ demographic data, clinical cause of death and cause of death established at autopsy were documented for each case. The clinical diagnoses were classified as being either concordant (similar) or discrepant (dissimilar) with respect to the pathologic diagnosis, using a modified Underwood classification. The frequencies of diagnostic discrepancy were analysed with respect to disease category, gender and age.

Results: For the study period, 68 of the 180 patients who died in the ED within 24 hours of their admission received autopsies (autopsy rate, 37.8%), and they ranged in age from 11–92 years (mean 54.9); M: F ratio, 1.4:1. The commonest autopsy cause of death category was circulatory disorders; cardiovascular diseases were more common than cerebrovascular diseases. The discrepancy rate between the clinical and autopsy cause of death diagnoses was 36.8%. The frequency of discrepancies increased with age; the majority (57.9%) occurred in patients > 50 years of age.

Conclusions: The autopsy rate, distribution of cause of death diagnoses and discrepancy rate documented in our ED are comparable to similar studies. The high frequency of discrepant diagnoses among older age groups, combined with the diagnostic challenges in the ED related to time and patient co-morbidities, warrant a concerted effort to increase the autopsy rate.