The concordance score. Correlation of clinical and autopsy findings.

The traditional pathology report does not indicate concordance of the antemortem clinical diagnosis with autopsy findings. While doing a retrospective review of autopsies performed in our facility, we developed an approach that permits the determination of a "concordance score." The concordance score expresses the extent of agreement or disagreement of clinical with autopsy findings in ten predetermined categories. This approach is open to the verdict of our colleagues.

Autopsies in a modern teaching hospital. A review of 2,537 cases.

We reviewed the clinical charts and the postmortem findings of 2,537 autopsies, and correlated them by constructing a "concordance score." In 2,293 cases (90%), the primary disease, as diagnosed at autopsy, had been recognized as such clinically, but in 244 cases (10%) it had not. In 2,300 cases a second disease was present, which had been diagnosed clinically in 1,795 patients. A third disease had been recognized clinically in 71% of 1,622 patients. In 1,601 patients (64%) the autopsy disclosed one or more unexpected important findings, which ranged from the main disease (244 cases) to a variety of significant incidental findings. The high incidence of surprises indicates that it is fallacious to preselect deaths for postmortem examination even when the clinical-autopsy correlation reaches 90%, and diagnostic error is only 10%.

An argument for the attendance of clinicians at autopsy.

We recorded the attendance of clinicians at the autopsies they had requested, and following personal notification that the autopsy was in progress. Of 679 residents paged , 37% attended and 63% did not. Of 786 internists paged , 36% attended and 64% did not. Of 58 surgeons, ten were not in the hospital, 35 attended, and 13 did not. With due allowance for reasons that legitimately could interfere with attendance at a labor-intensive and educational procedure requested of a colleague by the physician, these results reflect adversely on motivation. This attitude, more than opposition by the lay public, could explain the languishing autopsy rates.

Arterial thrombosis in scleroderma.

Clinical and pathological observations are presented on five patients with scleroderma who developed thrombosis of a major vessel. Three died following intestinal infarction or limb gangrene and two had digit or extremity amputation. Severe intimal thickening of major arteries with thrombus formation was noted but no significant abnormality was found in the clotting activity of the blood. Histochemical studies in three cases suggested a reduction of fibrinolytic activity at the site of thrombosis in the diseased vessels. These studies support the view that the vascular system is profoundly altered in scleroderma and may play an important role in some manifestations of the disease.