• G S Heriot, A G Pitman, M Gonzales, and P McKelvie.
• Department of Anatomical Pathology, St Vincent's Hospital (Melbourne), Melbourne, Victoria, Australia. gheriot@ugrad.unimelb.edu.au
• Intern Med J. 2010 Sep 1; 40 (9): 626-32.

BackgroundFew previous papers comparing clinical diagnoses with autopsy findings present sensitivities and positive predictive values for individual conditions. The aim of this study is to determine the sensitivity and positive predictive value of current clinical diagnosis both overall and for individual conditions.MethodsRetrospective review of hospital records of a consecutive series of patients undergoing hospital autopsy at two metropolitan teaching hospitals over a 7-year period (407 patients). Comparison was made with autopsy reports to allocate one of three outcome measures (true-positive, false-positive, false-negative) to each condition.ResultsThe overall sensitivity and positive predictive value of clinical diagnosis were 0.74 and 0.93 respectively. Pneumonia, acute myocardial infarction, bowel ischaemia and pulmonary embolism were each present in greater than 10% of patients and had sensitivities below 0.70 and positive predictive values below 0.90.ConclusionThere exists a large burden of clinically undiagnosed and incorrectly diagnosed disease in hospital. Pneumonia, acute myocardial infarction, bowel ischaemia and pulmonary embolism represent important and difficult diagnostic challenges.© 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.

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