摘要目的 分析尸体解剖病理诊断(简称尸检诊断)与临床诊断在不同类型医院和入院后病程时间(24 h内外)上的差异.方法 回顾性分析188例尸体解剖资料,比较尸检诊断与临床诊断的差异及疾病分布.结果 188例尸检的误诊率为48.9%(92/188),一级医院的误诊率(25/33,75.8%)显著高于三级医院(38/96,39.6%;x2=12.861,P=0.000)和二级医院(29/59,49.2%;x2=6.179,P=0.016).入院24 h后误诊率明显低于入院24 h内(x2=20.991,P=0.000).漏诊率为34.6%(65/188),一级医院明显高于三级医院(x2=8.241,P=0.006).入院24 h内各级别医院的漏诊率差异无统计学意义,入院24 h后三级医院的漏诊率显著低于一级医院(x2=5.181,P=0.047).误诊和漏诊的疾病分布以心脏病变、感染性疾病、动脉病变和肺栓塞等为主.结论 各级医院的临床诊断和尸检诊断差异较大.一级医院的误诊率和漏诊率显著高于三级医院,并与入院后病程时间密切相关.应提倡积极开展尸检工作和临床病理讨论,以提高临床诊断水平.

abstractsObjective To analyze the discrepancies between clinical and autopsy diagnoses in hospitals of different grades and with respect to duration of hospitalization. Methods 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. Results The overall rate of misdiagnosis was 48.9% (92/188). The misdiagnosis rate in gradeⅠhospitals (75.8%,25/33) was significantly higher than that in grade Ⅲ (39.6%,38/96;x2=12.861,P=0.000) and grade Ⅱ hospitals (49.2%,29/59;x2=6.179,P=0.016).The misdiagnosis rate of patients beyond 24 hours of admission was lower than that admitted within 24 hours (x2=20.991,P=0.000). The overall rate of missed diagnosis was 34.6% (65/188). The rate of missed diagnosis in gradeⅠhospitals was remarkably higher than that of the grade Ⅲ hospitals (x2=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 comparalng with that of grade Ⅰ hospitals in patients admitted beyond 24 hours (x2=5.181,P=0.047). The distribution of disease entities commonly encountered in patients of beth misdiagnosis and missed diagnosis were heart problems, infections, arterial diseases and pulmonary embolism. Conclusions The rate of discrepancies between clinical and autopsy diagnoses is relatively high. The misdiagnosis and missed diagnosis rate in gradeⅠhospitals 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.