To the Editor: The findings reported
by Dr Burton and colleagues1 and the accompanying
Editorial2 is a timely reminder to clinicians of the
importance of the autopsy as a quality-control tool and the danger of
its impending demise.
We reviewed 45 consecutive autopsies completed between January 1, 1995,
and December 31, 1995, at a small, general community teaching hospital
undertaken by residents in internal medicine as part of a quality
assurance and medical education program. There were 3061 medical
admissions and 317 medical deaths (10.4%) during the study period. The
autopsy rate was 14.2%. The purpose was to categorize the errors,
identify opportunities for improvement, and evaluate the impact of do
not resuscitate status. Whenever a discrepancy between the clinical
diagnosis and autopsy findings was found, the error was classified
according to the criteria by Landefeld et al3 as to its
contribution to the death of the patient. An error is defined as class
I when a major unexpected finding, if diagnosed antemortem, would have
led to change in therapy and potentially improved survival. A class II
error is defined as a major unexpected finding for which antemortem
diagnosis would not have changed management. Whenever a discrepancy
between the clinical diagnosis and autopsy findings was found, the
cause of error was determined using a format modified from Middleton et
al.4