Major discrepancy between clinical and autopsy diagnosis: a descriptive single-center analysis and its implications for the South African public health system

Moshawa Calvin Khaba, Khomotso Maaga, Ntebogeng Kgokong

Background A global decline in the number of clinical post-mortems sought and conducted indicates a diminishing necessity for post-mortem exams. Notwithstanding advancements in medical technology, autopsies continue to serve as a pertinent method for ascertaining the cause of death. Objectives This study aimed to identify prevalent major misdiagnoses in clinical settings through autopsy and to investigate potential contributing factors. Methods A retrospective cross-sectional study was conducted, including 51 autopsies retrieved from the NHLS Laboratory Information System (LIS) and classified as either Class I or Class II discrepancies according to the Goldman criteria. Stata-18 was used to analyse descriptive data and examine the associations between clinicopathological factors and the major discrepancy classes. Results Of the 51 autopsies included in the study, 68.63% ( n = 35) were female in contrast to 31.37% ( n = 16) of males, with a mean death age of 39.3 years. A total of 88.24% ( n = 45) of the cases were classified as Class I discrepancies, and 11.76% ( n = 6) were Class II. There was no evidence of an association between discrepancies and age, sex and disease type. However, autopsy diagnosis showed a statistically significant association with Class I discrepancies ( p ≤ 0.05) accounted for the largest proportion of misdiagnoses, with pulmonary disease being the most frequently misdiagnosed condition at 44.44% ( n = 20). Conclusions Autopsies remain a pertinent clinical audit tool despite advances in medical technology. The hospital should provide funds for autopsies and encourage doctors to utilize them as a clinical audit instrument to enhance patient management.