Correlation between clinical and autopsy diagnoses in a community hospital

Forty-six consecutive autopsies performed in 1 year on patients who died in a 120-bed urban community hospital were analysed with respect to clinical-pathological correlation. The mean age of the patients was 71 years. Errors in clinical diagnosis were assigned to one of four classes: class I, a missed major diagnosis, the detection of which before death would probably have changed management and resulted in longer survival or possible cure; class II, a major missed diagnosis that, if detected before death, would probably not have altered management; and classes III and IV, minor missed diagnoses. Six (13%) class I and 10 (22%) class II errors were found, as well as a number of class III and IV errors. Suggestions are made regarding the use of such data in audit procedures.