Medical error reporting must take necropsy data into account

doi:10.1136/bmj.323.7311.511

BMJ 2001;323:511 ( 1 September )

Letters

Medical error reporting must take necropsy data into account

The first 150 words of the full text of this article appear below.

EDITOR $---$ Responding to correspondence relating to medical error, organ retention, and death certification,¹ we wish to communicatethe results of our study comparing causes of death on death certificateswith those at 440 hospital necropsies, in which substantial discrepancieswere identified.²

The sensitivity of the death certificate in predicting cause of death was 0.47, with a range from 0.90 in the neurologicalsystem to 0.28 in the cardiovascular system. Sensitivity for malignantcauses of death on the certificate was 0.65, and in 35% of overdiagnosedmalignant deaths, no tumour was shown. Our data are in accordancewith similar studies showing divergence in cause of death recordedon the death certificate and at necropsy, including rates of upto 75% for previously undisclosed and clinically important findings.³

Despite improvements in diagnostic technology, necropsy is still considered to be the gold standard for determining the causeof death.⁴ Nevertheless the rate of hospital necropsy has fallen. . . [Full text of this article]

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