Quality assessment using concordance and discordance rates in medical findings

The purpose of this study was to determine the rate of concordance and discordance between clinical diagnosis and post‐mortem findings in patients admitted to the hospitals of the Saskatoon Health Region.

A retrospective record review of the medical and autopsy charts was carried out for all the deceased adult in‐patients admitted during calendar years 2002, 2003 and 2004. A total of 3416 in‐patient deaths were registered during the study period. Autopsies were performed on 206 of the deceased resulting in an autopsy rate of 6 percent. In accordance with selection criteria, 158 cases were included for this study. The mean age of subjects was 66.6±15.3 years with a range of 16‐94 years. The study group consisted of 92 males (58.2 percent) and 66 females (41.8 percent) with an average length of stay at the hospital of 12.9±10.9 days.

The concordance rate between clinical and autopsy diagnosis was found to be 75.3 percent. The discordance rate was 20.9 percent and in 3.8 percent of the study population a conclusive clinical or autopsy diagnosis was not finalized.

These results suggest that despite of the technical advances in medical and diagnostic modalities, diagnostic discrepancies in the present day health care system remain prevalent.

The authors encourage residents and physicians to continue using autopsy as an important tool to extend understanding of disease processes.