High rate of discordance between clinical and autopsy diagnoses in blood and marrow transplantation

M. D. Seftel, M. Ho, D. Pruthi, S. Orbanski, M. Rubinger, B. Schacter, D. Szwajcer, C. Bredeson, A. A. Demers

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

We analyzed autopsies performed in a Canadian blood and marrow transplantation (BMT) program. We aimed to assess variables that predict the performance of an autopsy, whether rates of autopsy are changing, and the rate of discordance between clinical and autopsy diagnoses. All deceased adult patients from January 1990 to December 2004 were reviewed. Autopsy rates were compared to a large teaching hospital. Of 476 myeloablative BMT patients, 225 died and 48 (27%) underwent autopsy. Autopsy was more likely in patients dying: <100 days post-BMT, in the intensive care unit, after allografting, and on weekends. Autopsy rates among BMT patients declined during the three time periods (1990-1994, 1995-1999, 2000-2004). The autopsy rate at the teaching hospital showed a similar downward temporal trend. Major and minor disagreements at autopsy were present in 16 (34%) and 14 (30%) of cases, respectively. There was no change in discordance rates over time. Thus, despite advances in diagnostic procedures, high levels of disagreement between clinical and autopsy diagnoses for BMT patients persist as autopsy rates decline. We recommend that the autopsy regains its role as a valuable investigation. This may become especially relevant in an era where patients with medical comorbidities are undergoing reduced-intensity BMT.

Original languageEnglish (US)
Pages (from-to)1049-1053
Number of pages5
JournalBone Marrow Transplantation
Volume40
Issue number11
DOIs
StatePublished - Dec 2007
Externally publishedYes

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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