A Study to compare Antemortem Diagnosis with autopsy diagnosis at the University Teaching Hospital,Lusaka,Zambia

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Omara, John Barry
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This study was done between April 1, 1993 to December 31/ 1993. It was done to compare antemortem and post mortem diagnosis. Full autopsy was performed on 30 subjects out of 888 patients who died under the care of Unit I in the department of Medicine during the period of the study. The study results were influenced by 2 disease epidemics:- The HIV epidemic and an outbreak of meningococcal meningitis which followed a ve'ry severe drought described as the worst to have affected the Southern African region in 40 years. Basic laboratory workup was done in 12% of the cases. By comparing antemortem, autopsy and the combined diagnosis it was possible to evaluate the contribution autopsy would have on improving the quality of clinical diagnosis for a physician working at the University teaching hospital. At the time of this study UTH lacked histopathology and sophisticated laboratory work up and clinical postmortem was not being regularly conducted at the hospital except for police cases.Although many minor discrepancies were noted, on comparing autopsy and ^ antemortem diagnosis, a major discrepancy was considered as omission of the disease directly contributing to the cause of death.The study showed that 63.3% of diagnoses were in agreement.!Sample size was not calculated before the study because there were no regular postmortems and no records of postmortems being done in 4 years preceding the study.Major discrepancies were found as follows: 25% in the central nervous system; 67% in the respiratory system; 40% in the cardiovascular system;0% in the gemto-urinary system; 33% Gastrointestinal and liver disease 50% miscellaneous diagnosis.This study concludes that its findings of 63.3% overall agreement between antemortem and autopsy diagnosis are similar to literature results from elsewhere but the hospital should conduct regular autopsy in order to contribute to overall medical knowledge in the'field of medicine.The number of:teaching staff at the hospital is small due to the weak national economy such that between admission and being seen by a senior registrar or consultant there m.ay be a time lag of between 4 hours and 72 hours. So the number of senior doctors also needs to be improved.The study sample was small (30 subjects) the results of this study should therefore be treated cautiously.
Autopsy diagnosis -- Zambia , Antemortem diagnosis -- Zambia