Discrepâncias clínico-patológicas nos diagnósticos ante e post mortem de doenças infecciosas

Abstract

Considering the correlation between clinical and anatomopathological diagnoses to be one of the most important strategies for verifying the quality of mortality information, this study compares clinical data and anatomopathological findings of deaths from infectious diseases that occurred at the Clinical Hospital of the Federal University of Minas Gerais (HC/UFMG). For this purpose, a descriptive study was carried out on data from clinical requests and anatomopathological reports of necropsies performed at the Pathological Anatomy Service of HC/UFMG, in the period between 1950 and 2000. To assess the agreement between clinical diagnoses and anatomopathological findings , Goldman's criteria were used. In the statistical analyses, classes I and II were considered discordant and classes III, IV and V were considered concordant. From 1950 to 2000, 3,384 necropsy protocols were analyzed for the selection and inclusion of 512 cases with clinical reports or histopathological findings of the disease infectious. The age of the participants ranged from 1 to 86 years, with a mean of 21.13 years and a median of 14.50 years. Regarding gender, 204 (39.84%) and 308 (60.16%) protocols with information on female and male genders, respectively, were evaluated. 270 (59.47%) and 184 (40.53%) protocols with information from Belo Horizonte and Metropolitan Region (RMBH) and Interior of Minas Gerais, respectively. In clinical diagnoses, the main causes identified were pneumonia (n = 61; 65.59%), sepsis (n = 42; 55.26%), tuberculosis (n = 16; 17.20%) and meningitis (n = 17.20%). = 15; 35.71%). The main pathological diagnoses were pneumonia (n= 182; 65.46%), tuberculosis (n = 66; 23.47%) and meningitis (n = 42; 55.26%). In the analysis of general agreement, a total of 362 (70.71%) of discordant cases were observed against a total of 150 (29.29%) of concordant cases and a large proportion of indeterminate cases in the clinical diagnosis. Considering the exclusion of undetermined cases, the overall discrepancy was 42.97%. Taken together, the results of the study corroborate the problem of underreporting of infectious diseases as a cause of death.