Mortui Vivos Docent (The Dead Teach the Living)

In the Literature

Schertenleib TI, Pospischil A, Hässig M, Kircher PR, Hilbe M. Comparison of clinical and pathological diagnoses in cats and dogs. J Comp Pathol. 2017;156(2-3):217-234.

The Research …

This retrospective study compared clinical antemortem and pathologic postmortem diagnoses in 1000 cats and 1000 dogs. Comparison of antemortem and postmortem diagnoses is critical for quality control; however, such studies are sparse in veterinary medicine, and postmortem numbers are declining.^1-3

Postmortem examination can help confirm initial clinical suspicion and further elucidate or correct presumptions about initial clinical diagnoses; it also allows opportunity for new discoveries.¹ In a broader context, information from necropsy can shape future medical practices through identification of systematic errors in diagnostic processes and can increase the accuracy of disease prevalence monitoring.¹ However, there are limitations. The most information comes through comparison of clinical and pathologic diagnoses combined with analysis of the cause of discordance between these diagnoses.^1,4,5

The study authors cited several reasons for declining post-mortem numbers. One is a presumption that postmortem evaluation will not provide additional information. However, discrepancies between antemortem and postmortem diagnoses persist (ie, new and clinically relevant information is discovered on postmortem) despite introduction of many new antemortem diagnostic techniques.⁶ Postmortem remains the diagnostic gold standard.⁷

Some clinicians fear that postmortem evaluation might reveal medical mistakes and fuel litigation; however, high postmortem rates and increased litigation rates are not necessarily correlated.⁸ Clinicians may also worry that pet owners or families will be distressed by discussion about postmortem examination. Cost constraints were also cited.

In this study, total agreement between antemortem and postmortem diagnoses was found in 38.3% of cats and 36.2% of dogs. It has previously been reported that postmortem examination is often ordered when there is clinical uncertainty, thus favoring a trend toward disagreement between antemortem and postmortem diagnoses.⁹ In another study, only 75% of cases had a correct initial main diagnosis—even when confidence in a clinical diagnosis was high.¹⁰

It is difficult to know whether knowledge of discrepancy between antemortem and postmortem diagnoses would have been used to alter patient management. However, the authors suggested that postmortem evaluation provides valuable information in nearly 50% of cases.

… To Your Patients

Key pearls to put into practice:

• Postmortem examination remains an important and informative tool that should be promoted in as many cases as possible.

• New diagnostic techniques and equipment are tremendous assets but do not obviate postmortem examination.

• Information from postmortem evaluation must be compared with antemortem findings to optimize case information.

• Before postmortem examination, communication and collaboration among clinicians and pathologists is essential.