Do we still need the autopsy? Clinical diagnosis versus autopsy diagnosis Beatrice Ioan 1 , Teodora Alexa 2 , Ioana-Dana Alexa 3 _________________________________________________________________________________________ Abstract: The autopsy is one of the main tools for the evolution of medicine. Nevertheless, the autopsy rate declined worldwide in the last decades due to several reasons: progress in diagnosis of diseases, fear of legal consequences if a wrong diagnosis is proved, refusal of the deceased's family, reluctance of forensic pathologists and pathologists because of infectious risk and time consumption. However, despite the huge progress of medical science, discrepancies between the death diagnosis established by the clinician and the diagnosis established by the pathologist after performing the autopsy still exist and have remained relatively constant over the last 50 years. Our study aimed to identify the concordance rate between the cause of death established in the hospital and the cause of death established after performing the forensic autopsy and to determine the factors that could inluence the concordance rate. The study group included 100 patients who died in hospital and underwent autopsy. We found a concordance rate of 45% which could be inluenced by certain factors, such as: duration of hospitalization, inter- clinic consultation, mechanism of death, postmortem microscopic examination and the biochemical analysis performed during hospitalization. Our results support the fact that autopsy remains an essential tool for assessing the quality of care, for improving medical education process and for highlighting those diseases that represent "diagnostic challenges". Key Words: autopsy, cause of death, diagnosis, concordance. 1) Associate Professor, Senior Forensic Pathologist, Dept. of Forensic Pathology, Medical Deontology and Bioethics, “Gr.T.Popa” University of Medicine and Pharmacy of Iasi, Romania *Corresponding author: E-mail: ioanbml@yahoo.com 2) Oncology Resident Physician, Regional Institute of Oncology, “Gr.T.Popa” University of Medicine and Pharmacy of Iasi, Romania 3) Associate Professor, Dept. of Internal Medicine and Geriatrics, “Gr.T.Popa” University of Medicine and Pharmacy of Iasi, Romania Rom J Leg Med [20] 307-312 [2012] DOI: 10.4323/rjlm.2012.307 © 2012 Romanian Society of Legal Medicine 307 T he evolution of medical science was heavily inluenced by examination of corpses, a key method for the description, characterization and understanding of the functioning of the human body and of the effects of the diseases on the target organs; from 1950 until now, such studies have contributed to the understanding of more than 80 pathologies [1], and for a long time they have been considered to be a prerequisite for medical education and professional development [2]. However, in recent years, the rate of autopsy decreased dramatically worldwide, from approximately 60% in 1960 to 10% or less in 2005, both in the U.S. and Europe [2], with a minimum of 3.7% in France in 1997 [3]. This decrease is due to several factors, including: progress in diagnosis of diseases, particularly the development of advanced medical imaging methods such as computer tomography and nuclear magnetic resonance [4]; the attitude of the deceased’s family, which often opposes to autopsy [5]. Some authors [6-9] suggest the reluctance of the forensic experts and pathologists to perform the autopsy, possibly due to infectious risk and time consumption. More, several articles published in the last 5 years question the value of the autopsy [2, 10, 11], contributing in its turn to the declining of the autopsy rate. Despite the progress in the diagnosis of various pathological or traumatic conditions, studies still ind discrepancies between the cause of death recorded in