Two decades of autopsy-detected diagnostic errors in Japan

Kohta Katayama; Tomoharu Suzuki; Maho Adachi-Katayama; Kenji Numata; Yuki Honda; Hiroyuki Nagano; Yuki Hiramatsu; Takashi Watari; Yasuharu Tokuda; Payal K. Patel; Yoshiyuki Ohira

doi:10.1515/dx-2025-0013

Article

Two decades of autopsy-detected diagnostic errors in Japan

Kohta Katayama , Tomoharu Suzuki , Maho Adachi-Katayama , Kenji Numata , Yuki Honda , Hiroyuki Nagano , Yuki Hiramatsu , Takashi Watari , Yasuharu Tokuda , Payal K. Patel and Yoshiyuki Ohira

Published/Copyright: April 11, 2025

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From the journal Diagnosis Volume 12 Issue 3

Abstract

Objectives

Autopsy plays an essential role in detecting diagnostic errors and the findings from autopsies have the potential to reduce future errors. However, there are few reports from Japan on diagnostic errors based on autopsy diagnoses. This study aimed to detail diagnostic errors in autopsy reports in Japan.

Methods

This descriptive study utilized the case report abstract database of the Japanese Society of Internal Medicine chapter meetings. Autopsy cases from 2002 to 2022 were included. We defined diagnostic errors as discrepancies in the primary cause of death between autopsy and clinical diagnosis. Diagnostic error cases were also categorized according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). To observe trends, a chi-square test was conducted by dividing the 20 years of data into four groups.

Results

Among 1,213 autopsied cases, diagnostic errors occurred in 435 cases (35.9 %; 95 % confidence interval, 33.2–38.6 %). The most frequent category of autopsy-detected diagnostic error cases was neoplasms (147, 33.8 %), followed by infections (131, 30.1 %), and cardiovascular diseases (49, 11.3 %). Over the 20 years, the incidence of diagnostic errors neither increased nor decreased.

Conclusions

Diagnostic errors detected in 35.8 % of autopsy cases in Japan. Autopsy is an important quality indicator for identifying diagnostic error.

Keywords: autopsy diagnosis; diagnostic error; Japan

Corresponding author: Kohta Katayama, MD, PhD, Department of General Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan; and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan, E-mail: pine77717@gmail.com

Research ethics: This study protocol was approved by the Ethics Committee of the St. Marianna University School of Medicine (5700).
Informed consent: Our data were derived from the database of case report abstracts from the chapter meetings of the Japanese Society of Internal Medicine (JSIM), which only members of JSIM can access the database. That is why we do not take patient consent statements.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: We used ChatGPT to improve language.
Conflict of interest: The authors state no conflicts of interest.
Research funding: This study did not receive specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability: All data and materials used in this work are available. Our data were derived from the database of case report abstracts from the chapter meetings of the JSIM, available at https://www.naika.or.jp/meeting/endaikensaku/. Only members of JSIM can access the database.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2025-0013).

Received: 2025-01-26

Accepted: 2025-03-18

Published Online: 2025-04-11

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Keywords for this article

autopsy diagnosis; diagnostic error; Japan