The reliability of autopsy diagnostics: inter-observer variation between pathologists, a preliminary report

Qual Assur Health Care. 1993 Dec;5(4):333-7. doi: 10.1093/intqhc/5.4.333.


The aim of the study was to analyse the agreement between pathologists regarding macroscopic autopsy diagnostics. Four pathologists examined 35 autopsies and determined the principal disease and its complications, the immediate cause of death, other major diseases and their complications, and minor diseases. The participants were paired and their diagnoses were analysed by using kappa statistics for interobserver variation. The agreement on the principal disease was almost perfect between the participants (kappa values between 0.83 and 0.97), whereas that on the immediate cause of death was moderate/substantial (kappa values between 0.43-0.75). The list of all other major diseases and their complications was almost complete for each observer, but that of the minor diseases showed a more considerable variation. In spite of the high level of agreement it is recommended that the autopsy findings be discussed among pathologists if the clinical picture cannot be explained satisfactorily, and that the cause of death be determined by the clinicians after the demonstration of the autopsy.

MeSH terms

  • Autopsy / standards*
  • Autopsy / statistics & numerical data
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / pathology
  • Cause of Death*
  • Diagnostic Errors*
  • Humans
  • Infections / mortality
  • Infections / pathology
  • Observer Variation
  • Pathology Department, Hospital / standards*
  • Quality Assurance, Health Care / statistics & numerical data*
  • Reproducibility of Results
  • Sweden / epidemiology