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Unsuspected Autopsy Findings in Obese Patients

I have previously blogged about some of the diagnostic challenges in obese patients.

A paper published a few years ago by Simon Gabriel and colleagues from the Drexel University College of Medicine, Philadelphia, PA, published in the American Journal of Clinical Pathology, further documents the impact of increased BMI levels on missed diagnoses.

Gabriel and colleagues re-examined autopsy reports of 311 patients who underwent full postmortem examinations from January 1, 1999, to December 31, 2002.

They classified unsuspected diagnoses found in these cases as follows:

class I, major clinically unsuspected diagnoses that were responsible for death;

class II, major clinically unsuspected diagnoses that were not directly responsible for death but if left undiagnosed may have resulted in patient death;

class V, no clinically unsuspected diagnoses.

The study included i16 underweight cases, 170 normal weight cases, and 125 obese cases. Class I
missed major diagnoses were identified in 0.0%, 15.9%, and 24.0% of the underweight, normal weight, and obese cases, respectively.

Obese patients were 1.65 times more likely to have a class I diagnosis than the normal weight and underweight groups combined. In fact, only BMI and umbilicus pannus size were independent predictors of class I diagnoses.

Perhaps, not unsurprisingly, pulmonary thromboembolism was the most frequent significant missed clinical diagnosis.

Patients with obese-level BMIs seem to be at increased risk for clinically significant unsuspected diagnoses compared with underweight and normal weight populations.

The authors conclude that greater clinical vigilance and efforts to develop novel technologies to facilitate clinical investigations in the obese population are warranted.

Edmonton, Alberta

Hat Tip to Nick Finer for pointing out this interesting study.

Gabriel S, Gracely EJ, & Fyfe BS (2006). Impact of BMI on clinically significant unsuspected findings as determined at postmortem examination. American journal of clinical pathology, 125 (1), 127-31 PMID: 16483001


  1. Is this a matter of not being able to make the diagnosis due to lack of technology alone or could it also be an indicator of a lack of opportunity to encounter diagnosis where negative history with medical professionals makes an obese patient unwilling to seek regular medical care?

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  2. Physicians often refuse medical intervention for obese patients even when they do have a diagnosis of another problem. Physicians often don’t investigate symptoms, other than blaming them on the obesity, for example, not looking into sudden weight gain and loss in a matter of a few days which would usually be investigated as possible edema.

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  3. One is more dead than the other due to obesity!

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