Apesar da considerável queda no índice de necrópsias - dado pelo número de necrópsias sobre o número total de mortes - por diferentes motivos tecnológicos, médicos e sociais, esse ainda é o principal exame para conferência de discrepâncias diagnósticas ante-mortem e post-mortem e elaboração de relatórios sobre morbidade e mortalidade e riscos aos pacientes. Nosso estudo compara e descreve diagnósticos ante-mortem e de necrópsia dos pacientes que faleceram no HC-FMRP/USP nos anos de 2010 e 2014. Foram analisadas 1216 necropsias realizadas no HC-FMRP nos anos de 2010 e 2014, sendo pareados os diagnósticos clínico e de necrópsia e classificados segundo o modelo de Goldman (1983) modificado. O índice médio de necrópsias foi de 49%. O percentual médio de discrepâncias diagnósticas maiores foi de 23,4%, com média de 15% de discrepâncias Grau 1 e de 8,3% Grau 2. A faixa etária com maior predomínio de discrepâncias foi de 80 a 100 anos. O diagnóstico de maior prevalência foi a pneumonia, presente em 40% de todos os casos avaliados, dentre os quais 25% apresentaram discrepâncias maiores. Nossos resultados são comparáveis aos registrados na maioria dos estudos mais recentes, em que a porcentagem de discrepâncias maiores em outros hospitais brasileiros se mantém em torno dos 32- 35%, e abaixo dos resultados de estudos internacionais, nos quais a discrepâncias maiores são em torno de 20%. / Although there is a drop on necropsies rates performed in each hospital, which is the number of necropsies by total of deaths, for a number of medical, technological and social reasons, necropsy remains as the main exam to evaluate the discrepancy of premortem and postmortem diagnoses and to estimate, morbidity and mortality and patient risks. Our study compares and describes the diagnoses of patients who died at the HC-FMRP/USP during the years of 2010 e 2014. We analyzed 1216 necropsies performed at he the HC-FMRP in 2010 and 2014, comparing agreement and disagreement between clinical diagnoses and necropsy reports, by the Goldman (1983) modified classification. The mean necropsy rate was 49%. Major discrepancies were 23.4%, with average of 15% for class 1 and 8.3% for Class 2 discrepancies. We found the most common discrepancies occurred at the ages of 80 to 100 years old. The most prevalent diagnostic was \'pneumonia\', found in 40% of all cases studied, among which 25% showed major discrepancies. Our results are compatible with the main recent studies in the field in Brazilian hospitals, in which the major discrepancies are between 32-35% and under the rates of the studies conducted abroad, in which major discrepancies were around 20%.

Apesar da considerável queda no índice de necrópsias - dado pelo número de necrópsias sobre o número total de mortes - por diferentes motivos tecnológicos, médicos e sociais, esse ainda é o principal exame para conferência de discrepâncias diagnósticas ante-mortem e post-mortem e elaboração de relatórios sobre morbidade e mortalidade e riscos aos pacientes. Nosso estudo compara e descreve diagnósticos ante-mortem e de necrópsia dos pacientes que faleceram no HC-FMRP/USP nos anos de 2010 e 2014. Foram analisadas 1216 necropsias realizadas no HC-FMRP nos anos de 2010 e 2014, sendo pareados os diagnósticos clínico e de necrópsia e classificados segundo o modelo de Goldman (1983) modificado. O índice médio de necrópsias foi de 49%. O percentual médio de discrepâncias diagnósticas maiores foi de 23,4%, com média de 15% de discrepâncias Grau 1 e de 8,3% Grau 2. A faixa etária com maior predomínio de discrepâncias foi de 80 a 100 anos. O diagnóstico de maior prevalência foi a pneumonia, presente em 40% de todos os casos avaliados, dentre os quais 25% apresentaram discrepâncias maiores. Nossos resultados são comparáveis aos registrados na maioria dos estudos mais recentes, em que a porcentagem de discrepâncias maiores em outros hospitais brasileiros se mantém em torno dos 32- 35%, e abaixo dos resultados de estudos internacionais, nos quais a discrepâncias maiores são em torno de 20%. / Although there is a drop on necropsies rates performed in each hospital, which is the number of necropsies by total of deaths, for a number of medical, technological and social reasons, necropsy remains as the main exam to evaluate the discrepancy of premortem and postmortem diagnoses and to estimate, morbidity and mortality and patient risks. Our study compares and describes the diagnoses of patients who died at the HC-FMRP/USP during the years of 2010 e 2014. We analyzed 1216 necropsies performed at he the HC-FMRP in 2010 and 2014, comparing agreement and disagreement between clinical diagnoses and necropsy reports, by the Goldman (1983) modified classification. The mean necropsy rate was 49%. Major discrepancies were 23.4%, with average of 15% for class 1 and 8.3% for Class 2 discrepancies. We found the most common discrepancies occurred at the ages of 80 to 100 years old. The most prevalent diagnostic was \'pneumonia\', found in 40% of all cases studied, among which 25% showed major discrepancies. Our results are compatible with the main recent studies in the field in Brazilian hospitals, in which the major discrepancies are between 32-35% and under the rates of the studies conducted abroad, in which major discrepancies were around 20%.

L’iatrogénie induite par les erreurs médicamenteuses est un problème majeur de santé publique. Ce travail a pour objectif de développer une approche systémique visant à réduire leur occurrence en cancérologie. L’étude est menée aux Hospices Civils de Lyon au sein du Groupement Hospitalier Sud. L’analyse des erreurs médicamenteuses interceptées, sur une période de 5 ans, révèle que 4 prescriptions de chimiothérapie sur 100 présentent au moins une erreur médicamenteuse, dont plus de la moitié sont des erreurs de dose. Les facteurs de risque d’erreurs de prescription identifiés sont la prescription par un interne, l’hospitalisation conventionnelle, le patient ayant une surface corporelle supérieure à 2 m², les protocoles de plus de trois médicaments anticancéreux, comprenant du carboplatine ou nécessitant une modification par le prescripteur. L’évaluation de la gravité clinique potentielle des erreurs médicamenteuses montre que 13,4% d’entre elles auraient causé un préjudice temporaire et 2,6% un préjudice permanent. Le pronostic vital aurait été engagé dans 2,6% des cas conduisant au décès pour 6 patients sur une période d’un an. L’évaluation médico-économique permet d’estimer le coût pour l’assurance maladie d’une erreur médicamenteuse en cancérologie avec conséquences cliniques à 1 523€ associé à 3,5 journées d’hospitalisation supplémentaires. Cette approche systémique conduit au développement de revues d’erreurs médicamenteuses et de morbi-mortalité, socle de l’analyse collective indispensable à la prévention du risque médicamenteux en cancérologie / Medication errors are a major public health problem. This work aims to develop a systemic approach to reduce their occurrence in oncology. The study was conducted in Groupement Hospitalier Sud (Hospices Civils de Lyon). The analysis of intercepted medication errors, over a period of five years, reveals that four out of 100 prescriptions of chemotherapy include at least one medication error, which over half are dose errors. Risk factors of prescribing errors identified are prescription by a resident physician, inpatient care, patient with a body surface area greater than 2 m², protocol with more that three anticancer drugs, protocol involving carboplatin or protocol requiring at least one modification by the physician. 13.4% of avoided errors would have resulted in temporary injury and 2.6% in permanent damage. The vital prognosis of the patient would have been compromised in 2.6% of cases leading to death for six patients over a period of one year. The cost of one medication error with clinical consequences was estimated at € 1 523 associated to 3.5 additional days of hospitalisation. This approach led to the development of systematic medication errors reviews and morbi-mortality conferences that allow a collective and multidisciplinary analysis to enhance the patient’s safety