Introduction
The clinical diagnosis is made in life by the treating physician; the pathological diagnosis is made after death (autopsy) or on biopsy and surgical material. Comparing the two is the basis of quality control in medicine. This note covers the terms main disease and immediate cause of death, how a diagnosis is constructed, and how clinical and pathological diagnoses are compared.
Main disease and immediate cause of death
Primary (main) disease
A disease that directly or through its complications can have a great impact on the patient's life or lead to his death.
- In some cases a syndrome can also be the main disease if it has led to the patient's death.
- The main disease is the one that started the chain of events leading to death (the underlying cause); it is chosen, not simply the most severe finding at the time of death.
Immediate cause of death
The specific nosological unit that led to cardiac or respiratory failure.
- It is the last link of the chain, for example pulmonary embolism, myocardial infarction, aspiration, pulmonary oedema or massive haemorrhage.
Other components of the diagnosis
- Complications of the main disease: conditions that arise from it and worsen the course (for example perforation, haemorrhage, sepsis).
- Concomitant diseases: other diseases present that are not causally related to the main disease; they may aggravate it or affect the outcome.
- Background disease: a disease that precedes and favours the development of the main disease.