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The Role of Autopsy in Critically Ill Patients

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Annual Update in Intensive Care and Emergency Medicine 2014

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2014))

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Abstract

A number of potentially treatable severe conditions different from those determining the hospital admission and/or acquired in the intensive care unit (ICU) can go unnoticed throughout the whole hospital stay and are discovered only at autopsy. Some investigators demonstrated with post-mortem studies that among patients admitted both to regular wards and to the ICU that the rate of major pathological conditions gone undetected during their stay ranged from 12.6 % to 41 % and that their clinical relevance can vary from nil to having been the main cause of death (Table 1) [1–5]. At the same time, the rate of non-legal autopsies of patients who die in the hospital has constantly declined throughout the last decades for a number of reasons, including the need for cost containment, the fear of litigation and the assumption that the unrelenting advances of imaging techniques enable physicians to observe details of almost all conditions many with an accuracy unthinkable only a few years ago; nevertheless, the rate of pathologic conditions missed during the admission and discovered only at the post-mortem examination seems to be affected only marginally by this progress [3].

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References

  1. Perkins GD, McAuley DF, Davies S, Gao F (2003) Discrepancies between clinical and post-mortem diagnosis in critically ill patients: an observational study. Crit Care 7:R129–R132

    Article  PubMed  Google Scholar 

  2. Tai DYH, El-Bilbeisi H, Tewari S, Masha EJ, Wiedemann HP, Arroliga AC (2001) A study of consecutive autopsies in a medical ICU. A comparison of clinical cause of death and autopsy diagnosis. Chest 119:530–536

    Article  CAS  PubMed  Google Scholar 

  3. Combes A, Mokhtari M, Couvelard A et al (2004) Clinical and autopsy diagnosis in the intensive care unit-a prospective study. Arch Intern Med 164:389–392

    Article  PubMed  Google Scholar 

  4. Shojania KG, Burton EC, McDonald KM, Goldman L (2003) Changes in the rate of autopsy detected diagnostic errors over time- a systematic review. JAMA 298:2849–2856

    Article  Google Scholar 

  5. Shojania KG, Burton EC (2008) The vanishing nonforensic autopsy. N Engl J Med 358:873–875

    Article  CAS  PubMed  Google Scholar 

  6. Tejerina E, Esteban A, Fernandez-Segovian P et al (2012) Clinical diagnoses and autopsy findings: discrepancies in critically ill patients. Crit Care Med 40:842–846

    Article  PubMed  Google Scholar 

  7. Berlot G, Dezzoni R, Viviani M, Silvestri L, Bussani R, Gullo A (1999) Does the length of stay in the intensive care unit influence the diagnostic accuracy? A clinical-pathological study. Eur J Emerg Med 6:227–231

    CAS  PubMed  Google Scholar 

  8. Herridge MS (2003) Autopsy in critical illness: it is obsolete. Crit Care 7:407–408

    Article  PubMed  Google Scholar 

  9. Goldman L, Sayson R, Robbins S, Cohn LH, Bettman M, Weisberg M (1983) The vakue of the autopsy in three medical eras. N Engl J Med 308:1000–1005

    Article  CAS  PubMed  Google Scholar 

  10. Cook DJ, Crowther MA, Meade MO, Douketis J (2005) Prevalence, incidence and risk factors for venous thromboembolism in medical-surgical intensive care unit patients. J Crit Care 20:309–313

    Article  PubMed  Google Scholar 

  11. Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism-ACCP EBM-based practice guidelines (8th edition). Chest 133:381S–453S

    Article  CAS  PubMed  Google Scholar 

  12. Cook D, Crowther M, Meade M et al (2005) Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence and risk factors. Crit Care 33:1565–1571

    Article  Google Scholar 

  13. Patel R, Cook DJ, Meade MO et al (2005) Burden of illness in venous thromboembolism in critical care: multicenter observational study. J Crit Care 20:341–347

    Article  PubMed  Google Scholar 

  14. Shorr AF, Jackson WL (2005) Deep vein thrombosis in the intensive care unit: underappreciated, understudied, and undertreated. J Crit Care 20:301–303

    Article  PubMed  Google Scholar 

  15. Pastores SM, Dulu A, Voigt L, Raoof N, Alicea M, Halpern NA (2007) Premortem clinical diagnoses and post-mortem autopsy findings: discrepancies in critically ill cancer patients. Crit Care 11:R48

    Article  PubMed  Google Scholar 

  16. Berlot G, Calderan C, Vergolini A et al (2011) Pulmonary embolism in critically ill patients receiving antithrombotic prophylaxis. A clinical-pathological study. J Crit Care 26:28–33

    Article  PubMed  Google Scholar 

  17. Kakkar N, Vasishta RK (2008) Pulmonary embolism in medical patients: an autopsy-based study. Clin Appl Thrombosis/hemostasis 14:159–167

    Article  Google Scholar 

  18. Hirsh J, Warkentin TE, Shaugnessy SG et al (2001) Heparin and low-molecular weight heparin-mechanism of action, pharmacokinetics, dosing, monitoring efficacy and safety. Chest 119:64S–94S

    Article  CAS  PubMed  Google Scholar 

  19. Priglinger U, Delle Karth G, Geppert A et al (2003) Prophylactic anticoagulation with enoxaparin: is the subcutaneous route appropriate in the critically ill ? Crit Care Med 31:1405–1409

    Article  CAS  PubMed  Google Scholar 

  20. Dörffler-Melly J, de Jonge E, de Pont AC et al (2002) Bioavailability of subcutaneous low-molecular-weigh heparin to patients on vasopressors. Lancet 359:849–850

    Article  PubMed  Google Scholar 

  21. Lim W, Qushmaq I, Cook DJ et al (2005) Elevated troponin and myocardial infarction in the intensive care unit: a prospective study. Crit Care 8:R636–R644

    Article  Google Scholar 

  22. Chockalingam A, Mehra A, Dorairajan S, Dellsperger KC (2010) Acute left ventricular dysfunction in the critically ill. Chest 138:198–207

    Article  PubMed  Google Scholar 

  23. Noble JS, Reid AM, Jordan LVM et al (1999) Troponin I and myocardial injury in the ICU. Br J Anaesth 82:41–46

    Article  CAS  PubMed  Google Scholar 

  24. Charlson ME, MacKenzie CR, Gold JP et al (1989) The preoperative and intraoperative hemodynamic predictors of postoperative myocardial infarction or ischemia in patients undergoing noncardiac surgery. Ann Surg 210:637–648

    Article  CAS  PubMed  Google Scholar 

  25. Spies C, Haude V, Fitzner R et al (1998) Serum cardiac troponin T as a prognostic marker of myocardial injury in early sepsis. Chest 113:1055–1063

    Article  CAS  PubMed  Google Scholar 

  26. Arlati S, Brenna S, Prencipe L et al (2000) Myocardial necrosis in ICU patients with acute non cardiac disease : a prospective study. Intensive Care Med 26:31–37

    Article  CAS  PubMed  Google Scholar 

  27. Berlot G, Vergolini A, Calderan C, Bussani R, Torelli L, Lucangelo U (2010) Acute myocardial infarction in critically ill patients: a clinical-pathological study. Monaldi Archives Chest Dis 74:164–171

    Google Scholar 

  28. Ver Elst KM, Spapen HD, Nguyen DN et al (2000) Cardiac troponins I and T are biological markers of left ventricular dysfunction in septic shock. Clin Chem 46:650–657

    CAS  PubMed  Google Scholar 

  29. Merx MW, Weber C (2007) Sepsis and heart. Circulation 116:793–802

    Article  CAS  PubMed  Google Scholar 

  30. Nadrous HF, Afesa B, Pfeifer EA, Peters SG (2003) The role of autopsy in critically ill patients. Majo Clin Proc 78:947–950

    Google Scholar 

  31. Hoen B, Duval X (2013) Infective Endocarditis. N Engl J Med 368:1425–1433

    Article  CAS  PubMed  Google Scholar 

  32. Thury F, Grisoli D, Collart F, Habib G, Raoult D (2012) Management of infective endocarditis: challenges and perspectives. Lancet 379:965–975

    Article  Google Scholar 

  33. Moreillon P, Que YO (2004) Infective endocarditis. Lancet 363:139–149

    Article  PubMed  Google Scholar 

  34. Truskinowsky AM, Hutchins GM (2001) Association between nonbacterial thrombotic endocarditis and hypoxigenic pulmonary diseases. Virchows Arch 438:357–361

    Article  Google Scholar 

  35. Lee V, Gilbert JD, Byard RW (2012) Marantic endocarditis – not a so benign entity. J Forensic Leg Med 19:312–315

    Article  PubMed  Google Scholar 

  36. Angus DC, van der Poll T (2013) Critical care medicine: severe sepsis and septic shock. N Engl J Med 369:840–851

    Article  CAS  PubMed  Google Scholar 

  37. Saad R, Yamada AT, da Pereira RFH, Gutierrez PS, Mansur AJ (2007) Comparison between clinical and autopsy diagnoses in a cardiology hospital. Heart 93:1414–1419

    Article  PubMed  Google Scholar 

  38. Silvfast T, Takkunen O, Kohlo E, Andersson LC, Rosemberg P (2003) Characteristics of discrepancies between clinical and autopsy diagnose in the intensive care unit: a 5-year review. Intensive Care Med 29:321–324

    Google Scholar 

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Authors and Affiliations

  1. Dept. of Anesthesia and Intensive Care, University of Trieste, Trieste, Italy

    G. Berlot & D. Cappelli

  2. Dept. of Pathology, University of Trieste, Trieste, Italy

    R. Bussani

Authors
  1. G. Berlot
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  2. R. Bussani
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  3. D. Cappelli
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Correspondence to G. Berlot .

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Editors and Affiliations

  1. Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent Prof.

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© 2014 Springer International Publishing Switzerland

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Berlot, G., Bussani, R., Cappelli, D. (2014). The Role of Autopsy in Critically Ill Patients. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_53

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  • DOI: https://doi.org/10.1007/978-3-319-03746-2_53

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03745-5

  • Online ISBN: 978-3-319-03746-2

  • eBook Packages: MedicineMedicine (R0)

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