Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic discrepancies between antemortem clinical diagnosis and autopsy findings in pediatric cancer patients

  • Original Article
  • Published:
Virchows Archiv Aims and scope Submit manuscript

Abstract

Prevalence of discrepancies between antemortem clinical diagnoses and postmortem autopsy findings is uncertain in pediatric oncology given improving diagnostic capabilities over time. Primary objective was to describe discrepancies between antemortem and postmortem diagnosis of pediatric cancer deaths. Secondary objective was to compare clinical characteristics of deaths with and without major diagnostic discrepancies. This was a retrospective study that included pediatric cancer patients diagnosed and treated in Ontario and who died from 2003 to 2012. Antemortem clinical diagnoses associated with mortality were determined by reviewing the patient’s health records 2 weeks prior to death while the postmortem diagnoses were determined by the autopsy report. Discrepancies among these diagnoses were classified using the Goldman criteria where major discrepancies were directly related to the cause of death in contrast to minor discrepancies. Among the 821 patients who died, 118 (14%) had an autopsy and were included. Of these autopsies, 12 (10%) had a major diagnostic discrepancy between antemortem and postmortem diagnoses. Major discrepancies consisted of opportunistic infections (n = 5), missed cancer diagnosis (n = 3), and organ complications (n = 4). Death in a high acuity setting (12/12, 100% vs. 60/106, 57%; P = 0.003) and treatment-related mortality (12/12, 100% vs. 60/106, 57%; P = 0.003) were significantly associated with major discrepancy. Major diagnostic discrepancy was found in 10% of pediatric oncology autopsies. Missed infections and organ complications were predominant etiologies. Death in a high acuity setting and treatment-related mortality were associated with major diagnostic discrepancies. Autopsies continue to be important for improving diagnostic insight and may improve future clinical care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

POGO:

Pediatric Oncology Group of Ontario

POGONIS:

Pediatric Oncology Group of Ontario Networked Information System

References

  1. Canada PHAo (2017) Cancer in young people in Canada: a report from the enhanced childhood cancer surveillance system. Health Canada

  2. Pritchard-Jones K, Pieters R, Reaman GH et al (2013) Sustaining innovation and improvement in the treatment of childhood cancer: lessons from high-income countries. Lancet Oncol 14(3):e95–e103

    Article  Google Scholar 

  3. SIOPE TESfPO (2015) The SIOPE strategic plan; a European cancer plan for children and adolescents (1st ed.). SIOPE

  4. Koszyca B, Moore L, Toogood I et al (1993) Is postmortem examination useful in pediatric oncology? Pediatr Pathol 13(6):709–715

    Article  CAS  Google Scholar 

  5. Kumar P, Taxy J, Angst DB et al (1998) Autopsies in children: are they still useful? Arch Pediatr Adolesc Med 152(6):558–563

    Article  CAS  Google Scholar 

  6. Shojania KG, Burton EC, McDonald KM et al (2003) Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA. 289(21):2849–2856

    Article  Google Scholar 

  7. Nigro JF, Gresik MV, Fernbach DJ (1990) Value of the postmortem examination in a pediatric population with leukemia. J Pediatr 116(3):350–354

    Article  CAS  Google Scholar 

  8. Buckner T, Blatt J, Smith SV (2006) The autopsy in pediatrics and pediatric oncology: a single-institution experience. Pediatr Dev Pathol 9(5):374–380

    Article  Google Scholar 

  9. Blanco E, Beyene J, Maloney AM et al (2012) Non-relapse mortality in pediatric acute lymphoblastic leukemia: a systematic review and meta-analysis. Leuk Lymphoma 53(5):878–885

    Article  Google Scholar 

  10. Alexander S, Pole JD, Gibson P et al (2015) Classification of treatment-related mortality in children with cancer: a systematic assessment. Lancet Oncol 16(16):e604–e610

    Article  Google Scholar 

  11. Pole JD, Gibson P, Ethier MC et al (2017) Evaluation of treatment-related mortality among paediatric cancer deaths: a population based analysis. Br J Cancer 116(4):540–545

    Article  Google Scholar 

  12. Battle RM, Pathak D, Humble CG et al (1987) Factors influencing discrepancies between premortem and postmortem diagnoses. JAMA. 258(3):339–344

    Article  CAS  Google Scholar 

  13. Pastores SM, Dulu A, Voigt L et al (2007) Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients. Crit Care 11(2):R48

    Article  Google Scholar 

  14. Slavin MA, Heath CH, Thursky KA et al (2008) Antifungal prophylaxis in adult stem cell transplantation and haematological malignancy. Intern Med J 38(6b):468–476

    Article  CAS  Google Scholar 

  15. Alexander S, Nieder M, Zerr DM et al (2012) Prevention of bacterial infection in pediatric oncology: what do we know, what can we learn? Pediatr Blood Cancer 59(1):16–20

    Article  Google Scholar 

  16. Science M, Robinson PD, MacDonald T et al (2014) Guideline for primary antifungal prophylaxis for pediatric patients with cancer or hematopoietic stem cell transplant recipients. Pediatr Blood Cancer 61(3):393–400

    Article  Google Scholar 

  17. Stambouly JJ, Kahn E, Boxer RA (1993) Correlation between clinical diagnoses and autopsy findings in critically ill children. Pediatrics. 92(2):248–251

    CAS  PubMed  Google Scholar 

  18. Carlotti AP, Bachette LG, Carmona F et al (2016) Discrepancies between clinical diagnoses and autopsy findings in critically ill children: a prospective study. Am J Clin Pathol 146(6):701–708

    Article  Google Scholar 

  19. Tejerina EE, Padilla R, Abril E et al (2018) Autopsy-detected diagnostic errors over time in the intensive care unit. Hum Pathol 76:85–90

    Article  Google Scholar 

  20. Kelly MS, Spees L, Vinesett R et al (2018) Utility of autopsy among pediatric allogeneic hematopoietic stem cell transplant recipients: one last chance to learn? Biol Blood Marrow Transplant 24(9):1861–1865

    Article  Google Scholar 

  21. Goldstein B, Metlay L, Cox C et al (1996) Association of pre mortem diagnosis and autopsy findings in pediatric intensive care unit versus emergency department versus ward patients. Crit Care Med 24(4):683–686

    Article  CAS  Google Scholar 

Download references

Funding

This study was funded by an operating grant from the Pediatric Oncology Group of Ontario. LS is the Canada Research Chair in Pediatric Oncology Supportive Care.

Author information

Authors and Affiliations

  1. Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Nikhil Raghuram, Ute Bartels, Sarah Alexander & Lillian Sung

  2. Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Khalid Alodan

  3. Centre for Health Services Research, The University of Queensland, Brisbane, Australia

    Jason D. Pole

  4. Division of Haematology/Oncology, McMaster Children’s Hospital, 1280 Main St West, Hamilton, Ontario, L8N 3Z5, Canada

    Paul Gibson

  5. Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada

    Donna L. Johnston

  6. Department of Pediatrics, McMaster Children’s Hospital, 1280 Main St West, Hamilton, Ontario, L8N 3Z5, Canada

    Carol Portwine

  7. Department of Pediatrics, Kingston General Hospital, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada

    Mariana Silva

  8. Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada

    Lillian Sung

Authors
  1. Nikhil Raghuram
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Khalid Alodan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ute Bartels
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason D. Pole
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul Gibson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Donna L. Johnston
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carol Portwine
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mariana Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lillian Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NR and KA collected and analyzed the data and wrote the manuscript. CP, MS, PG, and DJ contributed data. JP critically evaluated the manuscript. SA, UB, and LS analyzed the data. LS wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lillian Sung.

Ethics declarations

Ethics approval and consent to participate

This study received research ethics board approval from the Hospital for Sick Children Research Ethics Board (#1000041703). Given the retrospective nature of the study, the requirement for informed consent was waived by the SickKids Research Ethics Board.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Code availability

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 21 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Raghuram, N., Alodan, K., Bartels, U. et al. Diagnostic discrepancies between antemortem clinical diagnosis and autopsy findings in pediatric cancer patients. Virchows Arch 478, 1179–1185 (2021). https://doi.org/10.1007/s00428-020-03002-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00428-020-03002-4

Keywords

Search

Navigation