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Intensive Care Medicine

, Volume 27, Issue 11, pp 1750–1755 | Cite as

Should we confirm our clinical diagnostic certainty by autopsies?

  • M. Podbregar
  • G. Voga
  • B. Krivec
  • R. Skale
  • R. Parežnik
  • L. Gabršček
Original

Abstract.

Objective: To evaluate the frequency of diagnostic errors assessed by autopsies. Design and setting: Retrospective review of medical and pathological records in an 11-bed closed medical intensive care unit (ICU) at a 860-bed general hospital. Patients and interventions: Patients who died in the ICU between January 1998 and December 1999. Medical diagnoses were rated into three levels of clinical diagnostic certainty: complete certainty (group L1), minor diagnostic uncertainty (group L2), and major diagnostic uncertainty (group L3). The patients were divided into three error groups: group A, the autopsy confirmed the clinical diagnosis; group B, the autopsy demonstrated a new relevant diagnosis which would probably not have influenced the therapy and outcome; group C, the autopsy demonstrated a new relevant diagnosis which would probably have changed the therapy and outcome. Results: The overall mortality was 20.3% (270/1331 patients). Autopsies were performed in 126 patients (46.9% of deaths), more often in younger patients (66.6±13.9 years vs 72.7±12.0 years, p<0.001), in patients with shorter ICU stay (4.7±5.6 days vs 6.7±8.7 days, p=0.054), and in patients in group L3 without chronic diseases (15/126 vs 1/144, p<0.001). Fatal but potentially treatable errors [group C, 12 patients (9.5%)] were found in 8.7%, 10.0%, and 10.5% of patients in groups L1, L2, and L3, respectively (NS between groups). An ICU length of stay shorter than 24 h was not related to the frequency of group C errors. Conclusions: Autopsies are performed more often in younger patients without chronic disease and in patients with a low clinical diagnostic certainty. No level of clinical diagnostic certainty could predict the pathological findings.

Autopsy Postmortem Diagnostic errors Premortem errors Critical care 

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Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • M. Podbregar
    • 1
  • G. Voga
    • 1
  • B. Krivec
    • 1
  • R. Skale
    • 1
  • R. Parežnik
    • 1
  • L. Gabršček
    • 1
  1. 1.Department of Intensive Internal Medicine, General Hospital Celje, Oblakova 5, 3000 CeljeSlovenia

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