Comparison of clinical and post-mortem findings in intensive care unit patients
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The autopsy has long been regarded as an important tool for clinical confrontation, education and quality assurance. The aims of this study were to examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU) and to identify the types of errors in diagnosis to improve quality of care. Autopsies from 289 patients who died in the ICU during a 2-year period were studied. Post-mortem examination revealed unexpected findings in 61 patients (21%) including malignancy, pulmonary embolism, aspergillosis, myocardial or mesenteric infarction and unsuspected bacterial, viral or fungal infection. These unexpected findings were classified as Goldman class I errors in 17 (6%), class II in 38 (13%) and class III in six (2%) cases. Although the incidence of unexpected findings with clinical significance was low, post-mortem examination remains a valuable source of pertinent information that may improve the management of ICU patients.
KeywordsAutopsy Intensive care Diagnostic discrepancy Post-mortem examination
The authors declare that the experiments comply with the current laws of Belgium.
This work has been carried out with the support of grants awarded by the “Fondation Yvonne Boël” (Brussels, Belgium).
- 20.Haber SL (1996) Whither the autopsy? Arch Pathol Lab Med 120:714–717Google Scholar
- 21.Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R, Rubin Rh, Wingard JR, Stak P, Durand C, Caillot D, Thiel E, Chandrasekar PH, Hodges MR, Schlamm HT, Troke PF, De Pauw B, Invasive Fungal Infections Group of the European Organisation for Research and Treatment of Cancer and the Global Aspergillus Study Group (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415PubMedCrossRefGoogle Scholar
- 47.Slavin G, Kirkham N, Underwood JCE, Molt JM, Hopkins A, Jackson BT, Windsor CWO (1991) The autopsy and audit. Report of the Joint Working Party of the Royal College of Pathologists, the Royal College of Physicians of London and the Royal College of Surgeons of England. Royal College of Pathologists, LondonGoogle Scholar
- 51.The Royal College of Pathologists of Australasia Autopsy Working Party (2004) The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia. Med J Aust 180:281–285Google Scholar
- 54.Yalamarthi S, Ridley S, Barker T (1998) Agreement between ante-mortem diagnoses, death certificates and post-mortem causes of death in critically ill patients. Clin Intensive Care 9:100–104Google Scholar