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Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients

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Abstract

Worldwide, various autopsy studies have shown a decrease in the diagnostic error rate over the last years. The cause of this positive development is mainly due to the improvement of modern medicine. However, intensive care unit patients are thought to have a higher risk for diagnostic errors, which is documented in several studies in the adult population. In contrast, there is only limited information about diagnostic errors in pediatrics, particularly in pediatric and neonatal intensive care units. The aims of this study were to analyze the spectrum of childhood death, determine the prevalence and distribution of autopsy-confirmed diagnostic errors, and describe patient characteristics that might have influenced the discordance between antemortem and postmortem findings. We analyzed 143 autopsy reports from 2004 to 2013 and correlated these with clinical reports. The overall autopsy rate during this interval was 20.3%. The leading causes of death were congenital malformations (28%), diseases closely associated with perinatal disorders (25%), disorders of the cardiovascular system (18%), and infections (15%). Additional findings were obtained in 23% of the autopsies. Major diagnostic errors were found in 6%, the lowest reported value in a developed country as yet. Most cases (75%) showed complete concordance between clinical diagnoses and postmortem findings, in line with improvements in diagnostic and therapeutic processes over the last decades. In conclusion, autopsy of neonates, infants, and children represents an important tool for monitoring the quality of pediatric and neonatal medical care.

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Authors and Affiliations

  1. Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland

    Raphael Widmann, Rosmarie Caduff, Luca Giudici, Qing Zhong, Holger Moch & Peter K. Bode

  2. Division of Neonatology, University Hospital Zurich, Zurich, Switzerland

    Romaine Arlettaz

  3. Department of Intensive Care and Neonatology, Children’s Research Center, University Children’s Hospital, Zurich, Switzerland

    Bernhard Frey

  4. Department of Pathology, Cantonal Hospital Lucerne, Lucerne, Switzerland

    Alexander Vogetseder

  5. Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland

    Peter K. Bode

Authors
  1. Raphael Widmann
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  2. Rosmarie Caduff
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  3. Luca Giudici
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  4. Qing Zhong
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  5. Alexander Vogetseder
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  6. Romaine Arlettaz
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  7. Bernhard Frey
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  8. Holger Moch
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  9. Peter K. Bode
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Corresponding author

Correspondence to Peter K. Bode.

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Parent informed consent for autopsy was sought for all deceased children. Full compliance with ethical standards of the hospitals concerned.

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The authors declare that they have no conflict of interest.

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Widmann, R., Caduff, R., Giudici, L. et al. Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients. Virchows Arch 470, 217–223 (2017). https://doi.org/10.1007/s00428-016-2056-0

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  • DOI: https://doi.org/10.1007/s00428-016-2056-0

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