Discrepâncias clínico-patológicas e achados cardiovasculares em 409 autópsias consecutivas

Fares, Aline Fusco; Fares, Jorge A; Fares, Gislaine Fusco; Cordeiro, José Antônio; Nakazone, Marcelo Arruda; Cury, Patrí­cia Maluf

doi:10.1590/s0066-782x2011005000111

Cited by 12 publications

(3 citation statements)

References 15 publications

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“…Our results indicate that only the diagnosis-related system is associated with the discrepancy between the clinical diagnosis and the autopsy diagnosis. This is in agreement with results published by Fares et al 17, Aalten et al 18 and Kotovicz et al 19. However, some previously published articles stated that the discrepancy is related to the shorter duration of care 15,20,21 and sex and age differences 14,15.…”

Section: Discussionsupporting

confidence: 92%

Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

Zerbini

Singer

Leyton

2019

Clinics

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OBJECTIVES:An objective of clinical autopsies is to determine the final cause of death and the pathological changes that may have triggered it. Despite advances in Medicine, the level of discrepancy between clinical and autopsy diagnoses remains significant. The aim of this study was to compare the data obtained from autopsies carried out at the São Bernardo do Campo/SP Death Verification Section with clinical diagnostic hypotheses proposed during medical care.METHOD:This was a retrospective study involving the comparison of necroscopic reports issued by the São Bernardo do Campo/São Paulo Death Verification Section in 2014 and 2015 and the Cadaver Referral Guides completed by attending physicians prior to the necroscopic examination.RESULTS:A total of 465 cases were analyzed. In general, discrepancies between the clinical diagnostic hypothesis and the autopsy diagnosis occurred in 28% of the cases. A logistic regression model, with diagnostic discrepancy as a response variable and sex, age, duration of care, type of institution providing medical care and organ system as explanatory variables, was fit to the data; the results indicated that all explanatory variables with the exception of organ system are not significant (p>0.132).CONCLUSIONS:Discrepancies between clinical diagnostic hypotheses and autopsy diagnoses continue to occur, despite new developments in complementary examinations and therapies. The odds of a discrepancy when patients present with diseases of the cardiac system are greater than those when there are problems in the vascular, endocrine and neurological systems.

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Section: Discussionsupporting

confidence: 92%

Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

Zerbini

Singer

Leyton

2019

Clinics

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“…Dimopoulos et al [ 24 ] showed that minor discrepancies were more common in older patients (> 50 years old) than in younger patients, but no statistically significant relationship between age and number of missed discrepancies. However, this fact was not observed in our PME series, corroborating previous investigations in which age of patients was not significantly different between those with or without missed diagnoses [ 7 , 33 , 44 ]. We observed a predominance of PME in male patients, but there is no relationship between gender and the incidence of missed diagnosis, results that can be corroborated with both studies previously performed in our institution.…”

Section: Discussionsupporting

confidence: 91%

Comparison of antemortem clinical diagnosis and post-mortem findings in intensive care unit patients

et al. 2021

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Autopsy is an important quality assurance indicator and a tool to advance medical knowledge. This study aims to compare the premortem clinical and postmortem pathology findings in patients who died in the Intensive Care Unit (ICU), to analyze if there are any discrepancies between them, and to compare the results to two similar studies performed in our institution in 2004 and 2007. Between January 1, 2016, and December 31, 2018, 888 patients died in the ICU and 473 underwent post-mortem examination (PME) of whom 437 were included in the present study. Autopsies revealed discrepancies between clinical diagnosis and pathologic findings according to in 101 cases (23.1%) according to Goldman classification. Forty-eight major discrepancies (class I and class II) were identified in 44 cases and the most frequent identified discrepancies were pulmonary embolism (3/12) as class I and malignancies (13/35) as class II. They were more frequent in patients hospitalized for less than 10 days then in the group with more than 10 days of hospitalization (13.8% vs 4.5%; p = 0.002). No statistical difference has been noticed concerning age, gender, and ICU stay. We observed an increase of performed autopsies and a total discrepancy rate similar to the studies performed in the same institution in 2004 (22.5%) and 2007 (21%). In conclusion, discrepancies between clinical and PME diagnoses persist despite the medical progress. Secondly, the autopsy after a short hospital stay may reveal unexpected findings whose diagnosis is challenging even if it may be suspected by the intensivist.

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“…The mortality in these patients is increased [10][11][12] and it is one of the major missed diagnoses in deceased patients treated in intensive care units (ICU), implying an even higher incidence [13][14][15]. Overall mortality is estimated between 50% to 80% [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients

et al. 2021

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Background Intestinal ischemia is a common complication with obscure pathophysiology in critically ill patients. Since insufficient delivery of oxygen is discussed, we investigated the influence of oxygen delivery, hemoglobin, arterial oxygen saturation, cardiac index and the systemic vascular resistance index on the development of intestinal ischemia. Furthermore, we evaluated the predictive power of elevated lactate levels for the diagnosis of intestinal ischemia. Methods In a retrospective case-control study data (mean oxygen delivery, minimum oxygen delivery, systemic vascular resistance index) of critical ill patients from 02/2009–07/2017 were analyzed using a proportional hazard model. General model fit and linearity were tested by likelihood ratio tests. The components of oxygen delivery (hemoglobin, arterial oxygen saturation and cardiac index) were individually tested in models. Results 59 out of 874 patients developed intestinal ischemia. A mean oxygen delivery less than 250ml/min/m2 (LRT vs. null model: p = 0.018; LRT for non-linearity: p = 0.012) as well as a minimum oxygen delivery less than 400ml/min/m2 (LRT vs null model: p = 0.016; LRT for linearity: p = 0.019) were associated with increased risk of the development of intestinal ischemia. We found no significant influence of hemoglobin, arterial oxygen saturation, cardiac index or systemic vascular resistance index. Receiver operating characteristics analysis for elevated lactate levels, pH, CO2 and central venous saturation was poor with an area under the receiver operating characteristic of 0.5324, 0.52, 0.6017 and 0.6786. Conclusion There was a significant correlation for mean and minimum oxygen delivery with the incidence of intestinal ischemia for values below 250ml/min/m2 respectively 400ml/min/m2. Neither hemoglobin, arterial oxygen saturation, cardiac index, systemic vascular resistance index nor elevated lactate levels could be identified as individual risk factors.

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Discrepâncias clínico-patológicas e achados cardiovasculares em 409 autópsias consecutivas

Abstract: Background: Discrepancies between clinical and autopsy diagnoses persists worldwide.

Cited by 12 publications

References 15 publications

Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

Comparison of antemortem clinical diagnosis and post-mortem findings in intensive care unit patients

Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients

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