Discrepâncias clínico-patológicas em pacientes graves com difícil diagnóstico pre-mortem

Fares, Aline Fusco; Cury, Patrí­cia Maluf; Lobo, Suzana Margareth

doi:10.1590/s0103-507x2011000400008

Cited by 10 publications

(4 citation statements)

References 17 publications

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“…11 13 This decline in postmortem examinations is potentially detrimental: in the current era of high-tech medicine, postmortem examinations still reveal diagnostic errors and change the COD in a significant number of patients. [14][15][16][17] Postmortem imaging with or without postmortem tissue sampling (PMS) could decrease the persistent trend of declining autopsy rates, possibly by an increased awareness for postmortem examinations. 18 Postmortem imaging has gained popularity over the past decade, and may provide a solution for accurate determination of COD despite declining postmortem examination rates.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of postmortem CT and tissue sampling in establishing the cause of death in clinical practice: a prospective observational study

et al. 2022

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AimsThe aim of this study is to evaluate whether agreement with autopsy-determined cause of death (COD) increases by use of postmortem CT (PMCT) or PMCT in combination with postmortem sampling (PMS), when compared with clinical assessment only.MethodsThis prospective observational study included deceased patients from the intensive care unit and internal medicine wards between October 2013 and August 2017. The primary outcome was percentage agreement on COD between the reference standard (autopsy) and the alternative postmortem examinations (clinical assessment vs PMCT or PMCT+PMS). In addition, the COD of patient groups with and without conventional autopsy were compared with respect to involved organ systems and pathologies.ResultsOf 730 eligible cases, 144 could be included for analysis: 63 underwent PCMT without autopsy and 81 underwent both PMCT and autopsy. Agreement with autopsy-determined COD was significantly higher for both PMCT with PMS (42/57, 74%), and PMCT alone (53/81, 65%) than for clinical assessment (40/81, 51%; p=0.007 and p=0.03, respectively). The difference in agreement between PMCT with PMS and PMCT alone was not significant (p=0.13). The group with autopsy had a significantly higher prevalence of circulatory system involvement and perfusion disorders, and a lower prevalence of pulmonary system involvement.ConclusionPMCT and PMS confer additional diagnostic value in establishing the COD. Shortcomings in detecting vascular occlusions and perfusion disorders and susceptibility to pulmonary postmortem changes could in future be improved by additional techniques. Both PMCT and PMS are feasible in clinical practice and an alternative when autopsy cannot be performed.

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Section: Introductionmentioning

confidence: 99%

Efficacy of postmortem CT and tissue sampling in establishing the cause of death in clinical practice: a prospective observational study

et al. 2022

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“…But even in the era of advanced diagnostic methods, the percentage of major discrepancies between clinical and (traditional) autopsy diagnosis is as high as 50%. [8][9][10][11][12][13][14] Despite the need for a correct cause of death and the known discrepancies between the clinical cause of death and the cause of death according to the autopsy, the number of clinical autopsies is declining worldwide. [15][16][17][18][19][20][21] The reason for this decline is a combination of factors, such as the overconfidence in the diagnostic procedures, financial and religious reasons, fear of mutilation, workload issues and a fear of litigation.…”

Section: Introductionmentioning

confidence: 99%

Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study

et al. 2020

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AimThe aim of this implementation study was to assess the effect of postmortem CT (PMCT) and postmortem sampling (PMS) on (traditional) autopsy and postmortem examination rates. Additionally, the feasibility of PMCT and PMS in daily practice was assessed.MethodsFor a period of 23 months, PMCT and PMS were used as additional modalities to the autopsy at the Department of Internal Medicine. The next of kin provided consent for 123 postmortem examinations. Autopsy rates were derived from the Dutch Pathology Registry, and postmortem examination rates were calculated for the period before, during and after the study period, and the exclusion rate, table time, time interval to informing the referring clinicians with results and the time interval to the Multidisciplinary Mortality Review Board (MMRB) meeting were objectified to assess the feasibility.ResultsThe postmortem examination rate increased (from 18.8% to 32.5%, p<0.001) without a decline in the autopsy rate. The autopsy rate did not change substantially after implementation (0.2% decrease). The exclusion rate was 2%, the table time was 23 min, and a median time interval of 4.1 hours between PMCT and discussing its results with the referring clinicians was observed. Additionally, more than 80% of the MMRB meetings were held within 8 weeks after the death of the patient.ConclusionsOur study shows that the implementation of a multidisciplinary postmortem examination is feasible in daily practice and does not adversely affect the autopsy rate, while increasing the postmortem examination rate.

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“…Nos casos de óbitos para os quais não se consegue definir a causa mortis ou para aqueles ocorridos sem assistência, o médico patologista do Serviço de Verificação de Óbito (SVO) deve emitir a DO após a autópsia ser autorizada pelo responsável do falecido. [8][9][10] De acordo com as normas do Ministério da Saúde, é atribuição do SVO [...] promover ações que proporcionem, via autópsia, o esclarecimento da causa mortis de todos os óbitos, com ou sem assistência médica, sem elucidação diagnóstica, e em especial aqueles sob investigação epidemiológica. 11 Os procedimentos diagnósticos realizados pelo SVO são tomados como padrão-ouro.…”

Section: Introductionunclassified

“…17 Apesar da contribuição histórica dos SVO, a literatura científica tem priorizado a análise da qualidade das autópsias ou o perfil dos óbitos atestados pelos serviços. [8][9][10]12 Considerando-se a inexistência de avaliações da estrutura e do processo de trabalho desenvolvido nos SVO do país, além da carência de análises sobre a contribuição potencial desses serviços para a melhoria das estatísticas vitais e da vigilância epidemiológica, o presente estudo teve como objetivo avaliar a implantação dos Serviços de Verificação de Óbito -SVO -de Pernambuco.…”

Section: Introductionunclassified

Avaliação da implantação dos Serviços de Verificação de Óbito em Pernambuco, 2012: estudo de casos múltiplos*

Azevedo¹,

Vanderlei²,

Mello³

et al. 2016

Epidemiologia e Serviços de Saúde

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Discrepâncias clínico-patológicas em pacientes graves com difícil diagnóstico pre-mortem

Cited by 10 publications

References 17 publications

Efficacy of postmortem CT and tissue sampling in establishing the cause of death in clinical practice: a prospective observational study

Efficacy of postmortem CT and tissue sampling in establishing the cause of death in clinical practice: a prospective observational study

Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study

Avaliação da implantação dos Serviços de Verificação de Óbito em Pernambuco, 2012: estudo de casos múltiplos*

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