Clinical diagnoses and autopsy findings

Tejerina, Eva; Esteban, Andrés; Fernández-Segoviano, Pilar; Rodríguez-Barbero, J.M.; Gordo, Federico; Frutos‐Vivar, Fernando; Aramburu, J. A.; Algaba, Ángela; García, Óscar Gonzalo Salcedo; Lorente, José A.

doi:10.1097/ccm.0b013e318236f64f

Cited by 77 publications

(22 citation statements)

References 27 publications

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“…Finally, autopsy was rarely performed in the present cohort because of logistic limitations in our hospital. A number of studies have emphasized that autopsy findings substantially contributed to the diagnosis of critically ill patients [ 39 , 40 ]. Specifically, an autopsic study in patients who died from sepsis has revealed continuous septic foci that may have contributed to multiple organ failure and death [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Timing and causes of death in septic shock

Daviaud

Grimaldi

Dechartres

et al. 2015

Ann. Intensive Care

175

125

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BackgroundMost studies about septic shock report a crude mortality rate that neither distinguishes between early and late deaths nor addresses the direct causes of death. We herein aimed to determine the modalities of death in septic shock.MethodsThis was a 6-year (2008–2013) monocenter retrospective study. All consecutive patients diagnosed for septic shock within the first 48 h of intensive care unit (ICU) admission were included. Early and late deaths were defined as occurring within or after 3 days following ICU admission, respectively. The main cause of death in the ICU was determined from medical files. A multinomial logistic regression analysis using the status alive as the reference category was performed to identify the prognostic factors associated with early and late deaths.ResultsFive hundred forty-three patients were included, with a mean age of 66 ± 15 years and a high proportion (67 %) of comorbidities. The in-ICU and in-hospital mortality rates were 37.2 and 45 %, respectively. Deaths occurred early for 78 (32 %) and later on for 166 (68 %) patients in the ICU (n = 124) or in the hospital (n = 42). Early deaths were mainly attributable to intractable multiple organ failure related to the primary infection (82 %) and to mesenteric ischemia (6.4 %). In-ICU late deaths were directly related to end-of-life decisions in 29 % of patients and otherwise mostly related to ICU-acquired complications, including nosocomial infections (20.4 %) and mesenteric ischemia (16.6 %). Independent determinants of early death were age, malignancy, diabetes mellitus, no pathogen identification, and initial severity. Among 3-day survivors, independent risk factors for late death were age, cirrhosis, no pathogen identification, and previous corticosteroid treatment.ConclusionsOur study provides a comprehensive assessment of septic shock-related deaths. Identification of risk factors of early and late deaths may determine differential prognostic patterns.

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Section: Discussionmentioning

confidence: 99%

Timing and causes of death in septic shock

Daviaud

Grimaldi

Dechartres

et al. 2015

Ann. Intensive Care

175

125

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“…Discrepancies values of 7.5 to 23 %, classified as major, were found in patients admitted to the intensive care unit, with 11-13% for minor discrepancies 5,6 . For patients admitted to general hospitals, there were 6-37 % of major discrepancies and 25-28 % of minor ones 7-9 .…”

Section: Discussionmentioning

confidence: 99%

NHETS - Necropsy Heart Transplantation Study

Valette¹,

Ayub‐Ferreira²,

Benvenuti³

et al. 2014

Arquivos Brasileiros De Cardiologia

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BackgroundDiscrepancies between pre and post-mortem diagnoses are reported in the literature, ranging from 4.1 to 49.8 % in cases referred for necropsy, with important impact on patient treatment.ObjectiveTo analyze patients who died after cardiac transplantation and to compare the pre- and post-mortem diagnoses.MethodsPerform a review of medical records and analyze clinical data, comorbidities, immunosuppression regimen, laboratory tests, clinical cause of death and cause of death at the necropsy. Then, the clinical and necroscopic causes of death of each patient were compared.Results48 deaths undergoing necropsy were analyzed during 2000-2010; 29 (60.4 %) had concordant clinical and necroscopic diagnoses, 16 (33.3%) had discordant diagnoses and three (6.3%) had unclear diagnoses. Among the discordant ones, 15 (31.3%) had possible impact on survival and one (2.1%) had no impact on survival. The main clinical misdiagnosis was infection, with five cases (26.7 % of discordant), followed by hyperacute rejection, with four cases (20 % of the discordant ones), and pulmonary thromboembolism, with three cases (13.3% of discordant ones).ConclusionDiscrepancies between clinical diagnosis and necroscopic findings are commonly found in cardiac transplantation. New strategies to improve clinical diagnosis should be made, considering the results of the necropsy, to improve the treatment of heart failure by heart transplantation.

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“…First, the overall rate of MD of tumors varies among different studies, ranging from<4% to 50% of the autopsies performed in patients died either in regular wards and in ICU [8,9,27]; it is arguable that our relatively low rate of MD could be at least partly related to the above-enlisted exclusion criteria which impeded us to know the results of the autopsies performed in other categories of critically ill patients.…”

Section: Our Findings Deserve Some Remarksmentioning

confidence: 99%

“…A number of investigations demonstrated that infections and cardio-respiratory diseases, including pulmonary embolisms and myocardial infarctions account for a substantial rate of MD in this population, with variable effects on the outcome ranging from negligible to substantially deadly [1,[4][5][6][7]. Although the occurrence of autopsy-discovered malignancies is less common [8], yet they can represent as many as 10% of cases [9,10] in patients admitted for reasons other than tumors. However, independently from their rate of occurrence, the ante-mortem diagnosis of neoplastic diseases in critically ill patients appears relevant for two opposite reasons.…”

Section: Introductionmentioning

confidence: 99%

Missed Diagnosis of Cancer in Critically Ill Patients: A Single-Center Experience

Berlot¹,

Calderan²,

Bussani³

et al. 2016

J Clin Exp Pathol

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Abstract\ud Purpose and methods: In order to evaluate the rate of missed diagnoses (MD) of tumors in critically ill patients died in our Intensive Care Unit (ICU) and correlate them with the outcome, all the autopsy records from January 1st, 1996 and December 31st, 2014 have been reviewed. When the tumor was not diagnosed during the admission but discovered only at the post-mortem examination, the effect of the MD on the outcome was classified according to the Goldman’s criteria.\ud Results: A total of, 1045 autopsies were examined; a solid or hematological cancer was discovered in 74 cases (7%, 50 M, 24 F, age 75.5, IQR 29-90 years). Major discrepancies occurred in 42 patients, but only in one of them (2.4%) a class 1 error was identified; in the other cases the MD did not influence the outcome (class 2 errors) due to the underlying conditions determining the ICU admission and/or the very short length of stay in the ICU; for another\ud 32 patients the MD were considered without clinical relevance.\ud Conclusions: In our experience, autopsy remains an extremely valuable tool to detect MD and to improve the clinical and diagnostic procedures

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Clinical diagnoses and autopsy findings

Cited by 77 publications

References 27 publications

Timing and causes of death in septic shock

Timing and causes of death in septic shock

NHETS - Necropsy Heart Transplantation Study

Missed Diagnosis of Cancer in Critically Ill Patients: A Single-Center Experience

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