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

Abstract

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.

The Role of Autopsy in Medical Intensive Care Unit: Comparison of Clinical and Postmortem Diagnoses

“…In present study Male-to-female ratio was 1:1.47, while in other MICU studies like Maris C et al [6] and Aline Fusco et al [7] male-to-female ratio was 1.5:1 and 1.72:1 respectively, which is discordant with our study. Female preponderance in our study can be explained by the fact that there were deaths in MICU due to pregnancy related complications.…”

Heart infarct as the major cause of death of hematological patients as identified by autopsy

“…7,25,28 This was not confirmed by our study (33.3% of discrepant cases). The difference may result from the limitation of our group to hematological patients and previously reported decreasing incidence of misdiagnosed pulmonary embolism.…”

“…This finding is in accordance with various studies. 5,7,16,25,26 However, the number of undiagnosed infections in some studies is higher. 18,27 A more detailed analysis showed that 42.1% of the Aspergillus spp.…”

Clinical diagnoses and autopsy findings

“…Infectious diseases compromise the majority of missed causes of death in the various autopsy studies (2,4,5,13,15,17,18,20,21,30,31), especially when reporting cases from the ICU setting. Thus, the recognition of the source of infection remains a crucial unresolved problem and reinforces the difficulty of diagnosing different infectious entities such as peritonitis, pneumonia, endocarditis, and fungal infections in critically ill patients.…”