Comparison of Premortem Clinical Diagnoses in Critically Ill Patients and Subsequent Autopsy Findings

Roosen, John; Frans, Eric; Wilmer, Alexander; Knockaert, Daniël; Bobbaers, Herman

doi:10.4065/75.6.562

Cited by 148 publications

(105 citation statements)

References 25 publications

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“…Despite the recognized efficacy of autopsy as a tool for medical education and as a method for the evaluation of diagnostic accuracy in general, (23) the reduction in autopsy rates is a phenomenon observed worldwide, (9)(10)(11)(23)(24)(25) possibly due to the interaction of a number of factors, such as the development of sensitive diagnostic methods, which reduce the need for autopsy to investigate the cause of death; the aging of the population, which makes death be interpreted as a natural part of the process; a lack of interest on the part of the team of professionals, who question the validity of the procedure; the fear of assigning blame to the physician in charge; and the idea that autopsy findings can set a precedent for filing a medical malpractice lawsuit. (9,11,25) Consequently, autopsy studies have become scarce in the literature, and the potential of autopsies for diagnosis, medical education and evaluation of the quality of diagnosis has been minimized.…”

Section: Discussionmentioning

confidence: 99%

“…(9,11,25) Consequently, autopsy studies have become scarce in the literature, and the potential of autopsies for diagnosis, medical education and evaluation of the quality of diagnosis has been minimized. (9) Although our hospital had a relatively low autopsy rate in the past decade (12.7%), there was no seasonal influence and we were able to collect the demographic, clinical and anatomopathological variables of a series of 199 patients whose cause of death (underlying or contributing) was NP.…”

Section: Discussionmentioning

confidence: 99%

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Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

et al. 2010

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Objective: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. Methods: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. Results: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco-associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. Conclusions: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.Keywords: Autopsy; Risk factors; Prognosis; Pneumonia, aspiration; Pneumonia/mortality. ResumoObjetivo: Determinar a prevalência de pneumonia nosocomial nas autópsias em um hospital público universitário; identificar os fatores de risco relacionados à pneumonia nosocomial e os potenciais fatores prognósticos relacionados à ocorrência de pneumonia nosocomial fatal; e correlacionar os achados anatomopatológicos com a ocorrência de pneumonia nosocomial e/ou pneumonia aspirativa. Métodos: Estudo retrospectivo de 199 pacientes autopsiados, maiores de 1 ano de idade, internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista entre 1999 e 2006, cuja causa de morte (causa básica ou associada) foi pneumonia nosocomial. Testou-se a associação dos dados demográficos, clínicos e anatomopatológicos com os desfechos pneumonia nosocomial fatal e pneumonia aspirativa fatal. As variáveis significativas entraram na análise multivariada. Resultados: A idade média foi de 59 ± 19 anos. A prevalência de pneumonia nosocomial em autópsias foi 29%, e essa foi a causa mortis de 22,6% dos pacientes autopsiados. A pneumonia nosocomial fatal correlacionou-se com os achados anatomopatológicos de alterações estruturais tabágicas (OR = 3,23; IC95%: 1,26-2,95; p = 0,02) e acom...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

et al. 2010

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“…He found a 34% error rate in the diagnosis of myocardial infarction, 85% disagreement among internists in diagnosing emphysema, 93% disagreement among pediatricians in determining malnutrition in children, a 20% error rate in the interpretation of electrocardiograms, a 28% error rate in clinical laboratory tests, and a 30% error rate in the interpretation of chest radiographs [26,27]. Other investigators reported similar data: large autopsy studies uncovered frequent clinical errors and missed diagnoses, with error rates as high as 47% [28,29].…”

Section: Defensive Medicine and Medical Error Ratesmentioning

confidence: 93%

Medical errors, malpractice, and defensive medicine: an ill-fated triad

Berlin

2017

Diagnosis

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For the first 180 years following the founding of the US, physicians occasionally were sued for medical malpractice. Allegations of negligence were errors of commission -i.e. the physician made a mistake by doing something wrong, usually mistreatment of a fracture or dislocation, a complication or death following a surgical procedure, prescribing the wrong medication, and after the discovery of the X-ray by Roentgen in 1895, causing radiation burns. In the mid twentieth century malpractice allegations slowly changed from errors of commission to errors of omission -i.e. the physician failed to do something right: almost always, failed to make a diagnosis. The number of malpractice lawsuits increased at a geometric rate beginning in the 1960s, and in the 1970s physicians began practicing defensive medicine, which lead physicians to order unnecessary radiology exams and tests. In the past 20 years the number of malpractice lawsuits has been decreasing, but the practice of defensive medicine has continued. Unnecessary exams and tests increase the likelihood of overdiagnosis and overtreatment, i.e. a new kind of error of commission.

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“…The general rates of discrepancy between ante and post mortem diagnosis identified by various research varies between 10 and 50% depending on the postmortem examination criteria, the complexity of the necropsy, the methods used for the assessment of the differences and the studied population [5,6,31,34,39,41,45,54,11].…”

Section: Introductionmentioning

confidence: 99%

Clinical diagnosis versus autopsy diagnosis in head trauma

Velnic¹,

Hanganu²,

Ciudin³

et al. 2017

Romanian Neurosurgery

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Abstract:The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1) to total discordance (C4) and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis-missing injuries in the autopsy reports) and C3 (partial discordance in favor of the necroptic diagnosis-missing injuries in the medical files). Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral hematoma and ventricular hemorrhage (21.6%). In C3 cases the most frequently omitted injuries were subarachnoidian hemorrhage and skull base fractures autopsy diagnosis. Autopsy may identify the inconsistencies in diagnosis, the injuries frequently skipped and the factors favoring the discordance rate between the clinical death diagnosis and the autopsy diagnosis, making it a valuable tool for improving the clinical care of the patients with head trauma.

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Comparison of Premortem Clinical Diagnoses in Critically Ill Patients and Subsequent Autopsy Findings

Cited by 148 publications

References 25 publications

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

Medical errors, malpractice, and defensive medicine: an ill-fated triad

Clinical diagnosis versus autopsy diagnosis in head trauma

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