Death Within 48 Hours of Admission to the Emergency Department: The Value of Autopsy

Jayawardena, Suriya; Lauro, Joseph; Eisdorfer, Jacob; Barua, A.; Sridhar, Sundara; Indulkar, Shalaka

doi:10.1097/maj.0b013e31812f53d6

Cited by 7 publications

(14 citation statements)

References 13 publications

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“…As reported by Jayawardena et al , cardiac system involvement was the leading cause of death in both male and female patients that died within 48 hours of admission to the ED3; the most common causes of death in this study were cardiovascular disorders (46% of cases) including coronary heart disease and rupture of vascular. The sudden unexpected deaths in the EDs may provoke dissatisfaction of the relatives, and prompt them to ask the physicians to make up for a perceived treatment error, whether the given case involved actual medical malpractice.…”

Section: Discussionsupporting

confidence: 69%

Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

et al. 2017

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AimsEmergency medicine is a ‘high risk’ specialty. Some diseases develop suddenly and progress rapidly, and sudden unexpected deaths in the emergency department (ED) may cause medical disputes. We aimed to assess discrepancies between antemortem clinical diagnoses and postmortem autopsy findings concerning emergency medicine dispute cases and to figure out the most common major missed diagnoses.MethodsClinical files and autopsy reports were retrospectively analysed and interpreted. Discrepancies between clinical diagnoses and autopsy diagnoses were evaluated using modified Goldman classification as major and minor discrepancy. The difference between diagnosis groups was compared with Pearson χ2 test.ResultsOf the 117 cases included in this study, 71 of cases (58 class I and 13 class II diagnostic errors) were revealed as major discrepancies (60.7%). The most common major diagnoses were cardiovascular diseases (54 cases), followed by pulmonary diseases, infectious diseases and so on. The difference of major discrepancy between the diagnoses groups was significant (p<0.001). Aortic dissection and myocardial infarction were the most common cause of death (15 cases for each disease) and the most common missed class I diagnoses (80% and 66.7% for each), higher than the average 49.6% of all class I errors of the study patients.ConclusionsHigh major disparities between clinical diagnoses and postmortem examinations exist in emergency medical disputes cases; acute aortic dissection and myocardial infarction are the most frequently major missed diagnoses that ED clinicians should pay special attention to in practice. This study reaffirmed the necessity and usefulness of autopsy in auditing death in EDs.

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Section: Discussionsupporting

confidence: 69%

Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

et al. 2017

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“…We did not observe a statistically significant relationship between the time interval of assistance and the degree of diagnosis disagreement, although it is very difficult for the clinicians to make a correct diagnosis in cases in which the patient died soon after presentation to the hospital, and some of the physician diagnostic errors would have been due to this reason 25,26 …”

Section: Discussionmentioning

confidence: 60%

Clinical and pathological disagreement upon the cause of death in a teaching hospital: Analysis of 100 autopsy cases in a prospective study

Carvalho

Cordeiro

Cury

2008

Pathology International

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The aim of the present study was to analyze the concordance between clinical and autopsy diagnoses. For this purpose, 100 patients submitted to autopsy from July 2000 to April 2001 were studied prospectively. In all cases, clinicians gave the immediate and the underlying causes of death for patients dying under their care. The diagnoses were compared to the macroscopic autopsy diagnoses. Cohen's kappa coefficient of agreement was estimated. Sixty-four men and 36 women were submitted to autopsy. The most frequent pathological diagnosis of underlying cause of death were diseases of the circulatory system (35%), infections and parasitic diseases (20%) and diseases of the digestive system (11%). The kappa coefficient for immediate cause of death was 0.40 (95% confidence interval (CI): 0.29-0.50); for underlying cause it was 0.38 (95%CI: 0.18-0.44), and for basic cause codified by group according to ICD-10 it was 0.55 (95%CI: 0.44-0.67). Major disagreement occurred in 10 cases involving pathological causes of death as circulatory diseases, in which the clinicians diagnosed a digestive system disease as the cause of death (n = 5), or infectious and parasitic diseases (n = 5). The present study shows that agreement between clinical and pathological causes of death are moderate, proving that the autopsy is still a very important procedure.

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“…(7) In geriatric patients, a discrepancy rate of 52.5% (19) was reported. In a subset of patients with cardiovascular diseases, a 29,9% discrepancy rate was found.…”

Section: Discussionmentioning

confidence: 99%

“…(5,6) This divergence can vary depending on the institution that performed the autopsy; Jayawardena et al reported a very high agreement in 75% of cases, and Pastores et al obtained a rate of 74% agreement. (7,8) However, Valdez-Martínez et al recorded agreement in only 43% of cases. (9) Studies in the USA have shown that if the postmortem findings had been discovered earlier, there would have been changes in the therapeutic approach in approximately 16% of cases, with a consequent increase in survival.…”

Section: Introductionmentioning

confidence: 98%

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

Fares¹,

Cury²,

Lobo³

2011

Rev. bras. ter. intensiva

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Death Within 48 Hours of Admission to the Emergency Department: The Value of Autopsy

Cited by 7 publications

References 13 publications

Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

Clinical and pathological disagreement upon the cause of death in a teaching hospital: Analysis of 100 autopsy cases in a prospective study

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

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