Discrepancies Between Clinical and Autopsy Diagnoses in Rapid Response Team–Assisted Patients: What Are We Missing?

Abstract

Objectives:The rapid response team (RRT) assists hospitalized patients with sudden clinical deterioration. There is scarce evidence of diagnostic accuracy in this scenario, but it is possible that a considerable rate of misdiagnosis exists. Autopsy remains a valuable tool for assessing such question. This study aimed to compare clinical (premortem) and autopsy (postmortem) diagnoses in patients assisted by the RRT and describe major discrepancies. Methods:We reviewed 104 clinical data and autopsies from patients assisted by the RRT during a cardiac arrest event in a tertiary care hospital in Brazil. Clinical and autopsy diagnostic discrepancies were classified using the Goldman criteria. Other clinical and pathological data were described, and the group with major diagnostic discrepancies was further analyzed.Results: We found 39 (37.5%) patients with major diagnostic discrepancies. Most frequent immediate causes of death in this group determined by autopsy were sepsis (36%), pulmonary embolism (23%) and hemorrhagic shock (21%). Pulmonary embolism was the cause of death significantly more frequent in the major discrepancy group than in the minor discrepancy group (23% versus 3%, P = 0.002). We individually described all major diagnostic discrepancies. Conclusions:We found a high rate (37.5%) of major misdiagnosis in autopsies from patients assisted by the RRT in a tertiary teaching hospital. Pulmonary embolism was the most inaccurate fatal diagnosis detected by autopsy.

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“…Nessa situação, a maioria dos acidentes com lesões múl� plas (cerca de 60%) incluíram as regiões da cabeça/pescoço, face e abdômen/conteúdos pélvicos. De modo geral, os acidentados politrauma� zados ou com múl� plas lesões no mesmo segmento corpóreo estão em situação que piora o prognós� co, necessitando avaliação emergencial das equipes cirúrgicas (Giugni et al, 2022). Nessa situação, na RMVA no período de estudo se destacaram os acidentados no trajeto com uso de motocicleta, com elevada taxa de morbimortalidade.…”

Postmortem Gone Astray—A Systematic Review and Meta-Analysis

“…We also eliminated articles on intensive care unit (ICU) patients only, as ICUs are known for meticulously scrutinizing their patients [21]. Kurz et al, 2021;Giugni et al, 2022;Hudák et al, 2022 [2,9,13-20].…”

Impacto da implantação do Time de Resposta Rápida na mortalidade e na qualidade do atendimento ao paciente grave em hospital terciário

“…Houve discrepância em 37,5% dos casos, sendo tromboembolismo pulmonar (que faz parte dos "5H e 5T") o principal diagnóstico divergente, mostrando que o tratamento de pacientes com descompensação aguda e crítica, mesmo por um time especializado e altamente treinado, ainda se constitui em um desafio para a assistência hospitalar (73).…”