Is autopsy dead in the ICU?

Esteban, Andrés; Fernández-Segoviano, Pilar

doi:10.1007/s00134-002-1631-9

Cited by 14 publications

(7 citation statements)

References 24 publications

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“…Also, patients who die in the ICU are likely to be cared for by the intensivist who is usually not the primary physician who had long-term relation with the patient and family. [1724] This study shows that in spite of significant advances in the diagnosis and management of critically ill patients in general, there remains significantly high rate of major discrepancies between clinical and postmortem diagnoses. This underscores the significance of autopsy in the care of these patients.…”

Section: Discussionmentioning

confidence: 94%

Major discrepancies between clinical and postmortem diagnoses in critically ill cancer patients: Is autopsy still useful?

et al. 2013

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OBJECTIVE:Describe the major discrepancies between the clinical and postmortem findings in critically ill cancer patients admitted to the medical intensive care unit (MICU).MATERIALS AND METHODS:Retrospectively review of the medical records of all cancer patients who were admitted to the MICU and underwent postmortem examination over 6 year period. The records were reviewed for demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, clinical cause of death, and postmortem findings.RESULTS:There were 70 patients who had complete medical records. Mean age was 54.7 years (standard deviation (SD) ±14.8 years). Twenty-six patients had hematopoeitic stem cell transplantation (group I), 21 patients had hematological malignancies (group II), and 23 patients had solid malignancies (group III). The APACHE II score on admission to the MICU was 24.2 ± 8.0. Sixty-seven patients were mechanically ventilated, and the MICU stay was (mean ± SD) 9.0 ± 11.6 days. Major discrepancies between the clinical and postmortem diagnoses (Goldman classes I and II) were detected in 15 patients (21%). The most common missed diagnoses were aspergillosis, pulmonary embolism, and cancer recurrence. There were no differences between groups regarding the rate of major discrepancies.CONCLUSION:Despite the advances in the diagnosis and treatment of critically ill cancer patients, autopsies continue to show major discrepancies between the clinical and postmortem diagnoses. Autopsy is still useful in this patient population.

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Section: Discussionmentioning

confidence: 94%

Major discrepancies between clinical and postmortem diagnoses in critically ill cancer patients: Is autopsy still useful?

et al. 2013

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“…This reinforces the importance of the postmortem examination in detecting otherwise unexpected diagnoses. So, autopsy still plays a relevant role in clinical practice, despite advances in diagnostic technology (37,38). Furthermore, postmortem examination should be seen as a useful educational tool to improve quality of medical care by monitoring diagnostic accuracy and treatment of the critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical diagnoses and autopsy findings

Tejerina

Esteban

Fernández-Segoviano

et al. 2012

Critical Care Medicine

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“…Hospital administrators are not easily convinced to spend money on procedures lacking an immediate impact on patient management and just for teaching purposes [4,5]. In Belgium, the cost of an autopsy is estimated at 473 euros and is carried by the social security system.…”

Section: Reasons For the Decline In Autopsy Ratementioning

confidence: 99%

“…The imperfect correlation between pre- and post-mortem findings illustrates that existing diagnostic tools do not always provide 100% certainty about the existence of a specific disease entity [5]. Autopsies yield important information on the rates of discrepancies between clinical diagnosis and histology.…”

Section: Why Do Autopsies Still Play An Important Role In the Icu?mentioning

confidence: 99%

Clinical review: What is the role for autopsy in the ICU?

Vlieger¹,

Mahieu²,

Meersseman³

2010

Critical Care

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The availability of advanced diagnostic tools has grown in the past decades. Hence, a growing false belief exists that everything is known about the patient before death. Moreover, intensivists may wrongly believe that autopsy findings do not contribute to the understanding of pathophysiological events. The immediate result is that few ICUs nowadays assemble enough autopsy cases with new and interesting clinicopathological features. However, we believe that, at least in tertiary ICUs, autopsies remain a valuable examination, as a tool for quality control, as a way of establishing gold standards for diagnostic examinations and as an aid in developing guidelines for treatment and diagnosis of diseases frequently encountered in the ICU. Finally, due to the ever-expanding armamentarium of immunosuppressive agents, a growing list of opportunistic infections is discovered during autopsy. The present article gives an overview of autopsy studies conducted in the ICU and discusses the pros and cons of performing these.

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Is autopsy dead in the ICU?

Cited by 14 publications

References 24 publications

Major discrepancies between clinical and postmortem diagnoses in critically ill cancer patients: Is autopsy still useful?

Major discrepancies between clinical and postmortem diagnoses in critically ill cancer patients: Is autopsy still useful?

Clinical diagnoses and autopsy findings

Clinical review: What is the role for autopsy in the ICU?

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