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

Abstract

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.

Can low autopsy rates be increased? Yes, we can! Should postmortem examinations in oncology be performed? Yes, we should! A postmortem analysis of oncological cases

“…Regarding clinical autopsies, there are only few studies dealing with postmortem examinations in oncological cases and most of them only included cancer patients who died at an intensive care unit. Major discrepancy rates of 21–59% were reported in this collective [ 12 , 25 ] which is more or less comparable to the rates of our study. At the end of a cancer patient’s life, the extent to which diagnostic procedures are used might be smaller compared to other collectives.…”

The medical autopsy as quality assurance tool in clinical medicine: dreams and realities

“…In this study, in 28 % of the cases, at least one misdiagnosis was noted, 8 % of class I and 18 % of class II “despite presumably aggressive diagnostic assessment in the critical care environment.” They concluded “Our findings suggest that 34,000 ICU patients in the US may die as the result of a class I error annually, assuming that the error was the cause of death.” A Brazilian study [ 15 ] on critically ill patients with difficult antemortem diagnoses found in 50 % of 98 cases class I and class II discrepancies, of which cardiovascular complications were a main cause. An autopsy study in critically ill cancer patients in the ICU [ 16 ] found major discrepancies in 21 % of cases, with aspergillosis, pulmonary embolism, and cancer recurrence as the most commonly missed diagnoses. A study among pediatric patients requiring extracorporeal membrane oxygenator support found major discrepancies in 53 % of cases, the most commonly missed diagnosis being myocardial infarction found in 16 of 54 patients [ 17 ].…”

Metastatic tumor of the hand of unknown primary origin

“… 8 Autopsy is still useful in this patient population as many authors documented major discrepancies between the clinical and postmortem diagnoses. 11 , 12 …”