Post mortem examination in the intensive care unit: still useful?

Dimοpoulos, George; Piagnerelli, Michaël; Berré, Jacques; Salmon, Isabelle; Vincent, Jean‐Louis

doi:10.1007/s00134-004-2448-5

Cited by 87 publications

(70 citation statements)

References 35 publications

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“…These unexpected findings were considered as class I in 6% and as class II in 13% of the cases. These results are comparable with our previous study [13] where the discrepancy rate was 23%. Other studies have reported major diagnostic discrepancies in 5-40% of all hospitalised patients and in 7-32% of ICU patients [7,10,11,15,31,43,46,48,50].…”

Section: Discussionsupporting

confidence: 95%

Comparison of clinical and post-mortem findings in intensive care unit patients

Maris

Martin

Créteur³

et al. 2007

Virchows Arch

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The autopsy has long been regarded as an important tool for clinical confrontation, education and quality assurance. The aims of this study were to examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU) and to identify the types of errors in diagnosis to improve quality of care. Autopsies from 289 patients who died in the ICU during a 2-year period were studied. Post-mortem examination revealed unexpected findings in 61 patients (21%) including malignancy, pulmonary embolism, aspergillosis, myocardial or mesenteric infarction and unsuspected bacterial, viral or fungal infection. These unexpected findings were classified as Goldman class I errors in 17 (6%), class II in 38 (13%) and class III in six (2%) cases. Although the incidence of unexpected findings with clinical significance was low, post-mortem examination remains a valuable source of pertinent information that may improve the management of ICU patients.

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Section: Discussionsupporting

confidence: 95%

Comparison of clinical and post-mortem findings in intensive care unit patients

Maris

Martin

Créteur³

et al. 2007

Virchows Arch

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“…1,3,4,[20][21][22] Given that BMT is a relatively recent medical development, one would expect it to generate interest in explaining causes of death; however, the present study shows that autopsy rates among these patients have declined between 1990 and 2004. This decline matched the diminishing rates of autopsy in the associated teaching hospital and is incongruent with the results of Allan et al 3 who reported well-preserved rates during their 11-year study period.…”

Section: Discussionmentioning

confidence: 92%

High rate of discordance between clinical and autopsy diagnoses in blood and marrow transplantation

Seftel

Pruthi

et al. 2007

Bone Marrow Transplant

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“…When reviewing different studies comparing imaging and autopsy, scoring systems to deal with discrepancies are often very different. Systems have been devised to assess accuracy of clinical diagnoses compared with autopsy [35,36] and these have been adapted for use with PM imaging compared with autopsy [7]. However, these scoring systems and others used for imaging are often devised relating to technical performance or medical audit.…”

Section: What Are the Questions? How Do We Measure Accuracy Of The Anmentioning

confidence: 99%

“…However, these scoring systems and others used for imaging are often devised relating to technical performance or medical audit. For example a "major discrepancy" would be a failure to identify a diagnosis that could have changed medical management [36] or identifying the wrong organ system in the cause of death [15].…”

Section: What Are the Questions? How Do We Measure Accuracy Of The Anmentioning

confidence: 99%

How does post-mortem imaging compare to autopsy, is this a relevant question?

Morgan

Rutty

2016

Journal of Forensic Radiology and Imaging

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HighlightsEvidence of "efficacy" for a test does not imply it is effective in the real world Direct comparisons between autopsy and imaging may give misleading results Imaging is used in a wide variety of contexts, all with different questions The level of accuracy required of an imaging test depends on the context Research findings in one context may not be applicable in all contexts AbstractThe rapid development of imaging techniques used for the investigation of death invites the question "how does imaging compare with autopsy". This article is based on an invited talk given to the International Society of Forensic Radiology and Imaging in 2015 and attempts to show that this question cannot be answered, as it is in fact several questions depending on the circumstances of death. Review of the literature is fraught with difficulties due to the rapid evolution of technology, the varied circumstances of death investigation and the multiple possible post--mortem investigations that imaging can be compared with. The article focuses on the assessment of adult sudden natural death and suggests the questions that need to be answered.

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Post mortem examination in the intensive care unit: still useful?

Abstract: After a short ICU stay (<10 days), autopsy revealed discrepancies primarily related to the cause of death associated with diseases whose diagnosis can be difficult. Following more prolonged ICU stays (>10 days), autopsy was more likely to reveal coexisting diseases unrelated to death.

Cited by 87 publications

References 35 publications

Comparison of clinical and post-mortem findings in intensive care unit patients

Comparison of clinical and post-mortem findings in intensive care unit patients

High rate of discordance between clinical and autopsy diagnoses in blood and marrow transplantation

How does post-mortem imaging compare to autopsy, is this a relevant question?

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