Abstract
Objectives. To characterise discrepancies between clinical and autopsy diagnoses in patients who die in the intensive care unit.
Design. Retrospective chart review.
Setting. Ten-bed closed mixed adult intensive care unit in a tertiary referral teaching hospital.
Participants. All the clinical notes and autopsy reports of 346 patients who died in the intensive care unit in 1996–2000.
Interventions. Discrepancies between clinical and autopsy diagnoses were reviewed by two intensivists, a specialist in infectious diseases, a pathologist and an anaesthesiologist. New findings which would have changed current therapy in the intensive care unit were categorised as a Class I discrepancy, and those related to death but which would not have altered therapy as a Class II discrepancy.
Results. Of 2370 patients admitted, 388 (16.4%) died. An autopsy was performed in 346 (89%) of the deceased patients. A Class I discrepancy was found in 8 patients (2.3%) and a Class II discrepancy in 11 patients (3.2%). Five of the eight (62%) Class I discrepancies were infections which occurred in patients already treated for another infections.
Conclusion. Despite the availability of advanced diagnostic facilities, especially infectious complications seem to remain undiagnosed. Autopsy is a valuable tool with which to monitor diagnostic accuracy in these patients.
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Silfvast, T., Takkunen, O., Kolho, E. et al. Characteristics of discrepancies between clinical and autopsy diagnoses in the intensive care unit: a 5-year review. Intensive Care Med 29, 321–324 (2003). https://doi.org/10.1007/s00134-002-1576-z
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DOI: https://doi.org/10.1007/s00134-002-1576-z