Discrepancies between clinical and postmortem diagnoses in critically ill patients: an observational study

Area of Science:

• Medical diagnostics
• Critical care medicine
• Pathology

Background:

• Autopsies traditionally confirm cause of death, aid education, and ensure quality.
• Clinician anxiety regarding consent and organ retention impacts autopsy requests.
• The study investigates the continued relevance of autopsies for determining cause of death in intensive care settings.

Purpose of the Study:

• To evaluate the role of autopsies in determining the cause of death for critically ill patients.
• To assess the diagnostic accuracy of premortem clinical diagnoses compared to postmortem findings.

Main Methods:

• Retrospective analysis of postmortem examination rates and diagnostic discrepancies.
• Study population: critically ill patients in a general medical/surgical intensive care unit (January 1998 - June 2001).
• Comparison of premortem diagnoses with postmortem findings using the Goldman system.

Main Results:

• Only 7.7% of 636 deaths underwent postmortem examination (38 cases reviewed).
• Complete agreement between clinical diagnosis and autopsy findings occurred in less than half of cases (45%).
• Major diagnostic errors were identified in 39% of cases, with myocardial infarction, carcinoma, and pulmonary embolism being the most common missed diagnoses.

Conclusions:

• Postmortem examinations are valuable for verifying diagnostic accuracy in intensive care unit (ICU) patients.
• Considering autopsies for all ICU deaths can improve diagnostic outcomes.
• Identifying missed diagnoses can enhance patient care and potentially avoid futile treatment prolongation.