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

Area of Science:

• Intensive Care Medicine
• Pathology
• Clinical Diagnostics

Background:

• Declining autopsy rates worldwide raise concerns about their continued value.
• Understanding the diagnostic yield of post-mortem examinations in critical care is essential.

Purpose of the Study:

• To compare ante-mortem clinical findings with post-mortem autopsy results in a multidisciplinary intensive care unit (ICU).
• To evaluate the impact of hospitalization duration on the nature of unexpected autopsy findings.

Main Methods:

• Retrospective analysis of all patients who died in a 31-bed medico-surgical ICU in 1999 and underwent autopsy.
• Comparison of autopsy records with clinical data using modified Goldman's criteria.
• Categorization of unexpected findings based on duration of ICU stay (<10 days vs. >10 days).

Main Results:

• An autopsy rate of 45.4% (222 out of 489 deaths) was observed.
• Unexpected findings were identified in 22.5% (50/222) of autopsies, including malignancies, infections, and thromboembolic events.
• Major unexpected findings were more common in patients with shorter ICU stays (<10 days), while minor findings predominated in prolonged stays (>10 days).

Conclusions:

• In short-stay ICU patients, autopsies frequently revealed discrepancies related to difficult-to-diagnose causes of death.
• In long-stay ICU patients, autopsies were more likely to identify coexisting conditions unrelated to the primary cause of death.
• Autopsy remains a valuable tool for identifying diagnostic errors and understanding disease processes in the ICU.