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Published on: January 29, 2018
[Clinicopathological analysis of 141 pediatric autopsy cases]
Yuan-dong Duan1, Fei Yin, Jian-jun Dai
1Department of Pediatrics, Xiangya Hospital, Central South University, Changsha 410008, China.
Insights
Autopsy reviews of 141 pediatric cases revealed tumors as a leading cause of death, with misdiagnosis rates at 36.2%. This highlights the need to consider both common and rare diseases for improved pediatric diagnosis.
Area of Science:
- Pediatric pathology
- Autopsy analysis
- Diagnostic accuracy
Context:
- Retrospective analysis of 141 pediatric autopsy cases (1986-2006).
- Classification based on WHO disease codes, age groups, and clinical diagnoses.
- Comparison of clinical diagnoses against pathological findings.
Purpose:
- To summarize major pathological findings and causes of death in pediatric autopsies.
- To identify reasons for misdiagnosis in pediatric cases.
- To improve diagnostic levels and reduce misdiagnosis rates.
Summary:
- Tumors (29.1%), respiratory diseases (17.7%), and infections (12.7%) were the top pathological diagnoses.
- Malignant histiocytosis, sepsis, and lobular pneumonia were leading specific diseases.
- Misdiagnosis occurred in 36.2% of cases, with a shift in leading causes of death from respiratory diseases to tumors over time.
Impact:
- Autopsy findings confirm and correct clinical diagnoses, enhancing diagnostic experience.
- Emphasizes the importance of considering both common and rare diseases in critically ill children.
- Provides insights into evolving causes of pediatric mortality over a 20-year period.
Objective:
To summarize the major pathological findings, causes of deaths and reasons for misdiagnosis of 141 autopsy cases and thereby to improve the diagnosis level and reduce misdiagnosis.
Method:
A retrospective analysis of pathological reports and clinical materials of 141 pediatric autopsy cases from June, 1986 to June, 2006 of our department was performed. Classification was based on (1) international classification of diseases of the World Health Organization; (2) age: cases 28 d-3 years old were defined as infants and young children group, -7 yeas olds were defined as preschool age group, -14 years olds were school age group; (3) when statistics was conducted, the first 3 items of the clinical diagnoses were counted. If one of them was consistent with the pathological diagnosis, it was regarded as basically in accordance with the pathology, if none of the first 3 was consistent with pathological diagnosis, the case was regarded as misdiagnosed.
Results:
(1) The top three major pathological diagnosis and causes of death were: 1) Classified according to system: 41 cases had tumor (29.1%), 25 cases had respiratory diseases (17.7%), 18 cases had infectious diseases (12.7%); 2) Classified according to disease: 18 cases had malignant histiocytosis, 12 cases had sepsis, 11 cases had lobular pneumonia. (2) The causes of deaths changed gradually. The top cause of death was respiratory diseases during the former 10 years and was tumor during the latter 10 years; the materials showed that 95 cases were 28 d-3 years old (67.4%), and some rare diseases, such as mediastinal and lung chorionic epithelioma (choriocarcinoma), and pulmonary alveolar proteinosis were found. (3) In 90 cases the clinical diagnosis was basically in accordance with the pathological diagnosis (63.8%) and misdiagnosis was found in 51 cases (36.2%).
Conclusion:
For clinical diagnosis of critically ill patients, both common and rare diseases should be considered. Analysis of autopsy materials could confirm and/or correct clinical diagnosis and is helpful to summarize clinical diagnosis experience.
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