Autopsy-detected diagnostic errors over time in the intensive care unit

Area of Science:

• Medical research
• Clinical pathology
• Critical care medicine

Background:

• Autopsies are crucial for understanding disease processes and validating clinical diagnoses.
• Persistent discrepancies between clinical and postmortem findings highlight diagnostic challenges in intensive care settings.

Purpose of the Study:

• To evaluate the trends in discrepancies between clinical diagnoses and autopsy findings in critically ill patients.
• To identify factors associated with these diagnostic discrepancies over time.

Main Methods:

• Prospective study of consecutive patients undergoing autopsy in a medical-surgical intensive care unit (ICU) from January 2008 to December 2015.
• Analysis of 215 autopsies to identify major missed diagnoses (Class I and II discrepancies).

Main Results:

• Major missed diagnoses occurred in 17.7% of autopsies.
• Commonly missed diagnoses included invasive aspergillosis, intestinal ischemia, myocardial infarction, cancer, and intra-abdominal abscesses.
• No significant correlation was found between premortem factors and the level of diagnostic agreement.

Conclusions:

• Diagnostic discrepancies between clinical assessments and autopsy findings remain a persistent challenge in critically ill patients.
• Specific conditions like invasive aspergillosis, mesenteric ischemia, and myocardial infarction continue to be diagnostic challenges.
• Clinical diagnostic certainty does not improve with specific premortem patient characteristics.