Assessment of misdiagnosis in small animal intensive care patients using the Modified Goldman criteria

Area of Science:

• Veterinary Pathology
• Comparative Pathology
• Diagnostic Accuracy

Background:

• Postmortem examinations serve as a crucial quality control measure for clinical diagnoses in veterinary medicine.
• Accurate clinical diagnoses are essential for effective treatment and improved patient outcomes in small animal intensive care units (ICUs).

Purpose of the Study:

• To evaluate the diagnostic accuracy of clinical assessments in critically ill small animals by comparing them with postmortem findings.
• To identify the frequency and nature of discrepancies between clinical and pathological diagnoses.
• To analyze factors associated with undiagnosed major findings.

Main Methods:

• Retrospective study of 300 dogs and cats admitted to a small animal ICU.
• Comparison of clinical diagnoses with postmortem findings using the Modified Goldman criteria.
• Analysis of patient files and postmortem material for diagnostic discrepancies.

Main Results:

• Postmortem examination revealed additional findings in 65% of cases.
• Major discrepancies, impacting treatment and outcome, were present in 21.3% of cases.
• Commonly missed diagnoses included pneumonia, meningitis/meningoencephalitis, myocarditis, and vasculitis.
• Shorter ICU stays correlated with higher odds of major discrepancies.

Conclusions:

• Significant discrepancies exist between clinical diagnoses and postmortem findings in small animal ICUs.
• Postmortem examinations are vital for identifying diagnostic errors and improving the quality of veterinary care.
• Missed diagnoses in critical care settings can affect patient outcomes, underscoring the need for thorough diagnostic evaluation.