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Correlation between clinical diagnoses and autopsy findings in critically ill children
J J Stambouly1, E Kahn, R A Boxer
1Department of Pediatrics, North Shore University Hospital-Cornell University Medical College, Manhasset, NY 11030.
Insights
Autopsies in pediatric intensive care units (PICUs) revealed unexpected findings in 10% of cases, potentially altering treatment and survival. This highlights the autopsy's continued value in pediatric critical care.
Area of Science:
- Pediatric critical care medicine
- Pathology
- Clinical diagnostics
Background:
- Clinical diagnoses in pediatric intensive care units (PICUs) may not always align with post-mortem findings.
- Autopsies are crucial for verifying diagnoses and understanding mortality in critically ill children.
Observation:
- A retrospective chart review was conducted on children who died in a PICU and underwent autopsy.
- The study analyzed 50 autopsies performed over a 7.5-year period.
Findings:
- Autopsies revealed major, unsuspected findings that could have altered clinical management in 10% of cases.
- In 18% of cases, autopsies identified major findings that would not have changed management, with 8 relating to the cause of death.
- No correlation was found between new autopsy findings and patient age or length of PICU stay.
Implications:
- Autopsies remain valuable for uncovering critical information despite advancements in diagnostic technologies.
- These findings underscore the importance of autopsy in pediatric critical care for improving patient outcomes and medical knowledge.
Study Objective:
To examine the correlation between clinical diagnoses and autopsy findings in children who die in the pediatric intensive care unit (PICU).
Design:
Retrospective chart review.
Setting:
PICU of a university-affiliated hospital.
Patients:
A consecutive sample of patients who died in the PICU and had autopsies performed.
Measurements And Main Results:
Of 193 patients who died during the 7 1/2-year study period, 50 (26%) had autopsies performed. The mean age was 34.7 months (range 15 hours to 17 years), and the mean length of stay in the PICU was 12.2 days (range 2 hours to 60 days). Major admitting diagnoses included postoperative cardiac surgery (19), nonoperative cardiac disease (7), hematologic/malignant disorder (5), and acquired immunodeficiency syndrome (5). There were 5 cases (10%) where autopsy revealed a major finding that, if known prior to death, would have altered clinical management and might have resulted in cure or prolonged survival. In another 9 patients (18%) the autopsy revealed major findings that, if known prior to death, would not have altered management. Eight of these findings related to the cause of death and 2 of them involved the basic disease. There was no correlation between new findings and either patient age or length of stay in the PICU.
Conclusions:
Despite modern diagnostic techniques, the autopsy continues to reveal valuable and unsuspected information.