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[The evaluation of autopsy in the pediatric intensive unit]
A Castellanos Ortega1, F Ortiz Melón, M García Fuentes
1UCI Pediátrica, Departamento de medicina intensiva, Valdecilla, Santander.
Objective:
Because of concerns about the declining autopsy rate, an attempt was made to evaluate the contributions from the postmortem examination in children.
Patients And Methods:
We carried out a retrospective comparison analysis between clinical and pathological diagnosis of 56 consecutive autopsies performed on children who died in the PICU during the period 1983-1995.
Results:
The autopsy rate was 60%. Autopsy provided valuable clinical information in 50% of the cases. There were major diagnostic errors in three patients (5%), that if detected before death would probably have improved survival. Another 14 cases (25%) showed missed clinical diagnoses related to the basic illness and the cause of death, whose premortem diagnosis would not have prolonged survival. There were no diagnostic discrepancies in 28 cases (50%). The most unexpected findings revealed by the autopsies were iatrogenics (10 cases), metabolic diseases (4 cases), congenital immunodeficiency syndromes (4 cases) and pulmonary opportunistic infections (3 cases). Eight of these diseases were genetic. An age < 12 months or and ICU stay < 24 hours were not predicting factors of a higher incidence of major diagnostic errors.
Conclusions:
The value of the autopsy as quality assurance and to detect iatrogenics and occult genetic diseases is unquestionable. New strategies have to be designed to increase the rate of autopsies.