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Intensive Care Med. 2003 Feb;29(2):321-4. Epub 2002 Nov 30.

Characteristics of discrepancies between clinical and autopsy diagnoses in the intensive care unit: a 5-year review.

Author information

1
Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, 00029 Helsinki, Finland. tom.silfvast@hus.fi

Abstract

OBJECTIVES:

To characterise discrepancies between clinical and autopsy diagnoses in patients who die in the intensive care unit.

DESIGN:

Retrospective chart review.

SETTING:

Ten-bed closed mixed adult intensive care unit in a tertiary referral teaching hospital.

PARTICIPANTS:

All the clinical notes and autopsy reports of 346 patients who died in the intensive care unit in 1996-2000.

INTERVENTIONS:

Discrepancies between clinical and autopsy diagnoses were reviewed by two intensivists, a specialist in infectious diseases, a pathologist and an anaesthesiologist. New findings which would have changed current therapy in the intensive care unit were categorised as a Class I discrepancy, and those related to death but which would not have altered therapy as a Class II discrepancy.

RESULTS:

Of 2370 patients admitted, 388 (16.4%) died. An autopsy was performed in 346 (89%) of the deceased patients. A Class I discrepancy was found in 8 patients (2.3%) and a Class II discrepancy in 11 patients (3.2%). Five of the eight (62%) Class I discrepancies were infections which occurred in patients already treated for another infections.

CONCLUSION:

Despite the availability of advanced diagnostic facilities, especially infectious complications seem to remain undiagnosed. Autopsy is a valuable tool with which to monitor diagnostic accuracy in these patients.

PMID:
12594594
DOI:
10.1007/s00134-002-1576-z
[Indexed for MEDLINE]

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