title: Association of pre mortem diagnosis and autopsy findings in pediatric intensive care unit versus emergency department versus ward patients.
abstract: OBJECTIVE
  As part of the overall quality assurance program for the Department of Pediatrics, we determined whether there were differences in the rates of unexpected autopsy findings between pediatric intensive care unit (ICU), emergency department, and ward patients.
  
  
  METHODS
  Prospective, descriptive study.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Pediatric deaths (n = 212).
  
  
  METHODS
  None.
  
  
  RESULTS
  Autopsies were obtained more frequently in emergency department patients (27/29 [93%]) compared with pediatric ICU (88/121 [73%] and ward (42/62 [68%]) patients (p = .03). The medical examiner's cases were more frequently from emergency department patients (22/27 [81%]) compared with pediatric ICU (39/88 [44%]) or ward (11/42 [26%]) patients (p < .001). We found unexpected autopsy findings in 19 (12%) of 157 patients. There were no unexpected findings from the medical examiner's cases. The most common unexpected findings were unidentified infections (n = 7 [three fungal, three viral, and one nonspecific]) and unrecognized cardiac malformations (n = 4). Unexpected findings occurred more frequently in pediatric ICU patients (16/88 [18%]) vs. emergency department (2/27 [7%]) or ward (1/42 [2%]) patients (p = .03). The occurrence rates of major unexpected findings (Class I and II) in pediatric ICU (7/79 [9%]), emergency department (2/27 [7%]), and ward (1/42 [2%]) patients were similar (p = .4). There were two Goldman's Class I unexpected findings in the pediatric ICU and emergency department patients, and one Goldman's Class I unexpected finding in the ward patients.
  
  
  CONCLUSIONS
  Autopsies were performed more frequently in emergency department patients. Class I through IV unexpected findings occurred more frequently in pediatric ICU patients compared with emergency department or ward patients. Autopsy examinations are an especially valuable diagnostic tool for pediatric ICU patients and physicians.
authors.affiliation: Division of Critical Care, Oregon Health Sciences University, Portland, USA.
authors.forename: B
authors.initials: B
authors.lastname: Goldstein
authors.forename: L
authors.initials: L
authors.lastname: Metlay
authors.forename: C
authors.initials: C
authors.lastname: Cox
authors.forename: J S
authors.initials: JS
authors.lastname: Rubenstein
mesh_terms: D001344:Autopsy / Q000706:statistics & numerical data; D002423:Cause of Death; D002648:Child; D003933:Diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D009518:New York / Q000453:epidemiology; D010362:Patients' Rooms / Q000706:statistics & numerical data; D011446:Prospective Studies