title: Comparison of premortem clinical diagnoses in critically iII patients and subsequent autopsy findings.
abstract: OBJECTIVE
  To determine whether our practice of requesting an autopsy for patients who die in the medical intensive care unit (MICU) continues to be a valid approach to obtain clinically and educationally relevant findings.
  
  
  METHODS
  In this retrospective study conducted in an adult MICU population of a university hospital, the clinical diagnoses and postmortem major diagnoses of 100 patients who died in 1996 (autopsy rate of 93%) were compared.
  
  
  RESULTS
  Eighty-one percent of the clinical diagnoses were confirmed at autopsy. In 16%, autopsy findings revealed a major diagnosis that, if known before death, might have led to a change in therapy and prolonged survival (class I missed major diagnoses). The most frequent class I missed major diagnoses were fungal infection, cardiac tamponade, abdominal hemorrhage, and myocardial infarction. Another 10% of autopsies revealed a diagnosis that, if known before death, would probably not have led to a change in therapy (class II error).
  
  
  CONCLUSIONS
  Autopsy remains an important tool for education and quality control. In contrast with historical series of 1 to 2 decades ago, there is a clear shift in the type of class I missed major diagnoses toward opportunistic infections. Bedside-applicable techniques such as electrocardiography with supplemental posterior leads, echocardiography, and meticulous abdominal ultrasonography might improve the outcome in selected MICU patients.
authors.affiliation: Department of Internal Medicine, University Hospitals Gasthuisberg, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Roosen
authors.forename: E
authors.initials: E
authors.lastname: Frans
authors.forename: A
authors.initials: A
authors.lastname: Wilmer
authors.forename: D C
authors.initials: DC
authors.lastname: Knockaert
authors.forename: H
authors.initials: H
authors.lastname: Bobbaers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001530:Belgium; D002648:Child; D016638:Critical Illness; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D012189:Retrospective Studies