title: Should we confirm our clinical diagnostic certainty by autopsies?
abstract: OBJECTIVE
  To evaluate the frequency of diagnostic errors assessed by autopsies.
  
  
  METHODS
  Retrospective review of medical and pathological records in an 11-bed closed medical intensive care unit (ICU) at a 860-bed general hospital.
  
  
  METHODS
  Patients who died in the ICU between January 1998 and December 1999. Medical diagnoses were rated into three levels of clinical diagnostic certainty: complete certainty (group L1), minor diagnostic uncertainty (group L2), and major diagnostic uncertainty (group L3). The patients were divided into three error groups: group A, the autopsy confirmed the clinical diagnosis; group B, the autopsy demonstrated a new relevant diagnosis which would probably not have influenced the therapy and outcome; group C, the autopsy demonstrated a new relevant diagnosis which would probably have changed the therapy and outcome.
  
  
  RESULTS
  The overall mortality was 20.3% (270/1331 patients). Autopsies were performed in 126 patients (46.9% of deaths), more often in younger patients (66.6+/-13.9 years vs 72.7+/-12.0 years, p<0.001), in patients with shorter ICU stay (4.7+/-5.6 days vs 6.7+/-8.7 days, p=0.054), and in patients in group L3 without chronic diseases (15/126 vs 1/144, p<0.001). Fatal but potentially treatable errors [group C, 12 patients (9.5%)] were found in 8.7%, 10.0%, and 10.5% of patients in groups L1, L2, and L3, respectively (NS between groups). An ICU length of stay shorter than 24 h was not related to the frequency of group C errors.
  
  
  CONCLUSIONS
  Autopsies are performed more often in younger patients without chronic disease and in patients with a low clinical diagnostic certainty. No level of clinical diagnostic certainty could predict the pathological findings.
authors.affiliation: Department of Intensive Internal Medicine, General Hospital Celje, Oblakova 5, 3000 Celje, Slovenia. Matej.Podbregar@guest.arnes.si
authors.forename: M
authors.initials: M
authors.lastname: Podbregar
authors.forename: G
authors.initials: G
authors.lastname: Voga
authors.forename: B
authors.initials: B
authors.lastname: Krivec
authors.forename: R
authors.initials: R
authors.lastname: Skale
authors.forename: R
authors.initials: R
authors.lastname: Pareznik
authors.forename: L
authors.initials: L
authors.lastname: Gabrscek
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000706:statistics & numerical data*; D002423:Cause of Death; D016009:Chi-Square Distribution; D016638:Critical Illness / Q000401:mortality*; D003951:Diagnostic Errors; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies