Characteristics of discrepancies between clinical and autopsy diagnoses in the intensive care unit: a 5-year review.
OBJECTIVE
To characterise discrepancies between clinical and autopsy diagnoses in patients who die in the intensive care unit.


METHODS
Retrospective chart review.


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


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


METHODS
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.


CONCLUSIONS
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.
Silfvast
Tom
T
Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, 00029 Helsinki, Finland. tom.silfvast@hus.fi
Takkunen
Olli
O
Kolho
Elina
E
Andersson
Leif C
LC
Rosenberg
Per
P
D000368:Aged; D001344:Autopsy / Q000191:economics / Q000592:standards*; D002423:Cause of Death; D002983:Clinical Competence / Q000592:standards; D003951:Diagnostic Errors / Q000191:economics / Q000706:statistics & numerical data*; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies