title: Comparison of premortem clinical diagnosis and autopsy findings in patients with burns.
abstract: BACKGROUND
  Despite the diagnostic advancements, some clinically important diagnoses remain undetected during intensive care in burn patients. The aim of this study was to compare the premortem clinical diagnoses and autopsy findings.
  
  
  METHODS
  A retrospective review of all burn deaths during 1995-2005 was conducted. The clinical diagnoses and autopsy reports were reviewed, and diagnostic discrepancies were classified into four categories, according to the impact on the treatment.
  
  
  RESULTS
  Overall mortality during the study period was 5.4%. Altogether 74 deaths were recorded, of which 71 were included in the study. Typical patient was a 58-year-old male with flame burn of %TBSA 49, ABSI 10. Clinical diagnostic discrepancies were found in 14.1% of the patients; one diagnostic discrepancy was recorded in each of the patients. Of these diagnostic discrepancies, 8.5% were considered major, and 5.6% would have altered the clinical outcome or therapy, if known at the time. Diagnostic discrepancies consisted of one cardiovascular, seven respiratory and two gastrointestinal missed diagnosis. The most common missed diagnosis was pneumonia.
  
  
  CONCLUSIONS
  This study emphasizes the usefulness of autopsies to provide valuable clinical data for the treatment of burn patients. It also highlights the few missed diagnoses which may occur in burn patients.
authors.affiliation: Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Kallinen
authors.forename: Taina A
authors.initials: TA
authors.lastname: Partanen
authors.forename: Kreu
authors.initials: K
authors.lastname: Maisniemi
authors.forename: Tom
authors.initials: T
authors.lastname: Böhling
authors.forename: Erkki
authors.initials: E
authors.lastname: Tukiainen
authors.forename: Virve
authors.initials: V
authors.lastname: Koljonen
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002053:Burn Units; D002056:Burns / Q000150:complications* / Q000473:pathology / Q000628:therapy; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D013727:Terminal Care; D055815:Young Adult