title: Are autopsy findings still relevant to the management of critically ill patients in the modern era?
abstract: OBJECTIVE
  The purpose of this study was to determine the accuracy of clinical diagnoses compared to autopsy findings in critically ill patients in the current medical era.
  
  
  METHODS
  We conducted a retrospective, blinded review of matched medical records and postmortem findings in patients who died between June 2006 and June 2011.
  
  
  METHODS
  An ICU of a major university teaching hospital in Dublin, Ireland.
  
  
  METHODS
  None.
  
  
  RESULTS
  A modification of the Goldman criteria was used to classify diagnostic error. There were 629 ICU deaths during the study period. Two hundred and seven patients underwent autopsy and 204 records were available for review. The mean age was 59 ± 18.1 years, 62% were male, 70% were postoperative patients, and median length of ICU stay was 3 days. Admission diagnosis, admission source, and admission specialty were similar between autopsy and nonautopsy patients. Five patients (2.4%; CI, 0.8-5.6%) had a class I discrepancy and 11 patients (5.4%; CI, 2.4-9.7%) had a class II discrepancy. Minor missed diagnoses were present in 31 patients (15.2%; CI, 4.5-12.4%). There was complete concordance between clinical and postmortem findings (class V) in 161 patients (79%; CI, 72.7-84.3%). In more than half the cases of discrepancy, it was not possible for physicians to make the diagnosis antemortem in the time available, despite appropriate investigations.
  
  
  CONCLUSIONS
  We detected a lower rate of clinicopathological discrepancy in critically ill patients than previously reported. Potential reasons for such findings include advances in diagnostic techniques and the use of a more robust definition to classify diagnostic discrepancies. Autopsy can still identify discrepancies in diagnosis even in patients who have undergone appropriate investigations. Prospective research is required to accurately define discrepancy rates in the critically ill population and to identify the patient subgroups in whom autopsy will continue to yield valuable information.
authors.affiliation: 1Department of Anaesthesia and Intensive Care Medicine, St. Vincent's University Hospital, Dublin, Ireland. 2Department of Anaesthesia and Pain Management, Wellington Regional Hospital, Newton, Wellington, New Zealand. 3School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. 4Department of Pathology and Laboratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fröhlich
authors.forename: Orla
authors.initials: O
authors.lastname: Ryan
authors.forename: Noelle
authors.initials: N
authors.lastname: Murphy
authors.forename: Nuala
authors.initials: N
authors.lastname: McCauley
authors.forename: Tom
authors.initials: T
authors.lastname: Crotty
authors.forename: Donal
authors.initials: D
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D016638:Critical Illness; D019937:Diagnostic Techniques and Procedures / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies