title: The impact of antemortem computed tomographic scanning on postmortem examination rate and frequency of missed diagnosis: A retrospective analysis of postmortem examination data.
abstract: OBJECTIVE
  The present study was conducted to explore the impact of computed tomographic (CT) scanning on the diagnostic discrepancy rate.
  
  
  METHODS
  This single-center, retrospective study reviewed postmortem examination results, clinical diagnoses, and radiologic imaging data for patients admitted to the intensive care unit (ICU) in 2008 to 2013. The Goldman criteria were used to classify diagnostic discrepancies.
  
  
  RESULTS
  The data of 577 patients who died during their ICU stay were retrieved. The postmortem examination rate was 42.9% (n=248). Significant diagnostic discrepancies (Goldman I and II) were recorded in 24 cases (9.7%). The postmortem examination rate decreased significantly from the first half (n=143; 51.1%) to the second half (n=105; 35.4%) of the study period (P<.0001). Among those with postmortem examinations, the use of antemortem body CT scans increased significantly from the first half (n=59; 41.3%) to the second half (n=64; 51.0%; P=.002) of the study period. The significant diagnostic discrepancy rate did not change with time (8.4% vs 11.4%, respectively; P=.424).
  
  
  CONCLUSIONS
  The postmortem examination rate has decreased, whereas antemortem CT scans has increased.
authors.affiliation: Department of Anaesthesiology, University of Oulu and Division of Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu, Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, 90029 OUH, Finland. Electronic address: janne.liisanantti@ppshp.fi.
authors.forename: Janne Henrik
authors.initials: JH
authors.lastname: Liisanantti
authors.affiliation: Department of Anaesthesiology, University of Oulu and Division of Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu, Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, 90029 OUH, Finland.
authors.forename: Tero Ilmari
authors.initials: TI
authors.lastname: Ala-Kokko
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D002423:Cause of Death; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000145:classification; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Post-mortem examination; antemortem CT scan; diagnostics; intensive care