Do we still need autopsy in times of modern multislice computed tomography?-Missed diagnoses in the emergency room.
BACKGROUND
In spite of increasing quality of emergency room (ER) assessment in trauma patients and improved accuracy of modern multislice computed tomography (MSCT), the number of potentially missed diagnoses is still controversial. The aim of this study was to compare the initial findings of ER assessment and MSCT to the findings during autopsy in trauma patients not surviving the first 48 h after admission. We hypothesized that autopsy was more accurate than MSCT in diagnosing potentially fatal diagnoses.


METHODS
Between January 2004 and September 2007, all trauma patients undergoing ER treatment in our institution who deceased within 48 h after admission were analyzed regarding diagnoses from initial ER assessment, including MSCT, and diagnoses from autopsy. Data were prospectively collected and retrospectively analyzed. Autopsy reports were compared to diagnoses of ER assessment and MSCT. Missed diagnoses (MD) and missed potentially fatal diagnoses (MPFD) were analyzed.


RESULTS
Seventy-three patients with a mean age of 53.2 years were included into the study. Sixty-three percent were male. Autopsy revealed at least one missed diagnosis in 25% of the patients, with the thoracic area accounting for 67% of these. At least one MPFD was found in 4.1% of the patients, all of them being located in the thorax. Total numbers of MD and MPFD were significantly lower for the newer CT generation (64 MSCT, N = 11), compared to older one (4 MSCT, N = 26).


CONCLUSIONS
As determined by autopsy, modern multislice computed tomography is an accurate method to diagnose injuries. However, 25% of all diagnoses, and 4.1% of potentially fatal diagnoses are still missed in trauma patients, who deceased within the first 48 h after admission. Therefore, autopsy seems to be necessary to determine potentially missed diagnoses for both academic and medicolegal reasons as well as for quality control.
Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. simon.euler@tirol-kliniken.at.
S A
SA
Euler
Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
T
T
Kastenberger
Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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R
Attal
Department of Diagnostic & Interventional Radiology, Hall Regional Hospital, Milserstr. 10, 6060, Hall in Tirol, Austria.
M
M
Rieger
Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
M
M
Blauth
Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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M
Petri
D000328:Adult; D000368:Aged; D001344:Autopsy; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D055815:Young Adult
Autopsy; CT scan; Emergency room; Missed diagnoses; Trauma