title: Discrepancies Between Clinical Diagnoses and Autopsy Findings in Critically Ill Children: A Prospective Study.
abstract: OBJECTIVE
  To evaluate the discrepancies between clinical and autopsy diagnoses in patients who died in the pediatric intensive care units (PICUs) of a tertiary care university hospital.
  
  
  METHODS
  A prospective study of all consecutive autopsies discussed at monthly mortality conferences over 5 years. Discrepancies between premortem and autopsy diagnoses were classified according to modified Goldman et al criteria.
  
  
  RESULTS
  From January 1, 2011, to December 31, 2015, a total of 2,679 children were admitted to the two PICUs of our hospital; 257 (9.6%) died, 150 (58.4%) underwent autopsy, and 123 were included. Complete concordance between clinical and postmortem diagnoses was observed in 86 (69.9%) patients; 20 (16.3%) had a class I discrepancy, and eight (6.5%) had a class II discrepancy. Comparing 2011 and 2015, the rate of major discrepancies decreased from 31.6% to 15%.
  
  
  CONCLUSIONS
  Our results emphasize the importance of autopsy to clarify the cause of death and its potential contribution to improvement of team performance and quality of care.
authors.affiliation: From the Division of Pediatric Critical Care, Department of Pediatrics, apcarlotti@fmrp.usp.br.
authors.forename: Ana P C P
authors.initials: AP
authors.lastname: Carlotti
authors.affiliation: Division of Anesthesiology, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor Apparatus.
authors.forename: Letícia G
authors.initials: LG
authors.lastname: Bachette
authors.affiliation: From the Division of Pediatric Critical Care, Department of Pediatrics.
authors.forename: Fabio
authors.initials: F
authors.lastname: Carmona
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics.
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Manso
authors.affiliation: Division of Pediatric Cardiovascular Surgery, Department of Surgery and Anatomy.
authors.forename: Walter V A
authors.initials: WV
authors.lastname: Vicente
authors.affiliation: Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Ramalho
mesh_terms: D000293:Adolescent; D001344:Autopsy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies
keywords: Clinical diagnoses; Goldman criteria; Pediatric intensive care unit; Postmortem findings