title: Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients.
abstract: Worldwide, various autopsy studies have shown a decrease in the diagnostic error rate over the last years. The cause of this positive development is mainly due to the improvement of modern medicine. However, intensive care unit patients are thought to have a higher risk for diagnostic errors, which is documented in several studies in the adult population. In contrast, there is only limited information about diagnostic errors in pediatrics, particularly in pediatric and neonatal intensive care units. The aims of this study were to analyze the spectrum of childhood death, determine the prevalence and distribution of autopsy-confirmed diagnostic errors, and describe patient characteristics that might have influenced the discordance between antemortem and postmortem findings. We analyzed 143 autopsy reports from 2004 to 2013 and correlated these with clinical reports. The overall autopsy rate during this interval was 20.3%. The leading causes of death were congenital malformations (28%), diseases closely associated with perinatal disorders (25%), disorders of the cardiovascular system (18%), and infections (15%). Additional findings were obtained in 23% of the autopsies. Major diagnostic errors were found in 6%, the lowest reported value in a developed country as yet. Most cases (75%) showed complete concordance between clinical diagnoses and postmortem findings, in line with improvements in diagnostic and therapeutic processes over the last decades. In conclusion, autopsy of neonates, infants, and children represents an important tool for monitoring the quality of pediatric and neonatal medical care.
authors.affiliation: Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Widmann
authors.affiliation: Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland.
authors.forename: Rosmarie
authors.initials: R
authors.lastname: Caduff
authors.affiliation: Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Giudici
authors.affiliation: Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhong
authors.affiliation: Department of Pathology, Cantonal Hospital Lucerne, Lucerne, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Vogetseder
authors.affiliation: Division of Neonatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Romaine
authors.initials: R
authors.lastname: Arlettaz
authors.affiliation: Department of Intensive Care and Neonatology, Children's Research Center, University Children's Hospital, Zurich, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Frey
authors.affiliation: Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland.
authors.forename: Holger
authors.initials: H
authors.lastname: Moch
authors.affiliation: Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland. PeterKarl.Bode@usz.ch.|Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland. PeterKarl.Bode@usz.ch.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Bode
mesh_terms: D001344:Autopsy / Q000706:statistics & numerical data / Q000639:trends; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013557:Switzerland
keywords: Autopsy; Cause of death; Diagnostic error; NICU; PICU