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Clinical diagnoses and autopsy findings

Discrepancies in critically ill patients*

Tejerina, Eva MD, PhD; Esteban, Andrés MD, PhD; Fernández-Segoviano, Pilar MD, PhD; María Rodríguez-Barbero, José MD; Gordo, Federico MD, PhD; Frutos-Vivar, Fernando MD; Aramburu, José MD; Algaba, Ángela MD; Gonzalo Salcedo García, Óscar MD; Lorente, José A. MD

doi: 10.1097/CCM.0b013e318236f64f
Clinical Investigations
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Objectives: To determine the proportion of clinical errors by comparing clinical and pathological diagnoses, and to evaluate changes of errors over time.

Design: We conducted a prospective study of all consecutive autopsies performed on patients who died in the intensive care unit of the Hospital Universitario de Getafe, Madrid, Spain, between January 1982 and December 2007. The diagnostic errors were classified in two categories: class I errors that were major misdiagnoses with direct impact on therapy, and class II diagnostic errors which comprised major unexpected findings that probably would not have changed therapy.

Main Results: Of 2,857 deaths during the study period, autopsies were performed in 866 patients (30.3%). Autopsy reports were available in 834 patients, of whom 63 (7.5%) had class I errors and 95 (11.4%) had type II errors. The most frequently missed diagnoses were pulmonary embolism, pneumonia, secondary peritonitis, invasive aspergillosis, endocarditis and myocardial infarction. The autopsy did not determine the cause of death in 22 patients (2.6%). Our rate of diagnostic discrepancy remained relatively constant over time, and the conditions leading to discrepancies have slightly changed, with pneumonia showing a decline in diagnostic accuracy in the last years.

Conclusions: This study found significant discrepancies in 18.5% of patients who underwent autopsy, 7.5% of them were diagnoses with impact on therapy and outcome. This reinforces the importance of the postmortem examination in confirming diagnostic accuracy and improving the quality of care of critically ill patients.

From the Intensive Care Unit (ET, AE, FFV), Hospital Universitario de Getafe, Getafe, Spain and Ciber Enfermedades Respiratorias, Instituto Carlos III, Madrid, Spain; Department of Pathology (PFS), Hospital Universitario de Getafe, Getafe, Spain; Department of Pathology (JMRB), Hospital Universitario de Getafe, Getafe, Spain; Intensive Care Unit (FG), Hospital del Henares, Madrid, Spain; Department of Pathology (JA), Hospital Universitario de Getafe, Getafe, Spain; Intensive Care Unit (AA), Hospital del Tajo, Aranjuez, Spain; Intensive Care Unit (OGSG), Hospital San José, Bogotá, Colombia; Intensive Care Unit (JAL), Hospital Universitario de Getafe (Getafe, Spain).

* See also p. 1003.

Supported, in part, by Ciber Enfermedades Respiratorias, Instituto Carlos III, Madrid, Spain.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: evateje@gmail.com

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins