Original StudiesDiscrepancies Between Clinical and Autopsy Diagnoses in Rapid Response Team–Assisted Patients: What Are We Missing?Giugni, Fernando Rabioglio MD∗,†; Salvadori, Fernanda Aburesi MD‡; Smeili, Luciana Andrea Avena MD‡; Marcílio, Izabel MD, PhD§; Perondi, Beatriz MD‡; Mauad, Thais MD, PhD†; de Paiva, Edison Ferreira MD, PhD∥; Duarte-Neto, Amaro Nunes MD, PhD†,§ Author Information From the ∗Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo †Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo ‡Time de Resposta Rápida, Diretoria Clínica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo §Núcleo de Vigilância Epidemiológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo ∥Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Correspondence: Amaro Nunes Duarte-Neto, MD, PhD, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455—1° andar—Sala 1161, Cerqueira César, São Paulo, SP 01246-903, Brasil (e-mail: [email protected]). The authors disclose no conflict of interest. This work received no funding. F.R.G. and F.A.S. contributed equally to this work. Journal of Patient Safety: October 2022 - Volume 18 - Issue 7 - p 653-658 doi: 10.1097/PTS.0000000000000962 Buy Metrics Abstract Objectives The rapid response team (RRT) assists hospitalized patients with sudden clinical deterioration. There is scarce evidence of diagnostic accuracy in this scenario, but it is possible that a considerable rate of misdiagnosis exists. Autopsy remains a valuable tool for assessing such question. This study aimed to compare clinical (premortem) and autopsy (postmortem) diagnoses in patients assisted by the RRT and describe major discrepancies. Methods We reviewed 104 clinical data and autopsies from patients assisted by the RRT during a cardiac arrest event in a tertiary care hospital in Brazil. Clinical and autopsy diagnostic discrepancies were classified using the Goldman criteria. Other clinical and pathological data were described, and the group with major diagnostic discrepancies was further analyzed. Results We found 39 (37.5%) patients with major diagnostic discrepancies. Most frequent immediate causes of death in this group determined by autopsy were sepsis (36%), pulmonary embolism (23%) and hemorrhagic shock (21%). Pulmonary embolism was the cause of death significantly more frequent in the major discrepancy group than in the minor discrepancy group (23% versus 3%, P = 0.002). We individually described all major diagnostic discrepancies. Conclusions We found a high rate (37.5%) of major misdiagnosis in autopsies from patients assisted by the RRT in a tertiary teaching hospital. Pulmonary embolism was the most inaccurate fatal diagnosis detected by autopsy. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.