Characteristics of discrepancies between clinical and autopsy diagnoses in the intensive care unit: a 5-year review.

Abstract

To characterise discrepancies between clinical and autopsy diagnoses in patients who die in the intensive care unit. Retrospective chart review. Ten-bed closed mixed adult intensive care unit in a tertiary referral teaching hospital. All the clinical notes and autopsy reports of 346 patients who died in the intensive care unit in 1996-2000. Discrepancies between clinical and autopsy diagnoses were reviewed by two intensivists, a specialist in infectious diseases, a pathologist and an anaesthesiologist. New findings which would have changed current therapy in the intensive care unit were categorised as a Class I discrepancy, and those related to death but which would not have altered therapy as a Class II discrepancy. Of 2370 patients admitted, 388 (16.4%) died. An autopsy was performed in 346 (89%) of the deceased patients. A Class I discrepancy was found in 8 patients (2.3%) and a Class II discrepancy in 11 patients (3.2%). Five of the eight (62%) Class I discrepancies were infections which occurred in patients already treated for another infections. Despite the availability of advanced diagnostic facilities, especially infectious complications seem to remain undiagnosed. Autopsy is a valuable tool with which to monitor diagnostic accuracy in these patients.