Autopsy-detected diagnostic errors over time in the intensive care unit

Publication date: Available online 9 March 2018
Source:Human Pathology
Author(s): Eva E. Tejerina, Rebeca Padilla, Elena Abril, Fernando Frutos-Vivar, Aida Ballen, José María Rodríguez-Barbero, José Ángel Lorente, Andrés Esteban
We evaluate the evolution over time of discrepancies between clinical diagnoses and post-mortem findings in critically ill patients, and to assess the factors associated with these discrepancies. We conducted a prospective study of all consecutive patients who underwent autopsy autopsies in a medical-surgical ICU between January 2008 and December 2015. Among 7.655 patients admitted to our ICU, 671 (8.8%) died. Clinical autopsy was performed in 215 (32%) patients. Major missed diagnoses were noted in 38 patients (17.7%). Eighteen patients (8.4%) had class I discrepancies and, twenty patients (9.3%) had class II discrepancies. The most frequently missed diagnoses were invasive aspergillosis, intestinal ischemia, myocardial infarction, cancer, and intra-abdominal abscesses. We did not find a statistically significant correlation between any pre-mortem factor, including age, sex, severity of illness, length of hospital stay before ICU admission, length of ICU stay before death, duration of mechanical ventilation or admitting unit, and the level of agreement between clinical and pathological diagnosis. In last decades the discrepancies between clinical and autopsy diagnoses persisted despite advances in medical skills and technology. Specific clinical entities such as invasive aspergillosis, mesenteric ischemia, myocardial infarction, intra-abdominal abscesses, and neoplastic diseases remain a diagnostic challenge in critically ill patients. Clinical level of diagnostic certainty does not increase with specific pre-mortem characteristics.



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