Are Autopsy Findings Still Relevant to the Management of Critically Ill Patients in the Modern Era?

Fröhlich, Stephen; Ryan, Orla; Murphy, Noelle; McCauley, Nuala; Crotty, Tom; Ryan, Donal

doi:10.1097/ccm.0b013e3182a275b1

Cited by 20 publications

(23 citation statements)

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“…In the ICU setting, autopsy studies [13–15] have been performed to assess the discrepancies between clinical and post-mortem diagnoses. Nevertheless, there is scant information in the literature on the rates of autopsy performed to identify the etiology of lethal shock.…”

Section: Discussionmentioning

confidence: 99%

Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study

et al. 2016

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BackgroundThe lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others.MethodsWe conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France. We included all consecutive patients admitted to the ICU with suspected septic shock defined by clinical suspicion of infection leading to antibiotic prescription plus acute circulatory failure requiring vasopressor support.ResultsA total of 508 patients were admitted with suspected septic shock. Among them, 374 (74 %) had early-confirmed septic shock, while the 134 others (26 %) had no source of infection identified nor microbiological documentation retrieved 24 hours after shock onset. Among these, 37/134 (28 %) had late-confirmed septic shock diagnosed after 24 hours, 59/134 (44 %) had a condition mimicking septic (septic shock mimicker, mainly related to adverse drug reactions, acute mesenteric ischemia and malignancies) and 38/134 (28 %) had shock of unknown origin by the end of the ICU stay. There were no differences between patients with early-confirmed septic shock and the remainder in ICU mortality and the median duration of ICU stay, of tracheal intubation and of vasopressor support. The multivariable Cox model showed that the risk of day-60 mortality did not differ between patients with or without early-confirmed septic shock. A sensitivity analysis was performed in the subgroup (n = 369/508) of patients meeting the Sepsis-3 definition criteria and displayed consistent results.ConclusionsOne quarter of the patients admitted in the ICU with suspected septic shock had no infection identified 24 hours after its onset and almost half of them were eventually diagnosed with a septic shock mimicker. Outcome did not differ between patients with early-confirmed septic shock and other patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1537-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study

et al. 2016

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“…Flera studier under 2010-talet visar att obduktion är ett viktigt verktyg för att upptäcka diagnostiska misstag (Liao & Singh, 2013;Scordi-Bello et al, 2010;Tejerina et al, 2012). Genom att jämföra kliniska diagnoser med obduktionsprotokoll har man i studier visat (Alafuzoff & Veress, 1993;Fröhlich et al, 2014) att obduktionen till ca 75% kommer med tillägg som har betydelse för dödsfallet och påverkar dödsorsaksintyget. I studier på intensivvårdsavdelningar kan man i två studier (Fröhlich et al, 2014;Wong et al, 2015) se en lägre diskrepans mellan klinisk diagnos och diagnos efter obduktion.…”

Section: Diagnos Före Och Efter Obduktionunclassified

“…Genom att jämföra kliniska diagnoser med obduktionsprotokoll har man i studier visat (Alafuzoff & Veress, 1993;Fröhlich et al, 2014) att obduktionen till ca 75% kommer med tillägg som har betydelse för dödsfallet och påverkar dödsorsaksintyget. I studier på intensivvårdsavdelningar kan man i två studier (Fröhlich et al, 2014;Wong et al, 2015) se en lägre diskrepans mellan klinisk diagnos och diagnos efter obduktion. Fröhlich et al fann i sin studie att flera patienter inom intensivvården obducerades av rättsmedicinsk anledning.…”

Section: Diagnos Före Och Efter Obduktionunclassified

“…30% av patienterna på intensivvårdsavdelningen i den aktuella studien obducerades. Hög obduktionsfrekvens ledde till mindre skillnader i diagnoser före och efter obduktion (Fröhlich et al, 2014). Denna studier baserades på en modifierad Goldmanklassifikation där större krav på vad som ansågs vara missade diagnoser ställdes.…”

Section: Diagnos Före Och Efter Obduktionunclassified

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The clinical value of autopsies at a university hospital in Sweden

Rosendahl

Mjörnheim

Takman

et al. 2016

Nordic Journal of Nursing Research

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The rate of requests for autopsies has dropped over the last four decades. In the present study we have investigated the clinical usefulness of autopsies in a university hospital for determining the cause of death and as a source of information for the relatives. The autopsy routines were sufficient to fulfil clinical needs and resulted in essential information. The next of kin were involved in the decision to perform an autopsy in half the cases. In 10% of cases the relatives requested the examination. We believe that a desired increase in autopsies performed could be reached if the relatives of the deceased were informed of their value. We further suggest that nurses be included in a team process informing the relatives of the value of autopsies and their right to share the information gained.

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“…The landmark study by Goldman et al 1 found a 10% error rate in diagnosis in 100 randomly chosen autopsies. Their original classification of diagnostic errors was modified by Frohlich et al 2 in 2014 (Table 1). More recent analysis quotes a discrepancy rate of between 20% and 44% 3 despite improvements in modern imaging and diagnostic processes.…”

Section: Getting Death Right and Improving Practicementioning

confidence: 99%

Autopsy and critical care

Wong

Osborn

Waldmann

2015

Journal of the Intensive Care Society

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An autopsy is a medical procedure consisting of the thorough examination of the body and internal organs after death, to evaluate disease or injury and to determine the cause and manner of a person's death. In the intensive care setting, autopsies are usually performed to determine the cause of death or further medical knowledge. Early evidence that showed an alarmingly high rate of medical misdiagnosis found at autopsy is being called into question; the role of the procedure itself is being scrutinised. Furthermore, there has been a marked decline in the number of autopsies being performed both in the UK and across Europe. We examine the role of autopsies in modern health care for critically ill patients.

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Are Autopsy Findings Still Relevant to the Management of Critically Ill Patients in the Modern Era?

Cited by 20 publications

References 35 publications

Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study

Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study

The clinical value of autopsies at a university hospital in Sweden

Autopsy and critical care

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