Do autopsies of critically ill patients reveal important findings that were clinically undetected?

Blosser, Sandralee; Zimmerman, Helen E.; Stauffer, John L.

doi:10.1097/00003246-199808000-00015

Cited by 100 publications

(82 citation statements)

References 15 publications

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“…Such diagnostic disagreement can vary from 10 to 90%, depending on the disease and the population involved. (6)(7)(8)(9)11,18) These discrepancies might be attributable to different clinical manifestations of a single disease and to poor quality medical care. (9) However, recent studies have demonstrated the value of autopsy in medical education, in the evaluation of medical procedures, in physiopathology, in epidemiology, in public health and in the evaluation of the treatment employed.…”

Section: Discussionmentioning

confidence: 99%

“…(9) However, recent studies have demonstrated the value of autopsy in medical education, in the evaluation of medical procedures, in physiopathology, in epidemiology, in public health and in the evaluation of the treatment employed. (1,(6)(7)(8)10,11,(26)(27)(28)(29) Nevertheless, and specifically in pediatrics, autopsy can detect genetic diseases, allowing better counseling of the family. (7,9) Regarding issues such as whether to take into account the value of autopsy in medical education and medical procedures, and considering that many of the postmortem findings might have influenced treatment during the life of the patient and prevented the death of other patients, our study has limitations.…”

Section: Discussionmentioning

confidence: 99%

“…(4,5) Prompt investigation and diagnosis are essential to improving patient survival. (6)(7)(8) Clinical and radiographic findings of ARF are nonspecific, (9)(10)(11) and computed tomography has been shown to be useful in the assessment of these patients, (12) primarily in determining when biopsy is indicated. In this context, the complexity of clinical presentations makes diagnosis a constant challenge for the clinician.…”

Section: Introductionmentioning

confidence: 99%

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Alterações histopatológicas pulmonares em pacientes com insuficiência respiratória aguda: um estudo em autopsias

et al. 2008

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Objective: To present the pulmonary histopathological alterations found in the autopsies of patients with acute respiratory failure (ARF) and determine whether underlying diseases and certain associated risk factors increase the incidence of these histopathological patterns. Methods: Final autopsy reports were reviewed, and 3030 autopsies of patients > 1 year of age with an underlying disease and associated risk factors were selected. All had developed diffuse infiltrates and died of ARF-related pulmonary alterations. Results: The principal pulmonary histopathological alterations resulting in immediate death were diffuse alveolar damage (DAD), pulmonary edema, lymphocytic interstitial pneumonia (LIP) and alveolar hemorrhage. The principal underlying diseases were AIDS, bronchopneumonia, sepsis, liver cirrhosis, pulmonary thromboembolism, acute myocardial infarction (AMI), cerebrovascular accident, tuberculosis, cancer, chronic kidney failure and leukemia. The principal associated risk factors were as follows: age ≥ 50 years; arterial hypertension; congestive heart failure; chronic obstructive pulmonary disease; and diabetes mellitus. These risk factors and AIDS correlated with a high risk of developing LIP; these same risk factors, if concomitant with sepsis or liver cirrhosis, correlated with a risk of developing DAD; thromboembolism and these risk factors correlated with a risk of developing alveolar hemorrhage; these risk factors and AMI correlated with a risk of developing pulmonary edema. Conclusion: Pulmonary findings in patients who died of ARF presented four histopathological patterns: DAD, pulmonary edema, LIP and alveolar hemorrhage. Underlying diseases and certain associated risk factors correlated positively with specific histopathological findings on autopsy.Keywords: Respiratory insufficiency; Autopsy; Lung diseases, interstitial; Pulmonary edema; Hemorrhage. ResumoObjetivo: Apresentar alterações histopatológicas pulmonares encontradas em autópsias de pacientes falecidos por insuficiência respiratória aguda (IRA) e verificar se doenças de base e específicos fatores de risco associados aumentam a incidência dessas alterações. Métodos: Foram revisados laudos finais de autopsias e selecionadas 3.030 autopsias de pacientes > 1 ano de idade, com infiltrado pulmonar radiológico, portadores de doença de base e fatores de risco associados, que morreram por alterações pulmonares decorrentes de IRA. Resultados: As principais alterações histopatológicas pulmonares causadoras de morte imediata foram: dano alveolar difuso (DAD); edema pulmonar; pneumonia intersticial linfocítica (PIL) e hemorragia alveolar. As principais doenças de base encontradas foram: AIDS; broncopneumonia; sepse; cirrose hepática; tromboembolismo pulmonar; infarto agudo do miocárdio (IAM); acidente vascular cerebral; tuberculose; câncer; insuficiência renal crônica e leucemia. Os principais fatores de risco associados foram: idade ≥ 50 anos; hipertensão arterial; insuficiência cardíaca congestiva; doença pulmonar obstrutiva crônica...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Alterações histopatológicas pulmonares em pacientes com insuficiência respiratória aguda: um estudo em autopsias

et al. 2008

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“…However, studies show that the incidence of diagnostic errors remained relatively constant [23, 49,55], and autopsy is a fundamental tool of quality control in medical practice [5,34,25,26].…”

Section: Introductionmentioning

confidence: 99%

“…The general rates of discrepancy between ante and post mortem diagnosis identified by various research varies between 10 and 50% depending on the postmortem examination criteria, the complexity of the necropsy, the methods used for the assessment of the differences and the studied population [5,6,31,34,39,41,45,54,11].…”

Section: Introductionmentioning

confidence: 99%

Clinical diagnosis versus autopsy diagnosis in head trauma

Velnic¹,

Hanganu²,

Ciudin³

et al. 2017

Romanian Neurosurgery

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Abstract:The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1) to total discordance (C4) and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis-missing injuries in the autopsy reports) and C3 (partial discordance in favor of the necroptic diagnosis-missing injuries in the medical files). Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral hematoma and ventricular hemorrhage (21.6%). In C3 cases the most frequently omitted injuries were subarachnoidian hemorrhage and skull base fractures autopsy diagnosis. Autopsy may identify the inconsistencies in diagnosis, the injuries frequently skipped and the factors favoring the discordance rate between the clinical death diagnosis and the autopsy diagnosis, making it a valuable tool for improving the clinical care of the patients with head trauma.

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