Infectious Diseases Detected at Autopsy at an Urban Public Hospital, 1996–2001

Abstract

Previous studies have demonstrated significant discrepancy rates between clinical and autopsy diagnoses. However, infectious diseases have not received emphasis in these studies. We conducted a study to determine whether the clinical and autopsy diagnoses of infectious diseases are concordant or discrepant and to determine discrepancy rates. Retrospective reviews of the records of 276 patients (adults, 182; fetuses and neonates, 94) who underwent autopsy during the years 1996 through 2001 were performed. Comparison of clinical and autopsy diagnoses was performed using the Goldman classification scheme. Of 182 adult patients, 137 (75.3%) had an infectious disease at autopsy. In 59 (43.1%) of 137 patients, the infectious disease diagnoses were unknown clinically. Of 94 fetuses and neonates, 45 (48%) had an infectious disease at autopsy. In 26 (58%) of 45 patients, the infectious disease diagnoses were unknown before death. There are substantial discrepancies between clinical and autopsy diagnoses of infectious diseases. In adults, acute bronchopneumonia is the infectious disease most often missed clinically; in fetuses and neonates, it is acute chorioamnionitis.

Intrauterine inflammation and preterm delivery

“…Infection or inflammation was found in 48% of cases. 22 From the cases with infection or inflammation, 42% of them had a relevant clinical history, whereas 58% had no history. The most frequent diagnosis was chorioamnionitis.…”

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

“…Data from two other studies on the prevalence of pneumonia in autopsies were similar to those of the present study, ranging from 21.8% to 29.5%. (9,10) In the elderly, infectious pneumonitis was found in 40.6% of the autopsied cases, (11) and, in a study on ventilator-associated pneumonia, (12) it was reported that NP (identified in autopsies) accounted for 60% of the deaths due to nosocomial infections.…”

“…Despite the recognized efficacy of autopsy as a tool for medical education and as a method for the evaluation of diagnostic accuracy in general, (23) the reduction in autopsy rates is a phenomenon observed worldwide, (9)(10)(11)(23)(24)(25) possibly due to the interaction of a number of factors, such as the development of sensitive diagnostic methods, which reduce the need for autopsy to investigate the cause of death; the aging of the population, which makes death be interpreted as a natural part of the process; a lack of interest on the part of the team of professionals, who question the validity of the procedure; the fear of assigning blame to the physician in charge; and the idea that autopsy findings can set a precedent for filing a medical malpractice lawsuit. (9,11,25) Consequently, autopsy studies have become scarce in the literature, and the potential of autopsies for diagnosis, medical education and evaluation of the quality of diagnosis has been minimized.…”

“…(9,11,25) Consequently, autopsy studies have become scarce in the literature, and the potential of autopsies for diagnosis, medical education and evaluation of the quality of diagnosis has been minimized. (9) Although our hospital had a relatively low autopsy rate in the past decade (12.7%), there was no seasonal influence and we were able to collect the demographic, clinical and anatomopathological variables of a series of 199 patients whose cause of death (underlying or contributing) was NP. However, our study had some potential limitations.…”

“…(4)(5)(6)(7)(8) Therefore, it is believed that aspiration is the leading cause of ICU-acquired NP. (5,6) Although pneumonia is the principal infectious disease found in autopsies, (9) there have been no autopsy studies determining whether anatomopathological findings correlate with NP. Aspiration, which is histologically documented by the presence of vegetal cells or muscle fibers within the pulmonary alveoli with neutrophilic inflammatory infiltrate, deserves special attention due to its key role in causing NP.…”