Missed Diagnosis of Cancer in Critically Ill Patients: A Single-Center Experience

Abstract

Abstract\ud Purpose and methods: In order to evaluate the rate of missed diagnoses (MD) of tumors in critically ill patients died in our Intensive Care Unit (ICU) and correlate them with the outcome, all the autopsy records from January 1st, 1996 and December 31st, 2014 have been reviewed. When the tumor was not diagnosed during the admission but discovered only at the post-mortem examination, the effect of the MD on the outcome was classified according to the Goldman’s criteria.\ud Results: A total of, 1045 autopsies were examined; a solid or hematological cancer was discovered in 74 cases (7%, 50 M, 24 F, age 75.5, IQR 29-90 years). Major discrepancies occurred in 42 patients, but only in one of them (2.4%) a class 1 error was identified; in the other cases the MD did not influence the outcome (class 2 errors) due to the underlying conditions determining the ICU admission and/or the very short length of stay in the ICU; for another\ud 32 patients the MD were considered without clinical relevance.\ud Conclusions: In our experience, autopsy remains an extremely valuable tool to detect MD and to improve the clinical and diagnostic procedures