Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients

Pastores, Stephen M.; Dulu, Alina; Voigt, Louis; Raoof, Nina; Alicea, Margarita; Halpern, Neil A.

doi:10.1186/cc5782

Cited by 90 publications

(73 citation statements)

References 28 publications

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“…Even in these cases, autopsy may help to exclude some suspected conditions as the cause of death. However, Pastores et al (19) described in an oncologic ICU a category of patients (17%) who experienced prolonged ICU and hospital length of stay and had uncertain premortem diagnoses, and their autopsies were inconclusive, showing only nonspecific chronic inflammatory and fibrotic changes in various organs.…”

Section: Discussionmentioning

confidence: 99%

Clinical diagnoses and autopsy findings

Tejerina

Esteban

Fernández-Segoviano

et al. 2012

Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Clinical diagnoses and autopsy findings

Tejerina

Esteban

Fernández-Segoviano

et al. 2012

Critical Care Medicine

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“…5 Other studies since then have shown similar results with discrepancy rates ranging from 8 to more than 30%, depending on the clinical setting. [5][6][7][8][9][10][11] No study to date has adequately addressed the hypothesis that the intensity and the extent of antemortem diagnostic evaluation correlate with an actual decrease in the number of unexpected discrepancies at autopsy. We retrospectively reviewed all adult autopsies performed at a tertiary care center over a 4-year period to assess whether the discrepancy rate correlated with an index of diagnostic intensity.…”

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confidence: 99%

Clinical setting and extent of premortem evaluation do not predict autopsy discrepancy rates

2010

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Autopsy rates have been affected by a number of factors, including technological advances and clinician beliefs of the diminished value of the autopsy. Such factors have resulted in a cultural shift in medicine away from the autopsy. Despite this shift, a number of studies have shown significant differences between antemortem clinical diagnoses and postmortem findings. Surveys of clinician beliefs about the autopsy have pointed toward antemortem diagnostic advancements as an important factor in declining rates. No study to date has addressed the hypothesis that such perceptions in diagnostic certainty have been matched by an actual decay in the yield of valuable or new information obtained by the autopsy. To address this hypothesis, we retrospectively compared the class I and class II discrepancies identified in 284 patients who died in three clinical settings with differing intensities of antemortem diagnostic workup. Despite a significantly different intensity of antemortem workup for patients in each clinical setting, including patients on a medical intensive care unit, patients on a surgical service and patients in an affiliated nursing home, discrepancy rates were found to be similar. Overall discrepancy rates for the medical intensive care unit, surgery service and nursing home patients were 27.8, 32.7 and 31.3%, respectively (P ¼ 0.84). In addition, we found no statistical difference in the complexity of workup in discrepant and nondiscrepant cases in each clinical setting. Our study data refute the hypothesis that the intensity of antemortem diagnostic evaluation correlates with an actual decrease in the rate of major diagnostic discrepancies identified at autopsy.

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“…Stephen M Pastores. [18] showed in their study that majority of class II discrepancies were due to cardiopulmonary complications (70).…”

Section: Discussionmentioning

confidence: 99%

The Role of Autopsy in Medical Intensive Care Unit: Comparison of Clinical and Postmortem Diagnoses

Dahake¹,

Khedekar²,

Faizal³

et al. 2016

jemds

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Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients

Cited by 90 publications

References 28 publications

Clinical diagnoses and autopsy findings

Clinical diagnoses and autopsy findings

Clinical setting and extent of premortem evaluation do not predict autopsy discrepancy rates

The Role of Autopsy in Medical Intensive Care Unit: Comparison of Clinical and Postmortem Diagnoses

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