Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients

Abstract

Worldwide, various autopsy studies have shown a decrease in the diagnostic error rate over the last years. The cause of this positive development is mainly due to the improvement of modern medicine. However, intensive care unit patients are thought to have a higher risk for diagnostic errors, which is documented in several studies in the adult population. In contrast, there is only limited information about diagnostic errors in pediatrics, particularly in pediatric and neonatal intensive care units. The aims of this study were to analyze the spectrum of childhood death, determine the prevalence and distribution of autopsy-confirmed diagnostic errors, and describe patient characteristics that might have influenced the discordance between antemortem and postmortem findings. We analyzed 143 autopsy reports from 2004 to 2013 and correlated these with clinical reports. The overall autopsy rate during this interval was 20.3%. The leading causes of death were congenital malformations (28%), diseases closely associated with perinatal disorders (25%), disorders of the cardiovascular system (18%), and infections (15%). Additional findings were obtained in 23% of the autopsies. Major diagnostic errors were found in 6%, the lowest reported value in a developed country as yet. Most cases (75%) showed complete concordance between clinical diagnoses and postmortem findings, in line with improvements in diagnostic and therapeutic processes over the last decades. In conclusion, autopsy of neonates, infants, and children represents an important tool for monitoring the quality of pediatric and neonatal medical care.

Genetic aetiology of early infant deaths in a neonatal intensive care unit

“…Another study enrolled 35 infants younger than 4 months of age with an acute illness of suspected genetic cause in NICUs or paediatric intensive care units (PICUs), and identified 21 (60%) infants with a genetic disorder 35. Several studies concerned with death in NICUs have demonstrated the causes and clinical characteristics of death in neonates,36 end-of-life care practices and decisions,37 as well as the value of postmortem autopsy 38. However, genetic causes of death in NICUs are less frequently reported.…”

The Value of Autopsy in Neonates in the 21st Century

“…Reports in other NICUs range from 20.3 to 82% [2, 4]. Additional findings determined by autopsy (class I–IV) were encountered in 48% of the cases, consisting of major (24%) and minor (24%) additional findings, also referred to as diagnostic errors.…”

“…Since clinical manifestations of conditions in newborn infants are often nonspecific [2], unintentionally delayed, wrong, or missed diagnoses are still inevitable. In the literature, the latter are defined as diagnostic errors [3].…”

“…Although adult and pediatric intensive care unit patients seem to have a higher risk of diagnostic errors [5, 6], limited information is available on diagnostic errors in NICU patients in particular [2, 4]. Even less is known about the clinical relevance of additional findings, missed due to the use of postmortem MRI instead of autopsy.…”

Diagnostic Errors in the Neonatal Intensive Care Unit: A Case Series

“…4 To date, however, the few studies on diagnostic errors in the NICU have been autopsy-based evaluations that did not assess nonlethal diagnostic errors. 4 5…”