engleski

Autopsy as a fundamental part of quality assurance in the intensive care unit

The role and number of autopsies performed in hospitals have declined over the last decades. An increasing number of retrospective studies analyzed tried to establish the role of autopsy as a fundamental part of progress in medical knowledge. Intensive care unit (ICU) data pointed to major discrepancies between clinical and autopsy diagnoses in 10%-25% of cases. The aim of this study was to assess the correlation between clinical diagnosis and subsequent autopsy findings in adult patients and to identify the types of errors in the diagnosis to help upgrade the quality of care at ICU. We retrospectively reviewed medical records and final autopsy reports of patients admitted to surgical and non-surgical ICU at our hospital from January 1, 2001 until December 31, 2005, classifying clinical and pathological diagnoses according to the International Classification of Diseases 10th revision (1994). In order to compare discrepancies between premortem and postmortem diagnoses, we used modified classification of Goldman, which divides diagnoses into 5 classes: class I and II discrepancies were termed major, class III and IV as minor if clinically diagnosable or not, and class V as non-discrepant diagnosis. This study addressed class I: a discrepant primary diagnosis with adverse impact on survival (e.g., unrecognized treatable infection diagnosed as inoperable tumor mass) ; and class II: a discrepant primary diagnosis with equivocal impact on survival (e.g., pulmonary embolus diagnosed and treated as acute myocardial infarction). During the study period, there were 5133 hospital deaths, including 2760 (53.7%) and 722 (15.0%) patients that died at internal and surgical departments, respectively. The total number of autopsies (n=1415) performed accounted for a minor part (27.6%) of the total number of patients that died at internal (n=970 ; 68.5%) and surgical (n=122 ; 8.6%) departments. The share of autopsy at internal department ICU was 37.4% (363 of 970) and at surgical ICU 69.7% (85 of 122). Out of 448 ICU autopsies analyzed, 109 (24.3%) were classified as Goldman class I and 43 (9.6%) as class II. There was no significant sex difference. The most common discrepant cause of death was cardiovascular disease (46.6%). The share of pulmonary embolism (up to 40%) was the leading misdiagnosed cause of death in both classes (I and II). It is concluded that even in the era of modern diagnostic technologies, pertinent information on autopsies performed is one of the fundamental parts of diagnostic methods that can improve future management of ICU patients.

Autopsy

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