Chest
Clinical Investigations in Critical CareA Study of Consecutive Autopsies in a Medical ICU: A Comparison of Clinical Cause of Death and Autopsy Diagnosis
Section snippets
Study Patients
Consecutive patients admitted to the MICU at the Cleveland Clinic Foundation over a 2-year period from January 1, 1994, to, December 31, 1995, were studied retrospectively. The MICU is staffed by, Residents from the Internal Medicine Residency Program, Fellows fromthe Pulmonary and Critical Care Department, and Attendings for the, Pulmonary Department, board certified in internal medicine, pulmonarymedicine, and critical care medicine. The medical staff makes roundsevery day, and every medical
Results
During the study period, there were 1,800 admissions to the MICU. The in-ICU mortality was 22.3% (401 of 1,800 patients). Theautopsy rate was 22.7% (91 of 401 deaths). The patientswho had an autopsy were younger than those without autopsy(p < 0.001; Table 1). There were no significant differences in sex, race, APACHE IIIscores, and lengths of stay in the MICU and hospital between thesetwo groups (Table 1).
Discussion
The 22.7% autopsy rate in our study is higher than the overallnational hospital autopsy rates in the United States (12%) andsome studies in the United Kingdom (11 to 24%),22 and arecomparable to the autopsy rates in two postmortem studies inadult ICUs (31% and 29%, respectively).1718 The largestcomparison of clinical and autopsy diagnoses was made by, Britton,13 from 1970 to 1971. In his analysis of 400consecutive deaths in the medical department with an autopsy rate of96%, the main cause of
Conclusion
Advances in diagnostic technology have not diminished the value ofautopsy. The discordance between the clinical cause of death andpostmortem diagnosis was 19.8%. In 44.4% of the discordant cases, knowledge of the correct diagnosis would have altered therapy. Postmortem study can serve as a valuable monitor of quality control indiagnostic accuracy of MICU patients.
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