Elsevier

Mayo Clinic Proceedings

Volume 78, Issue 8, August 2003, Pages 947-950
Mayo Clinic Proceedings

Original Article
The Role of Autopsy in the Intensive Care Unit

https://doi.org/10.4065/78.8.947Get rights and content

Objective:

To identify the frequency and spectrum of clinically relevant diagnoses found at autopsy but not determined before death in adult patients admitted to an intensive care unit (ICU).

Patients and Methods:

We retrospectively reviewed medical records and autopsy reports of patients admitted to ICUs from January 1, 1998, to December 31, 2000. Disagreements between autopsy and antemortem diagnoses were classified as type I or type II errors. A new major diagnosis with potential for directly impacting therapy was considered a type I error. Type II errors included important findings that would not have likely changed therapy.

Results:

Of 1597 deaths in all ICUs during the study period, autopsies were performed in 527 patients (33%). Autopsy reports were available in 455 patients, of whom 19 (4%) had type I errors and 78 (17%) had type II errors. The most common type I error was cardiac tamponade. There were no significant differences in age, sex, or length of stay in the ICU or hospital among patients with and without diagnostic errors or among patients with type I and II errors. Seventy-eight patients had 81 type II errors. Organ transplant recipients had more type I or II errors than did nontransplant patients (35% vs 20%; P=.04).

Conclusions:

Diagnoses with impact on therapy and outcome are missed in approximately 4% of deaths of adult patients admitted to the ICU. Transplant recipients are especially likely to have occult conditions for which additional therapy might be indicated.

Section snippets

PATIENTS AND METHODS

We reviewed the medical records, Acute Physiology and Chronic Health Evaluation III database, and autopsy reports of patients treated in adult ICUs of the Mayo Medical Center, Rochester, Minn, from January 1, 1998, through December 31, 2000. The ICUs included the medical ICU, coronary care unit, neurologic ICU, surgical and trauma ICUs at Saint Marys Hospital, and a multidisciplinary ICU at Rochester Methodist Hospital. The medical staff make rounds in these units every day, and medical

RESULTS

During the study period, 1597 deaths occurred in the ICUs. Autopsies were performed in 527 patients (33%). Patients’ mean ± SD age was 59.6±18.7 years. Autopsy reports were available in 455 adult patients, of whom 19 (4%) had type I errors and 78 (17%) had type II errors (Table 1). The other 72 patients did not meet the inclusion criteria because they died in the pediatric ICU (46); they died in the chronic ventilator unit (5), which is not an ICU; or they did not authorize their medical charts

DISCUSSION

In this study, we found that one third of patients who died in the ICU underwent autopsy, and type I or II errors were found in 21%. There were no significant differences in age, sex, or length of hospital stay among patients with and without errors. Major diagnoses with impact on treatment were missed in 4% of patients. Pericardial tamponade was the most common type I error, occurring in 4 patients. Infections were the most common type II errors. Errors were more likely to occur in transplant

REFERENCES (24)

  • AG Scottolini et al.

    The autopsy in clinical quality control

    JAMA

    (1983)
  • CS Landefeld et al.

    Diagnostic yield of the autopsy in a university hospital and a community hospital

    N Engl J Med

    (1988)
  • Cited by (25)

    • Diagnostic Error: Why Now?

      2022, Critical Care Clinics
    • High-Risk Chief Complaints I: Chest Pain—The Big Three (an Update)

      2020, Emergency Medicine Clinics of North America
    • The impact of antemortem computed tomographic scanning on postmortem examination rate and frequency of missed diagnosis. A retrospective analysis of postmortem examination data.

      2015, Journal of Critical Care
      Citation Excerpt :

      The single-center retrospective design had inherent limitations in data collection; for example, we were not able to collect reliable data of the underlying comorbidities of the deceased. Most studies of this nature, however, are retrospective [3-5]. In addition, the retrospective analysis does not allow one to follow the clinical decision-making process that led to the final diagnostic and therapeutic strategies.

    • Deaths at a Level 1 Trauma Unit: A clinical finding and post-mortem correlation study

      2012, Injury
      Citation Excerpt :

      Missed injuries in trauma patients can lead to increased morbidity and mortality, and continue to be a cause of death in trauma patients even with the introduction of a tertiary survey.2,5,14 Previous studies have reported an incidence of missed injuries ranging between 2.5 and 65%.1,5,8,9 The existing literature defines missed injuries in a number of different ways.

    • High-Risk Chief Complaints I: Chest Pain-The Big Three

      2009, Emergency Medicine Clinics of North America
    • Comparison of premortem clinical diagnosis and autopsy findings in patients with burns

      2008, Burns
      Citation Excerpt :

      The autopsy rate in this study was 100%. This autopsy rate is high, as compared to other studies in an adult ICU setting, in which the autopsy rate ranged from 33 to 89% [6,24,25] and slightly higher than in Fish et al. study [3]. In Finland medico-legal autopsies are obligatory by law in certain circumstances.

    View all citing articles on Scopus
    View full text