Discrepant autopsy findings in ICU patients remain common

Nearly one third of the autopsies conducted on patients who died while in one intensive care unit in France over a 3-year period revealed major diagnostic errors, physicians report. Many of these indiscrepancies were probably due to false-positive and false-negative findings on diagnostic studies.

“At the beginning of the 21st century, autopsies still have a major role to play in assuring and improving the quality of medical care by monitoring diagnostic accuracy and treatment of the ICU patient,” Dr. Alain Combes and colleagues conclude in their report, published in the Archives of Internal Medicine for February 23.Although discrepancies between clinical and autopsy diagnoses have been reported, theirs is the first to prospectively examine this issue, note the authors, who are based at Groupe Hospitalier Pitie-Salpetriere in Paris.They documented outcomes for 1492 patients admitted to their ICU between 1995 and 1998. Of the 315 who died during their stay, 167 were autopsied. In the other cases, authorization from family members could not be obtained.Thirty-three diagnoses, primarily cancer, endocarditis, MI and pneumonia, were refuted, the authors report. Another 171 diagnoses were made only at autopsy; missed diagnoses included infarctions, strokes, pulmonary emboli, cancer and infections.Class I errors – missed major diagnoses that could have changed patient management if recognized – were identified in 17 patients. Major missed diagnoses that would not have changed patient care were identified in 44 patients. Major discrepancies were more likely in patients who were immunocompromised. However, these patients were no less likely to have undergone computed tomography, ultrasound or fiberoptic bronchoscopy.Dr. Combes’ team notes that many diseases are still difficult to identify. “For example,” they write, “the available methods to diagnose fungal infections do not reliably differentiate between colonization and systemic infections, distal pulmonary emboli can be missed on computed tomographic scan, and endocarditis can be overlooked on transesophageal echocardiography.”(Source: Arch Intern Med 2004;164:389-392: Reuters Health: February 23, 2004: Oncolink)