Study compares clinical diagnoses and autopsy diagnoses in ICU deaths

CHICAGO – Comparing clinical diagnoses with autopsy findings for patients who died in intensive care units (ICUs) provides information about underlying missed diagnoses, according to an article in the February 23 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, autopsy rates have decreased worldwide. The reasons for the decline in autopsy rates are attributed to fear of potential legal repercussions should misdiagnoses be discovered, reluctance of families to give permission for the procedure, and doubt regarding the usefulness of autopsies given today's modern diagnostic techniques. Recent studies suggest that major discrepancies between clinical and autopsy diagnoses exist, and may be discovered in 19 percent to 27 percent of autopsies performed on patients who die in intensive care units.

Alain Combes, M.D., Ph.D., from Groupe Hospitalier Pitie-Salpetriere, Paris, and colleagues conducted a three-year study of 1,492 intensive care unit patients. Of these patients, 315 died, and 167 were autopsied.

The most common reason for not performing an autopsy (79.7 percent) was family refusal, according to the researchers. Among the 694 clinical diagnoses, 33 (4.8 percent) were refuted and 13 (1.9 percent) were judged incomplete by autopsy findings. However, autopsies also revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 heart attacks, 10 pulmonary emboli (blood clot in the lungs) and 9 endocarditis (inflammation of the heart valves).

"With an autopsy rate of 53 percent, major diagnostic errors were identified for 31.7 percent of the autopsied patients, and the correct diagnosis would have changed management and possibly resulted in a cure or prolonged survival for up to 10 percent of patients," the authors write.

"Even in the era of modern diagnostic technology, regular comparisons of clinical and autopsy diagnoses provide pertinent information that might improve future management of ICU patients," the researchers conclude.

(Arch Intern Med. 2004;164:389-392. Available post-embargo at http://www.archinternmed.com)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

To contact Alain Combes, M.D., Ph.D., e-mail alain.combes@psl.ap-hop-paris.fr.

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