Premortem clinical diagnoses and postmortem autopsy findings

Discrepancies in critically ill cancer patients

Stephen M. Pastores, Alina O. Dulu, Louis Voigt, Nina Raoof, Margarita Alicea, Neil A. Halpern

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Introduction: Limited data are available regarding the relationship of premortem clinical diagnoses and postmortem autopsy findings in cancer patients who die in an oncologic intensive care unit (ICU). The purposes of this study were to compare the premortem clinical and postmortem diagnoses of cancer patients who died in the ICU and to analyze any discrepancies between them. Methods: This is a retrospective review of medical records and autopsy reports of all cancer patients who died in a medical-surgical ICU and had an autopsy performed between 1 January 1999 and 30 September 2005 at a tertiary care cancer center. Premortem clinical diagnoses were compared with the postmortem findings. Major missed diagnoses were identified and classified, according to the Goldman criteria, into class I and class II discrepancies. Results: Of 658 deaths in the ICU during the study period, 86 (13%) autopsies were performed. Of the 86 patients, 22 (26%) had 25 major missed diagnoses, 12 (54%) patients had class I discrepancies, 7 (32%) had class II discrepancies, and 3 (14%) had both class I and class II discrepancies. Class I discrepancies were due to opportunistic infections (67%) and cardiac complications (33%), whereas class II discrepancies were due to cardiopulmonary complications (70%) and opportunistic infections (30%). Conclusion: There was a discrepancy rate of 26% between premortem clinical diagnoses and postmortem findings in cancer patients who died in a medical-surgical ICU at a tertiary care cancer center. Our findings underscore the need for enhanced surveillance, monitoring, and treatment of infections and cardiopulmonary disorders in critically ill cancer patients.

Original languageEnglish (US)
Article numberR48
JournalCritical Care
Volume11
Issue number2
DOIs
StatePublished - Apr 20 2007
Externally publishedYes

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Critical Illness
Autopsy
Intensive Care Units
Neoplasms
Opportunistic Infections
Critical Care
Tertiary Care Centers
Medical Records
Infection

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Premortem clinical diagnoses and postmortem autopsy findings : Discrepancies in critically ill cancer patients. / Pastores, Stephen M.; Dulu, Alina O.; Voigt, Louis; Raoof, Nina; Alicea, Margarita; Halpern, Neil A.

In: Critical Care, Vol. 11, No. 2, R48, 20.04.2007.

Research output: Contribution to journalArticle

Pastores, Stephen M. ; Dulu, Alina O. ; Voigt, Louis ; Raoof, Nina ; Alicea, Margarita ; Halpern, Neil A. / Premortem clinical diagnoses and postmortem autopsy findings : Discrepancies in critically ill cancer patients. In: Critical Care. 2007 ; Vol. 11, No. 2.
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abstract = "Introduction: Limited data are available regarding the relationship of premortem clinical diagnoses and postmortem autopsy findings in cancer patients who die in an oncologic intensive care unit (ICU). The purposes of this study were to compare the premortem clinical and postmortem diagnoses of cancer patients who died in the ICU and to analyze any discrepancies between them. Methods: This is a retrospective review of medical records and autopsy reports of all cancer patients who died in a medical-surgical ICU and had an autopsy performed between 1 January 1999 and 30 September 2005 at a tertiary care cancer center. Premortem clinical diagnoses were compared with the postmortem findings. Major missed diagnoses were identified and classified, according to the Goldman criteria, into class I and class II discrepancies. Results: Of 658 deaths in the ICU during the study period, 86 (13{\%}) autopsies were performed. Of the 86 patients, 22 (26{\%}) had 25 major missed diagnoses, 12 (54{\%}) patients had class I discrepancies, 7 (32{\%}) had class II discrepancies, and 3 (14{\%}) had both class I and class II discrepancies. Class I discrepancies were due to opportunistic infections (67{\%}) and cardiac complications (33{\%}), whereas class II discrepancies were due to cardiopulmonary complications (70{\%}) and opportunistic infections (30{\%}). Conclusion: There was a discrepancy rate of 26{\%} between premortem clinical diagnoses and postmortem findings in cancer patients who died in a medical-surgical ICU at a tertiary care cancer center. Our findings underscore the need for enhanced surveillance, monitoring, and treatment of infections and cardiopulmonary disorders in critically ill cancer patients.",
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