Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive care: a retrospective cohort study

• Published in: Virchows Archiv : an international journal of pathology Vol. 478; no. 6; pp. 1173 - 1178
• Main Authors: Driessen, Rob G. H., Latten, Bartholomeus G. H., Bergmans, Dennis C. J. J., Hulsewe, Riquette P. M. G., Holtkamp, Johanna W. M., van der Horst, Iwan C. C., Kubat, Bela, Schnabel, Ronny M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2021; Springer Nature B.V
• Subjects: Autopsies; Autopsy; Cohort analysis; Death; Diagnosis; Forensic medicine; Intensive care; Medical diagnosis; Medicine; Medicine & Public Health; Mortality; Myocardial infarction; Original; Original Article; Pathology; Patients; Quality in Pathology; Sepsis; Diagnostic discrepancy; Sepsis; Septic shock; Intensive care; Autopsy
• ISSN: 0945-6317; 1432-2307
• DOI: 10.1007/s00428-020-02984-5

Early death in sepsis occurs frequently; however, specific causes are largely unknown. An autopsy can contribute to ascertain causes of death. The objective of the study was to determine discrepancies in clinical diagnosis and postmortem findings in septic intensive care unit (ICU) patients deceased within 48 h after ICU admission. All septic ICU patients who deceased within 48 h after ICU admission were identified and included. Four intensivists determined the clinical cause of death by medical record review. An autopsy was performed within 24 h of death. Clinical diagnosis and postmortem findings were compared and classified as autopsy-identified missed clinical diagnoses and autopsy-refuted diagnoses. Class I and II missed major diagnoses using the Goldman criteria were scored. Between 2012 and 2017, 1107 septic patients were admitted to ICU. Of these, 344 patients (31%) died, of which 97 patients (28%) deceased within 48 h. In 32 (33%) early deceased patients, an autopsy was agreed. There were 26 autopsy-identified missed clinical diagnoses found, mostly myocardial infarction ( n  = 4) and pneumonia ( n  = 4). In four patients (13%), a class I discrepancy was found. In fourteen patients (42%), a class II discrepancy was found. In conclusion, an autopsy is an important diagnostic tool that can identify definite causes of death. These diagnoses deviate from diagnoses established during admission in early deceased sepsis patients.