Should we confirm our clinical diagnostic certainty by autopsies?

被引:68
作者
Podbregar, M [1 ]
Voga, G [1 ]
Krivec, B [1 ]
Skale, R [1 ]
Pareznik, R [1 ]
Gabrscek, L [1 ]
机构
[1] Gen Hosp Celje, Dept Intens Internal Med, Celje 3000, Slovakia
关键词
autopsy; postmortem; diagnostic errors; premortern errors; critical care;
D O I
10.1007/s00134-001-1129-x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To evaluate the frequency of diagnostic errors assessed by autopsies. Design and setting: Retrospective review of medical and pathological records in an 11-bed closed medical intensive care unit (ICU) at a 860-bed general hospital. Patients and interventions: Patients who died in the ICU between January 1998 and December 1999. Medical diagnoses were rated into three levels of clinical diagnostic certainty: complete certainty (group L1). minor diagnostic uncertainty (group L2), and major diagnostic uncertainty (group 1-3). The patients were divided into three error groups: group A, the autopsy confirmed the clinical diagnosis; group B, the autopsy demonstrated a new relevant diagnosis which would probably not have influenced the therapy and outcome. group C, the autopsy demonstrated a new relevant diagnosis which would probably have changed the therapy and outcome. Results: The overall mortality was 20.3 % (270/1331 patients). Autop- sics were performed in 126 patients (46.9 % of deaths), more often in younger patients (66.6 +/- 13.9 years vs 72.7 +/- 12.0 years, p < 0.001), in patients with shorter ICU stay (4.7 +/- 5.6 days vs 6.7 +/- 8.7 days, p = 0.054), and in patients in group L3 without chronic diseases (15/126 vs 1/144, p < 0.001). Fatal but potentially treatable errors [group C, 12 patients (9.5 %)] were found in 8.7 %, 10.0 %, and 10.5 % of patients in groups L1, L2, and L3, respectively (NS between groups). An ICU length of stay shorter than 24 h was not related to the frequency of group C errors. Conclusions: Autopsies are performed more often in younger patients without chronic disease and in patients with a low clinical diagnostic certainty. No level of clinical diagnostic certainty could predict the pathological findings.
引用
收藏
页码:1750 / 1755
页数:6
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