Relationship between premortem and postmortem diagnosis in critically ill bone marrow transplantation patients

Objectives: To determine the relationship between the premortem and postmortem diagnosis in critically ill bone marrow transplantation patients Also, to evaluate the appropriateness of the reliance on clinical diagnosis for withdrawal of active treatment decision-making. Design: Retrospective cohort study. Setting: Two university-affiliated tertiary care medical surgical intensive care units. Patients: Critically ill bone marrow transplantation patients who died in the intensive care unit between November 1, 1994, and June 30, 1999, and underwent postmortem examination. Intervention: Review of medical records by two independent data extractors. Clinical diagnosis and cause of death in the intensive care unit were compared with the final autopsy report. Measurements and Main Results. Premortem clinical diagnoses were classified according to the Goldman criteria and compared with postmortem findings. Twenty-eight autopsies were done. Ten of 28 (36%) patients had discrepancies uncovered on autopsy; only two discrepancies would have influenced patient management and none would have altered patient outcome. Twenty patients had their active treatment withdrawn and underwent postmortem examination. None of the discrepancies noted would have altered outcome in these patients. Conclusion: In the bone marrow transplantation population, there is significant concordance between clinical diagnosis and postmortem findings. Reliance on clinical diagnosis may be valid for withdrawal of active treatment decision-making in these patients.