Hôpital Erasme, Department of Pathology, Université Libre de Bruxelles, Brussels, Belgium.
Hôpital Erasme, Department of Intensive Care, Université Libre de Bruxelles, Brussels, Belgium.
Virchows Arch. 2021 Aug;479(2):385-392. doi: 10.1007/s00428-020-03016-y. Epub 2021 Feb 13.
Autopsy is an important quality assurance indicator and a tool to advance medical knowledge. This study aims to compare the premortem clinical and postmortem pathology findings in patients who died in the Intensive Care Unit (ICU), to analyze if there are any discrepancies between them, and to compare the results to two similar studies performed in our institution in 2004 and 2007. Between January 1, 2016, and December 31, 2018, 888 patients died in the ICU and 473 underwent post-mortem examination (PME) of whom 437 were included in the present study. Autopsies revealed discrepancies between clinical diagnosis and pathologic findings according to in 101 cases (23.1%) according to Goldman classification. Forty-eight major discrepancies (class I and class II) were identified in 44 cases and the most frequent identified discrepancies were pulmonary embolism (3/12) as class I and malignancies (13/35) as class II. They were more frequent in patients hospitalized for less than 10 days then in the group with more than 10 days of hospitalization (13.8% vs 4.5%; p = 0.002). No statistical difference has been noticed concerning age, gender, and ICU stay. We observed an increase of performed autopsies and a total discrepancy rate similar to the studies performed in the same institution in 2004 (22.5%) and 2007 (21%). In conclusion, discrepancies between clinical and PME diagnoses persist despite the medical progress. Secondly, the autopsy after a short hospital stay may reveal unexpected findings whose diagnosis is challenging even if it may be suspected by the intensivist.
尸检是一项重要的质量保证指标，也是推进医学知识的工具。本研究旨在比较在重症监护病房（ICU）死亡的患者的生前临床和死后病理学发现，分析它们之间是否存在差异，并将结果与我们机构在 2004 年和 2007 年进行的两项类似研究进行比较。在 2016 年 1 月 1 日至 2018 年 12 月 31 日期间，ICU 中有 888 名患者死亡，其中 473 名接受了尸检（PME），其中 437 名被纳入本研究。尸检结果显示，根据 Goldman 分类，临床诊断与病理发现之间存在差异的病例有 101 例（23.1%）。在 44 例中发现了 48 个主要差异（I 类和 II 类），最常见的差异是肺栓塞（3/12）为 I 类和恶性肿瘤（13/35）为 II 类。在住院时间少于 10 天的患者中比在住院时间超过 10 天的患者中更常见（13.8%比 4.5%；p = 0.002）。在年龄、性别和 ICU 住院时间方面没有观察到统计学差异。我们观察到进行的尸检数量增加，并且总差异率与 2004 年（22.5%）和 2007 年（21%）在同一机构进行的研究相似。总之，尽管医学取得了进展，但临床和 PME 诊断之间仍存在差异。其次，在短时间住院后进行的尸检可能会揭示意想不到的发现，即使重症监护医生可能怀疑这些发现，但诊断仍具有挑战性。
