Autopsies of ICU Deaths Show Missed Diagnoses

A study of performed autopsies has revealed major discrepancies with clinical diagnoses in 31.7% of patients who died in the intensive care unit (ICU). The findings were published in the February 23, 2004, issue of The Archives of Internal Medicine.

Autopsy rates have dropped in recent years, because of fears of legal action over misdiagnoses, the reluctance of family members to authorize the procedure, and general doubt as to its usefulness. Researchers at the Groupe Hospitalier Pitie-Salpetriere (Paris, France; www.chups.jussieu.fr) conducted a three-year study of 1,492 patients in the ICU. Of these, 315 died and 167 patients were autopsied. The autopsies showed major diagnostic mistakes for 31.7% of the patients and revealed 21 missed cancers, 12 strokes, 11 heart attacks, 10 pulmonary emboli, and nine cases of endocarditis. The researchers found that the most common reason for not performing an autopsy was family refusal (79.7%).

"Even in the era of modern diagnostic technology, regular comparisons of clinical and autopsy diagnoses provide pertinent information that might improve future management of ICU patients,” the researchers concluded. The study was led by Alain Combes, M.D., Ph.D.




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