Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive care: a retrospective cohort
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ORIGINAL ARTICLE
Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive care: a retrospective cohort study Rob G. H. Driessen 1,2 & Bartholomeus G. H. Latten 3 & Dennis C. J. J. Bergmans 1 & Riquette P. M. G. Hulsewe 1 & Johanna W. M. Holtkamp 4 & Iwan C. C. van der Horst 1 & Bela Kubat 3 & Ronny M. Schnabel 1 Received: 15 October 2020 / Revised: 18 November 2020 / Accepted: 1 December 2020 # The Author(s) 2020
Abstract 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. Keywords Autopsy . Intensive care . Sepsis . Septic shock . Diagnostic discrepancy
Background Sepsis is a life-threatening syndrome following a dysregulated host response to infection [1]. It still causes major public health concerns and has an increasing incidence [2]. Early death occurs in one-third of these patients [3]; however, studies investigating specific causes of death are scarce. This article is part of the Topical Collection on Quality in Pathology * Rob G. H. Driessen [email protected] 1
Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
2
Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
3
Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
4
Department of Intensive Care Medicine, St. Jans Gasthuis, Weert, The Netherlands
Autopsy, being the ultimate diagnostic test [4], is a reliable diagnostic tool in determining causes of death in critically ill patients. It also has an educational role, as studies show that attending necropsies foster clinical problem solving [5] and most st
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