Objective: To determine the degree of concordance
between clinical cause of death and autopsy diagnosis in a medical ICU
Design: Retrospective medical chart
and autopsy report review.
Setting: MICU in a tertiary
Patients: Consecutive admissions to
an MICU over a 2-year period from January 1, 1994, to December 31,
main results: One thousand eight hundred patients were admitted
to the MICU during the study period. There were 401 in-ICU deaths
(22.3%). The autopsy rate was 22.7% (91 of 401). The mean ± SD age
of the autopsied patients (55.1 ± 13.5 years) was lower than
those without autopsy (62.4 ± 15.2 years; p < 0.001). The two
groups were otherwise similar with regard to sex, race, APACHE (acute
physiology and chronic health evaluation) III scores, and lengths of
stay in the MICU and hospital. The discordance between clinical and
postmortem diagnoses was 19.8% (95% confidence interval, 12 to 29%).
There were no differences in age, sex, APACHE III scores, predicted
mortality, and lengths of stay in MICU hospital between patients with
concordant and discordant diagnoses. In 44.4% (8 of 18) of the
discordant cases, management would have been modified had the autopsied
diagnosis been made premortem. Seven of the autopsied patients had
organ transplantation. Three of the patients who had organ
transplantation had discordant diagnoses, including two patients with
disseminated fungal infection that was not diagnosed clinically.
Although the observed discordance in transplant patients (43%) was
higher than in those without transplant (19%), the difference was not
statistically significant (p = 0.15).
Younger patients tended to have a higher autopsy rate than older
patients. The discordance between the clinical cause of death and
postmortem diagnosis was 19.8%. In 44.4% of the discordant cases,
knowledge of the correct diagnosis would have altered