Post mortem examination in the intensive care unit: still useful?
Intensive Care Medicine(2004)
摘要
Objective Post mortem examination rates have decreased worldwide and their usefulness has been challenged. The aim of this study was to compare ante- versus post mortem findings in a multidisciplinary ICU. Design Retrospective study. Setting Thirty-one-bed, medico-surgical ICU. Patients All patients who died on the ICU and underwent an autopsy examination in 1999. Measurements Records from autopsies were compared with clinical records. A modified Goldman’s criteria was used to categorize the post mortem diagnoses. Unexpected findings were evaluated according to the duration of hospitalization prior to death (fewer than or more than 10 days). Results Among 2,984 ICU admissions, there were 489 deaths; 222 autopsies were conducted (45.4% autopsy rate). Post mortem examination revealed unexpected findings in 50 patients (22.5%), including malignancy (22 [9.9%]), fungal infections (9 [4%]), pulmonary embolism (7 [3.2%]), nosocomial infections (3 [1.3%]), Hashimoto’s disease (3 [1.3%]), mesenteric infarction (2 [0.9%]), Barrett’s esophagus (2 [0.9%]), endocarditis (1 [0.5%]) and myocardial infarction (1 [0.5%]). These unexpected findings were considered as major (Class I/II) in 19 (8.5%), and minor (Class III) in 31 (14%) patients. In patients with a short ICU length of stay (<10 days), there were more major unexpected findings than minor, while after a prolonged stay (>10 days), minor unexpected findings were more common. Conclusions After a short ICU stay (<10 days), autopsy revealed discrepancies primarily related to the cause of death associated with diseases whose diagnosis can be difficult. Following more prolonged ICU stays (>10 days), autopsy was more likely to reveal coexisting diseases unrelated to death.
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关键词
Intensive Care Unit,Pulmonary Embolism,Medical Education,Endocarditis,Medical Technology
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