Association of pre mortem diagnosis and autopsy findings in pediatric intensive care unit versus emergency department versus ward patients

Brahm Goldstein, Leon Metlay, Christopher Cox, Jeffrey S. Rubenstein

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: As part of the overall quality assurance program for the Department of Pediatrics, we determined whether there were differences in the rates of unexpected autopsy findings between pediatric intensive care unit (ICU), emergency department, and ward patients. Design: Prospective, descriptive study. Setting: Tertiary care children's hospital. Patients: Pediatric deaths (n = 212). Interventions: None. Measurements and Main Results: Autopsies were obtained more frequently in emergency department patients (27/29 [93%]) compared with pediatric ICU (08/121 [73%]) and ward (42/62 [68%]) patients (p = .03). The medical examiner's cases were more frequently from emergency department patients (22/27 [81%]) compared with pediatric ICU (39/88 [44%]) or ward (11/42 [26%]) patients (p < .001). We found unexpected autopsy findings in 19 (12%) of 157 patients. There were no unexpected findings from the medical examiner's cases. The most common unexpected findings were unidentified infections (n = 7 [three fungal, three vital, and one nonspecific]) and unrecognized cardiac malformations (n = 4). Unexpected findings occurred more frequently in pediatric ICU patients (16/80 [18%]) vs. emergency department (2/27 [7%]) or ward (1/42 [2%]) patients (p = .03). The occurrence rates of major unexpected findings (Class I and II) in pediatric ICU (7/79 [9%]), emergency department (2/27 [7%]), and ward (1/42 [2%]) patients were similar (p = .4). There were two Goldman's Class I unexpected findings in the pediatric ICU and emergency department patients, and one Goldman's Class I unexpected finding in the ward patients. Conclusions: Autopsies were performed more frequently in emergency department patients. Class I through IV unexpected findings occurred more frequently in pediatric ICU patients compared with emergency department or ward patients. Autopsy examinations are an especially valuable diagnostic tool for pediatric ICU patients and physicians.

Original languageEnglish (US)
Pages (from-to)683-686
Number of pages4
JournalCritical care medicine
Volume24
Issue number4
DOIs
StatePublished - Apr 1 1996
Externally publishedYes

Keywords

  • autopsy
  • cause of death
  • critical illness
  • diagnosis, pre mortem
  • emergency department
  • intensive care unit, pediatric

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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