Abstract
Our study had two objectives: (1) to review ante- and post-mortem diagnoses and assign a Goldman error classification and (2) establish autopsy rates within our centre. We performed a retrospective analysis of autopsies performed on patients who died in our paediatric intensive care unit (PICU) between November 13, 2012, and October 31, 2018. Medical and autopsy data of all patients was reviewed, and Goldman classification of discrepancy between ante- and post-mortem diagnoses was assigned. Our centre is a tertiary PICU, and we included all patients that died in PICU within the designated timeframe. Our results were as follows: 396 deaths occurred in PICU from 8329 (4.75%) admissions. Ninety-nine (25%) had an autopsy, 75 required by the coroner. All were included in the study. Fifty-three were male and 46 females. Fifty-three patients were transferred from external hospitals, 46 from our centre. Forty-one were neonates, 32 were < 1 year of age, and 26 were > 1 year of age. The median length of stay was 3 days. Eighteen were post-cardiac surgery, and three post-cardiac catheter procedure. Major diagnostic errors (class I/II) were identified in 14 (14.1%), 2 (2%) class I, and 12 (12.1%) were class II errors. Class III and IV errors occurred in 28 (28.2%) patients. Complete concordance (class V) occurred in 57 (57.5%) cases.Conclusion: We conclude that the autopsy rate and the diagnostic discrepancy rate within our PICU are comparable to those previously reported. Our findings show the continuing value of autopsy in determining the cause of death and providing greater diagnostic clarity. Given their value, post-mortem examinations, where indicated, should be considered part of a physician’s duty of care to families and future patients. What is Known:• Major diagnostic discrepancies (class I/II) in PICU have been reported at 20.2%. (10)• PICU autopsy rates have varied from 36 to 67% since 1994 with most recently reported rates in 2018 being 36%. (6-9)What is New:• We report an Irish PICU major diagnostic discrepancy (class I/II) rates of 14.1% contributing further to reported discrepancy rates in PICU literature to date.• This study contributes the Irish PICU post-mortem rate in a tertiary centre which was 25% over an almost 6-year period.
Highlights
Communicated by Piet LeroyGiven the severity of illness managed in a paediatric intensive care unit (PICU), deaths are inevitable
We conclude that the autopsy rate and the diagnostic discrepancy rate within our PICU are comparable to those previously reported
We report an Irish PICU major diagnostic discrepancy rates of 14.1% contributing further to reported discrepancy rates in PICU literature to date
Summary
Communicated by Piet LeroyGiven the severity of illness managed in a PICU, deaths are inevitable. The majority of deaths amongst in-patients in our institution occur in the PICU. Credible medical post-mortem examinations were first per-. Eur J Pediatr discrepancies are still identified at post-mortem. Post-mortem examination remains a valuable tool for the identification and evaluation of pathologic processes in complex patients [2]. PICU autopsy rates have been reported between 20 and 36% which in part can be attributed to illness complexity [3, 4]. The Goldman criteria—first described in 1983—are a means of classifying a discrepancy occurring between anteand post-mortem diagnoses and are outlined in Table 1 [5]. Major diagnostic errors (class I/II) in PICU have been reported to be approximately 20%, showing the necessity for continued advocacy for post-mortem examination within institutions [6]
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