Characteristics of patients before sudden death in emergency department and autopsy examination with comparison between ante-mortem diagnosis and autopsy diagnosis

Abstract

Objective To identify the causes of discrepancy and to compare the clinical diagnosis and postmortem examination diagnosis in patients of sudden death with unknown etiology or with disputed causes in the emergeney department,and to analyze the discrepancy between them.Method The data of adult patients of sudden death in the emergency department of Beijing University Third Hospital,from January 1,21302 to December 15,2009,were tetrospectire reviewed.All patients were divided into the autopsy group,oup and non-autopsy group.The gender and age of the two groups were compared with Student t-test and Chi-squme test,and ante-mortem diagnoses were compared with autopsy diagnoses in autopsy group.Results A total of 2420 patients were eligible for inclusion in the study.There were 8 victims received the autopsy examination after death,while 2412 victims did not.Compsred with the non-antopsy pauents,the autopsy patients had yoanger ages[(35.5±12.4)vs.(68.9±15.8)years,t=5.973,P＜0.01],but there was no significant difference in number between two genders.Three of the autopsy patients were sent to hospital by passer-by because of patients in aetate of unconsciousness.Of two patients,the ant-mortem diagnoses were consistent with the autopsy findings.There was one patient with a discrepancy between major ante-mortem diagnosis and the autopsy finding.And the major diagnoses in 5 patients were identified by autopsy examination.In all the 8 autopsy patients,the causes of death were detennined as cardiovaseular(5/8),infectious(2/8)and other(1/8).Conclusions As a last resort,autopsy is used to anthenticate the precise causes of fatal patients died in emergency department.There is a significant discrepancy rate between the ante-mortem diagnoses and autopsy findings.The major cause of sudden death in emergency department is cardiovascular disorder. Key words: Sudden death; autopsy; Emergency; Antemortem clinical diagnosis; Postmortem autopsy diagnosis; Cardiovascular cause; Infectious; Clinical errors