Post-mortem examination in the ICU

Abstract

Autopsy has long been regarded as a valuable and reliable tool to improve quality of medical care by monitoring diagnostic accuracy and treatment of the critically-ill patients. However, post-mortem examination rates have fallen worldwide during the past decades. Unexpected findings at autopsy contribute to the increasing pool of medical knowledge and may allow the development of strategies for the early detection of diagnoses, leading to better patient care. Several studies have shown that major discrepancies are frequent, and in 5–40% of all hospitalized patients, and in 7–32% of adult intensive care patients a treatable condition that might have altered outcome, had it been recognized, is identified at post-mortem examination. Despite technological improvements in medicine, the percentage of missed diagnoses had not changed over time. Autopsy provides a ‘gold standard’ to assess the accuracy of diagnostic tests and also offers relevant information for the advance of medical knowledge and the description of new disease entities. The health care system as a whole can benefit enormously from autopsy data, the autopsy providing information unavailable by any other method, and should be considered in every patient who dies in the intensive care unit.