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Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive care: a retrospective cohort study
Virchows Archiv ( IF 3.5 ) Pub Date : 2020-12-11 , DOI: 10.1007/s00428-020-02984-5
Rob G H Driessen 1, 2 , Bartholomeus G H Latten 3 , Dennis C J J Bergmans 1 , Riquette P M G Hulsewe 1 , Johanna W M Holtkamp 4 , Iwan C C van der Horst 1 , Bela Kubat 3 , Ronny M Schnabel 1
Affiliation  

Early death in sepsis occurs frequently; however, specific causes are largely unknown. An autopsy can contribute to ascertain causes of death. The objective of the study was to determine discrepancies in clinical diagnosis and postmortem findings in septic intensive care unit (ICU) patients deceased within 48 h after ICU admission. All septic ICU patients who deceased within 48 h after ICU admission were identified and included. Four intensivists determined the clinical cause of death by medical record review. An autopsy was performed within 24 h of death. Clinical diagnosis and postmortem findings were compared and classified as autopsy-identified missed clinical diagnoses and autopsy-refuted diagnoses. Class I and II missed major diagnoses using the Goldman criteria were scored. Between 2012 and 2017, 1107 septic patients were admitted to ICU. Of these, 344 patients (31%) died, of which 97 patients (28%) deceased within 48 h. In 32 (33%) early deceased patients, an autopsy was agreed. There were 26 autopsy-identified missed clinical diagnoses found, mostly myocardial infarction (n = 4) and pneumonia (n = 4). In four patients (13%), a class I discrepancy was found. In fourteen patients (42%), a class II discrepancy was found. In conclusion, an autopsy is an important diagnostic tool that can identify definite causes of death. These diagnoses deviate from diagnoses established during admission in early deceased sepsis patients.



中文翻译:

重症监护病房中早期死亡败血症患者的临床诊断与尸检结果:一项回顾性队列研究

败血症的早期死亡经常发生。但是,具体原因尚不清楚。尸检有助于确定死亡原因。该研究的目的是确定ICU入院后48小时内死亡的败血重症监护病房(ICU)患者的临床诊断和验尸结果差异。确定并纳入了所有在ICU入院后48小时内死亡的败血性ICU患者。四名强化医生通过病历审查确定了临床死亡原因。死亡后24小时内进行尸检。比较临床诊断和验尸结果,并将其分类为尸检确定的漏诊临床诊断和尸检驳回的诊断。使用高盛标准对第一类和第二类错过的主要诊断评分。在2012年至2017年之间,有1107名败血症患者被送入ICU。其中,有344例患者(31%)死亡,其中97例(28%)在48小时内死亡。在32名(33%)早期死亡患者中,同意进行尸检。发现了26个经过尸检鉴定的临床诊断漏诊,主要是心肌梗死(n  = 4)和肺炎(n  = 4)。在四名患者(13%)中,发现I类差异。在十四名患者(42%)中,发现了II类差异。总之,尸检是一种重要的诊断工具,可以确定确切的死亡原因。这些诊断与早期死亡的脓毒症患者入院期间建立的诊断有所不同。

更新日期:2020-12-12
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