Prevalence of discrepancies between antemortem clinical diagnoses and postmortem autopsy findings is uncertain in pediatric oncology given improving diagnostic capabilities over time. Primary objective was to describe discrepancies between antemortem and postmortem diagnosis of pediatric cancer deaths. Secondary objective was to compare clinical characteristics of deaths with and without major diagnostic discrepancies. This was a retrospective study that included pediatric cancer patients diagnosed and treated in Ontario and who died from 2003 to 2012. Antemortem clinical diagnoses associated with mortality were determined by reviewing the patient’s health records 2 weeks prior to death while the postmortem diagnoses were determined by the autopsy report. Discrepancies among these diagnoses were classified using the Goldman criteria where major discrepancies were directly related to the cause of death in contrast to minor discrepancies. Among the 821 patients who died, 118 (14%) had an autopsy and were included. Of these autopsies, 12 (10%) had a major diagnostic discrepancy between antemortem and postmortem diagnoses. Major discrepancies consisted of opportunistic infections (n = 5), missed cancer diagnosis (n = 3), and organ complications (n = 4). Death in a high acuity setting (12/12, 100% vs. 60/106, 57%; P = 0.003) and treatment-related mortality (12/12, 100% vs. 60/106, 57%; P = 0.003) were significantly associated with major discrepancy. Major diagnostic discrepancy was found in 10% of pediatric oncology autopsies. Missed infections and organ complications were predominant etiologies. Death in a high acuity setting and treatment-related mortality were associated with major diagnostic discrepancies. Autopsies continue to be important for improving diagnostic insight and may improve future clinical care.

由于随着时间的推移诊断能力的提高，在儿科肿瘤学中，死前临床诊断与死后尸体解剖发现之间差异的普遍性尚不确定。主要目的是描述小儿癌症死亡的事前诊断和事后诊断之间的差异。次要目的是比较有无重大诊断差异的死亡的临床特征。这是一项回顾性研究，其中包括在安大略省诊断和治疗并于2003年至2012年死亡的小儿癌症患者。与死亡相关的死前临床诊断是通过检查患者死亡前2周的健康记录来确定的，而死后诊断则由死亡前的确定。验尸报告。这些诊断之间的差异使用高盛标准进行分类，其中主要差异与死亡原因直接相关，而较小差异则与死亡原因直接相关。在821例死亡患者中，有118例（14％）进行了尸检并被包括在内。在这些尸检中，有12个（10％）在死前和死后诊断之间存在重大诊断差异。主要差异包括机会感染（n  = 5），癌症漏诊（n  = 3）和器官并发症（n  = 4）。高敏锐度下的 死亡率（12/ 12，100％vs.60 / 106，57％; P = 0.003）和治疗相关的死亡率（12/12，100％vs.60 / 106，57％; P  = 0.003 ）与重大差异显着相关。在10％的儿科肿瘤尸检中发现重大诊断差异。遗漏的感染和器官并发症是主要病因。高敏度条件下的死亡和与治疗有关的死亡率与主要的诊断差异有关。尸检对于提高诊断能力仍然很重要，并可能改善未来的临床护理。