Correlation between clinical diagnoses and autopsy findings in critically ill children

Abstract

Study objective: To examine the correlation between clinical diagnoses and autopsy findings in children who die in the pediatric intensive care unit (PICU).

Design: Retrospective chart review.

Setting: PICU of a university-affiliated hospital.

Patients: A consecutive sample of patients who died in the PICU and had autopsies performed.

Measurements and main results: Of 193 patients who died during the 7 1/2-year study period, 50 (26%) had autopsies performed. The mean age was 34.7 months (range 15 hours to 17 years), and the mean length of stay in the PICU was 12.2 days (range 2 hours to 60 days). Major admitting diagnoses included postoperative cardiac surgery (19), nonoperative cardiac disease (7), hematologic/malignant disorder (5), and acquired immunodeficiency syndrome (5). There were 5 cases (10%) where autopsy revealed a major finding that, if known prior to death, would have altered clinical management and might have resulted in cure or prolonged survival. In another 9 patients (18%) the autopsy revealed major findings that, if known prior to death, would not have altered management. Eight of these findings related to the cause of death and 2 of them involved the basic disease. There was no correlation between new findings and either patient age or length of stay in the PICU.

Conclusions: Despite modern diagnostic techniques, the autopsy continues to reveal valuable and unsuspected information.