Intensivmedizin Fragen und Antworten

240 Kapitel 13 · Klinische Studien
jAutopsieergebnisse zeigen klinisch relevante Zusatzdiagnosen bei
Intensivpatienten
Tejerina E, Esteban A, Fernández-Segoviano P, María Rodríguez-Barbero J, Gordo F,
Frutos-Vivar F, Aramburu J, Algaba A, Gonzalo Salcedo García O, Lorente JA (2012) Clinical
diagnoses and autopsy findings: discrepancies in critically ill patients. Crit Care 40 (3):
842–6. doi: 10.1097/CCM.0b013e318236f64f
Objectives To determine the proportion of clinical errors by comparing
clinical and pathological diagnoses, and to evaluate changes of errors over time.
Design We conducted a prospective study of all consecutive autopsies performed
on patients who died in the intensive care unit of the Hospital Universitario
de Getafe, Madrid, Spain, between January 1982 and December 2007.
The diagnostic errors were classified in two categories: class I errors that were
major misdiagnoses with direct impact on therapy, and class II diagnostic
errors which comprised major unexpected findings that probably would not
have changed therapy.
Results Of 2,857 deaths during the study period, autopsies were performed in
866 patients (30.3 %). Autopsy reports were available in 834 patients, of whom
63 (7.5 %) had class I errors and 95 (11.4 %) had type II errors. The most frequently
missed diagnoses were pulmonary embolism, pneumonia, secondary
peritonitis, invasive aspergillosis, endocarditis and myocardial infarction. The
autopsy did not determine the cause of death in 22 patients (2.6 %). Our rate of
diagnostic discrepancy remained relatively constant over time, and the conditions
leading to discrepancies have slightly changed, with pneumonia showing
a decline in diagnostic accuracy in the last years.
Conclusion This study found significant discrepancies in 18.5 % of patients
who underwent autopsy, 7.5 % of them were diagnoses with impact on therapy
and outcome. This reinforces the importance of the postmortem examination
in confirming diagnostic accuracy and improving the quality of care of critically
ill patients.
Fazit
Die Autopsie bleibt auch in der modernen Intensivmedizin ein wichtiges Element
der Qualitätssicherung unter dem Motto »mortui vivos docent«.