Abstract
Objectives: The aims of the study were: i) to determine the agreement between the ante-mortem clinical diagnoses, death certificates and post-mortem causes of death; ii) to determine the incidence of unexpected findings; and iii) to compare the post-mortem rates on the intensive care unit with national recommendations. Design: Retrospective observational study. Setting: Adult general intensive care unit. Subjects: Critically ill patients. Interventions: Post-mortem examination. Measurements and main results: The post-mortem rate was calculated by checking the post-mortem register. The disease or condition leading directly to death (Ia on the death certificate and post-mortem report) in patients who died on the intensive care unit in our hospital was compared with the ante-mortem clinical diagnosis. The level of agreement between the ante-mortem cause of death, death certificate and post-mortem report was assessed. Unexpected post-mortem findings were noted and their probable impact on the patient's outcome estimated. The post-mortem rate in our unit was 35%. The agreement between the ante-mortem clinical diagnoses and post-mortem diagnoses (58%) was higher than when the death certificates were compared to the post-mortem diagnoses (42%). Discrepancies between the ante-mortem clinical diagnoses and the death certificates were found in 32% of cases. Unexpected findings were found in 42%, of which 9% could have influenced the patient's final outcome. The most common clinically significant unexpected findings were the misdiagnoses of myocardial infarction and pulmonary embolism. Conclusions: In conclusion, we feel that although the incidence of clinically significant unexpected findings was low, post-mortem examination remains a valuable tool as it offers the opportunity to subsequently amend incorrect death certificates. The death certificates were found not to agree with the ante-mortem clinical diagnoses in about one-third of deaths. Avoiding the use of modes of death when completing death certificates needs enforcing. For patients dying of critical illness, a high degree of clinical awareness of alternative pathology is required, especially in those dying with cardiovascular failure.