Resumen

FERNANDEZ 1, Alicia et al. El valor de la autopsia en una unidad de cuidados intensivos pediátricos. Arch. Pediatr. Urug. [online]. 2006, vol.77, n.2, pp.103-109. ISSN 1688-1249.

Summary Objectives: to evaluate the diagnostic contributions from an autopsy examination in a Pediatric Intensive Care Unit. Material and methods: a review of the clinical history and the autopsy protocol of all consecutive clinical autopsies performed between October 1st 1998 and December 31st 2004 at the Intensive Care Unit (ICU) was done. The results were classified according to the Goldman criteria in major diagnosis which includes the most important disease and the cause of death, and minor diagnosis which are non related findings that were found through the autopsy. The findings revealed by the autopsy that were not clinically suspected were considered errors. They are subdivided in 4 groups according to the same author. Results: in the 6 years and 3 months period studied, 5024 patients were admitted at the ICU. 339 deaths occurred (6.7%) . An autopsy was performed in 131 cases (39%). In 111 cases a clinical autopsy was performed by the pathologist; in 30 cases it was a forensic autopsy. The age range was from 1 month to 15 years (media 27 months). Of the 208 deaths without autopsy, the consent was not obtained in 118 cases; the parental consent was not asked in 90 cases. In 33 of the 111 clinical autopsies performed the PRISM at admitance showed a death risk of 25%. In 13 children (12%) a type I error was found (a diagnosis that was revealed by autopsy; in which a previous knowledge of it would have changed the prognosis). In 15 children (14%) a type II error was found (a major diagnosis revealed by the autopsy, in which a previous knowledge would not have changed the treatment or the prognosis). Conclusions: postmortem examination frequently shows diagnosis that was clinically unsuspected. A parental consent for necropsy examination should always be asked even when the cause of death is clear. Autopsy is an excellent mean to evaluate assistance quality in an Intensive Care Unit

Palabras clave :  AUTOPSY; DIAGNOSTIC ERRORS; INTENSIVE CARE UNITS, PEDIATRIC.

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