[Discrepancies between clinical and pathological diagnosis in a polyvalent intensive care service]. / Discrepancias entre el diagnóstico clínico y el anatomopatológico en un Servicio de Cuidados Intensivos Polivalente.

ABSTRACT

OBJECTIVES: Analyze the frequency and spectrum of the most relevant diseases found in the necropsic study. Assess the association between stay in Intensive Care Unit (ICU) less than 24 hours and rate of diagnostic errors. MATERIAL AND METHODS: Retrospective, observational study during a 46 month period in a polyvalent ICU. The differences between the clinical and pathological diagnoses were established based on Goldman's classification. RESULTS: A total of 85 autopsies out of 520 exitus (16.3%) were done. Five patients were excluded due to incomplete information. Of the 80 cases, we found 30 patients with major errors, 21 with therapeutic and prognostic repercussion, 9 in which the therapeutic strategy had not been modified. The most frequently found diagnosis in type I error was bacterial infection followed by cardiovascular disease. Major error rate with therapeutic repercussion was superior in patients with a stay in the ICU less than 24 hours (40% vs 21%; p < 0.05). CONCLUSIONS: Autopsy continues to be a useful tool to assess quality of clinical diagnosis. The diagnostic errors with therapeutic repercussion are bacterial infections and cardiovascular disease. Patients with a stay less than 24 hours have a higher rate of type I diagnostic errors.