%0 Journal Article %T Discrepancies between clinical and postmortem diagnoses in critically ill patients: an observational study %A Gavin D Perkins %A Danny F McAuley %A Sarah Davies %A Fang Gao %J Critical Care %D 2003 %I BioMed Central %R 10.1186/cc2359 %X We retrospectively investigated trends in postmortem examination rates and discrepancies between premortem clinical and postmortem diagnoses in a population of critically ill patients admitted to a 13 bed, general medical/surgical intensive care unit between January 1998 and June 2001. Agreement between diagnoses before death and postmortem findings were compared using the Goldman system.Out of total 636 deaths, 49 (7.7%) underwent postmortem examinations. Of these, 38 (78%) cases were available for review. We found that postmortem findings were in complete agreement with predeath diagnoses in fewer than half of the cases (n = 17, 45%). Major missed diagnoses were present in 15 cases (39%). Myocardial infarction, carcinoma and pulmonary embolism represented the most frequently missed diagnoses.Postmortem examinations remain a useful tool in confirming diagnostic accuracy and should be considered in all patients who die in the intensive care unit. Recognition of the diagnoses missed before death may improve outcome or avoid unnecessary prolongation of life where terminal disease is present.The postmortem examination has been recognised as an important tool for confirming the clinical cause of death. The rate of postmortem examination, however, is declining [1,2]. Technological advances in diagnostic tests and imaging methods have led to the value of the postmortem examination being challenged. This, along with concerns surrounding informed consent and the retention of organs, has made clinicians reluctant to request a postmortem examination. However, previous studies in patients admitted to intensive care have shown that premortem clinical diagnoses are frequently incorrect, and in up to 27% of patients a treatable condition that might have altered outcome, had it been recognised, is identified at postmortem examination [3]. The aim of the present study was to determine the trends in postmortem examination rate and establish the diagnostic accuracy of clinical diagno %K autopsy %K clinical diagnosis %K critical illness %K death %K intensive care %U http://ccforum.com/content/7/6/R129