ASSOCIATION OF PREMORTEM DIAGNOSIS AND AUTOPSY FINDINGS IN PEDIATRIC INTENSIVE-CARE UNIT VERSUS EMERGENCY DEPARTMENT VERSUS WARD PATIENTS

Objective: As part of the overall quality assurance program for the De partment of Pediatrics, we determined whether there were differences i n the rates of unexpected autopsy findings between pediatric intensive care unit (ICU), emergency department, and ward patients. Design: Pro spective, descriptive study. Setting: Tertiary care children's hospita l. Patients: pediatric deaths (n = 212). Interventions: None. Measurem ents and Main Results: Autopsies were obtained more frequently in emer gency department patients (27/29 [93%]) compared with pediatric ICU (8 8/21 [73%]) and ward (42/62 [68%]) patients (p = .03), The medical exa miner's cases were more frequently from emergency department patients (22/27 [81%]) compared with pediatric ICU (39/88 [44%]) or ward (11/42 [26%]) patients (p < .001). We found unexpected autopsy findings in 1 9 (12%) of 157 patients. There were no unexpected findings from the me dical examiner's cases. The most common unexpected findings were unide ntified infections (n = 7 [three fungal, three viral, and one nonspeci fic]) and unrecognized cardiac malformations (n = 4). Unexpected findi ngs occurred more frequently in pediatric ICU patients (16/88 [18%]) v s, emergency department (2/27 [7%]) or ward (1/42 [2%]) patients (p = .03), The occurrence rates of major unexpected findings (Class I and I I) in pediatric ICU (7/79 [9%]), emergency department (2/27 [7%]), and ward (1/42 [2%]) patients were similar (p = .4), There were two Goldm an's Class I unexpected findings in the pediatric ICU and emergency de partment patients, and one Goldman's Class I unexpected finding in the ward patients. Conclusions: Autopsies were performed more frequently in emergency department patients, Class I through IV unexpected findin gs occurred more frequently in pediatric ICU patients compared with em ergency department or ward patients. Autopsy examinations are an espec ially valuable diagnostic tool for pediatric ICU patients and physicia ns.