THE UTILITY OF AUTOPSIES IN A PEDIATRIC EMERGENCY DEPARTMENT

The role of the autopsy in verifying clinical diagnosis and as a quali ty assurance tool in pediatric emergency medicine has not been studied . We reviewed the charts of all children who died soon after arriving at to the pediatric emergency department between October 1985 and Dece mber 1989. Opinions as to clinical diagnoses and cause of death were o btained by presenting a summary of patient data, in a blinded fashion, to three emergency pediatricians. Clinical diagnoses were then compar ed with autopsy diagnoses using the Class Error System. Major diagnost ic errors (Class I, Class II) were examined to determine if the autops y was more useful in any particular patient group. There were 69 child ren: 36 (52%) were female, and 30 (43%) were infants. Autopsies were p erformed on 52 (75%) patients. Autopsy diagnoses were categorized as f ollows: sudden infant death syndrome (SIDS) 14 (27%); underlying disea se 15 (29%); trauma 13 (25%); sepsis 8 (16%); and aspiration 2 (4%). N o errors were made in 67% of cases. The autopsy confirmed the major cl inical diagnosis in 85% of patients. There were no Class I errors. Cla ss II error rate was 15%. Most Class II errors occurred in patients be tween one and five years of age (57%), and in patients who had sepsis or underlying disease (95%). Our data show that autopsy is useful in d etermining the cause of death and may be useful for education and qual ity assurance in pediatric emergency medicine.