The objective of this observational study is to compare clinical diagnoses with autopsy and anatomopathological reports of patients who died in the intensive care units of the Nancy University Hospital and the Metz-Thionville Regional Hospital since 2008. This would highlight diagnostic discrepancies that could have influenced patient management and help redefine the role and importance of autopsy in this population.
Study Type
OBSERVATIONAL
Enrollment
32
Autopsy realised in adult patients during of after a hospitalization in an intensive care unit.
Central Hospital, Nancy, France
Nancy, France
Rate of Major Diagnostic Discrepancies (Goldman Class I and II) between Clinical and Autopsy Diagnoses
Proportion of autopsied ICU patients with a major diagnostic discrepancy (Goldman class I or II) between the antemortem clinical diagnosis and the post-mortem autopsy diagnosis, classified according to the Goldman classification
Time frame: Diagnoses assessed at time of autopsy, for patients who died in ICU between January 1, 2008 and December 31, 2025
Type and anatomical/etiological category of diagnoses missed clinically and identified at autopsy (Goldman Class I-IV)
Distribution of missed diagnoses by organ system and etiological category (infectious, vascular, neoplastic, etc.) among discrepancies classified as Goldman class I to IV.
Time frame: Diagnoses assessed at time of autopsy, for patients who died in ICU between January 1, 2008 and December 31, 2025
Odds Ratios for Patient and Clinical Characteristics Associated With Major Diagnostic Discrepancy (Goldman Class I/II)
Association between diagnostic discrepancy status (Goldman class I/II vs. class III-VI) and pre-specified patient/clinical characteristics - including age, sex, immunosuppression status, indication for hospitalization, duration of hospital and ICU stay, admission unit, SAPS II score, type of organ failure, presence of septic shock, use of mechanical ventilation, renal replacement therapy, ECMO support, immunosuppressive therapy, and imaging modality - assessed by univariable and multivariable logistic regression, expressed as odds ratios with 95% confidence intervals.
Time frame: Assessed using clinical data collected from ICU admission to death, for patients who died and underwent autopsy between January 1, 2008 and December 31, 2025
Autopsy Rate Among ICU Deaths
Proportion of ICU deaths for which an autopsy was performed, calculated as the number of autopsies divided by the total number of deaths occurring after ICU admission, expressed as a percentage
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Time frame: Calculated over the entire study period, from January 1, 2008 to December 31, 2025
Concordance Rate Between Antemortem Imaging Findings and Autopsy/Pathology Findings
Proportion of cases in which findings from the last antemortem imaging examination (CT, MRI, or ultrasound) performed before death are concordant with autopsy and/or anatomopathological findings. Concordance was assessed qualitatively by investigator review of imaging reports compared with autopsy/pathology reports, and classified as concordant, partially concordant, or discordant, without use of a standardized scoring system.
Time frame: Assessed at time of autopsy report, for patients who underwent both antemortem imaging and autopsy between January 1, 2008 and December 31, 2025