Study objective. To examine the correlation between clinical diagnoses and autopsy findings in children who die in the pediatric intensive care unit (PICU).

Design. Retrospective chart review.

Setting. PICU of a university-affiliated hospital.

Patients. A consecutive sample of patients who died in the PICU and had autopsies performed.

Measurements and main results. Of 193 patients who died during the 7½year study period, 50 (6%) had autopsies performed. The mean age was 34.7 months (range 15 hours to 17 years), and the mean length of stay in the PICU was 12.2 days (range 2 hours to 60 days). Major admitting diagnoses included postoperative cardiac surgery (19), nonoperative cardiac disease (7), hematologic/malignant disorder (5), and acquired immunodeficiency syndrome (5). There were 5 cases (10%) where autopsy revealed a major finding that, if known prior to death, would have altered clinical management and might have resulted in cure or prolonged survival. In another 9 patients (18%) the autopsy revealed major findings that, if known prior to death, would not have altered management. Eight of these findings related to the cause of death and 2 of them involved the basic disease. There was no correlation between new findings and either patient age or length of stay in the PICU.

Conclusions. Despite modern diagnostic techniques, the autopsy continues to reveal valuable and unsuspected information.

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