Major discrepancy between clinical diagnosis of death and anatomopathological findings in adolescents with chronic diseases during 18-years

Author(s):Show less -

Maira P. Ribeiro ^[1] ; Amaro N. Duarte Neto ^[2] ; Marisa Dolhnikoff ^[3] ; Livia Lindoso ^[4] ; Benito Lourenco ^[5] ; Heloisa H. Marques ^[6] ; Maria F.B. Pereira ^[7] ; Lilian M. Cristofani ^[8] ; Vicente Odone Filho ^[9] ; Lucia M.A. Campos ^[10] ; Adriana M.E. Sallum ^[11] ; Magda Carneiro-Sampaio ^[12] ; Artur F. Delgado ^[13] ; Werther B. Carvalho ^[14] ; Thais Mauad ^[15] ; Clovis A. Silva ^[16]

Affiliation:Show less -

^[1] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[2] Universidade de São Paulo (FMUSP). Faculdade de Medicina. Patology Department - Brasil

^[3] Universidade de São Paulo (FMUSP). Faculdade de Medicina. Patology Department - Brasil

^[4] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[5] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[6] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[7] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[8] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[9] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[10] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[11] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[12] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[13] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[14] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

^[15] Universidade de São Paulo (FMUSP). Faculdade de Medicina. Patology Department - Brasil

^[16] Universidade de Sao Paulo (HCFMUSP). Faculdade de Medicina. Hospital das Clinicas - Brasil

• Document type: Journal article
• Source: Clinics; v. 78, 2023-05-19.

Abstract

Abstract Objectives: To evaluate the inconsistency between clinical diagnosis of death and autopsy findings in adolescents with chronic diseases. Methods: A cross-sectional study including a sample of adolescents’ autopsies who died in a pediatric and adolescent tertiary hospital over 18 consecutive years. During this period, there were n = 2912 deaths, and n = 581/2912(20%) occurred in adolescents. Of these, n = 85/581(15%) underwent autopsies and were analyzed. Further results were divided into two groups: Goldman classes I or II (high disagreement between main clinical diagnosis of death and anatomopathological findings, n = 26) and Goldman classes III, IV or V (low or no disagreement between these two parameters, n = 59). Results: Median age at death (13.5 [10‒19] vs. 13 [10‒19] years, p = 0.495) and disease duration (22 [0‒164] vs. 20 [0‒200] months, p = 0.931), and frequencies for males (58% vs. 44%, p = 0.247) were similar between class I/II vs. class III/IV/V. The frequency of pneumonia (73% vs. 48%, p = 0.029), pulmonary abscess (12% vs. 0%, p = 0.026), as well as isolation of yeast (27% vs. 5%, p = 0.008), and virus (15% vs. 2%, p = 0.029) identified in the autopsy, were significantly higher in adolescents with Goldman class I/II compared to those with Goldman class III/IV/V. In contrast, cerebral edema was significantly lower in adolescents of the first group (4% vs. 25%, p = 0.018). Conclusion: This study showed that 30% of the adolescents with chronic diseases had major discrepancies between clinical diagnosis of death and autopsy findings. Pneumonia, pulmonary abscess, as well as isolation of yeast and virus were more frequently identified at autopsy findings in the groups with major discrepancies. (AU)

• FAPESP's process: 15/03756-4 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Research Projects - Thematic Grants