Comparison of premortem clinical diagnosis and autopsy findings in patients with burns Outi Kallinen a , Taina A. Partanen a , Kreu Maisniemi b , Tom Bo ¨ hling c , Erkki Tukiainen a , Virve Koljonen a, * a Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland b Department of Anaesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland c Department of Pathology, Helsinki University and HUSLAB, Helsinki, Finland 1. Introduction Mortality in burned patients has decreased over the past decades [1,2]. Despite the progress in burn care, studies indicated that some clinically important diagnoses remain undetected during intensive care and are revealed only in autopsies [3]. If properly diagnosed, some of these might have altered the treatment and clinical outcome of patients [3–6]. According to Goldman and Goldman et al., the frequency of unexpected autopsy findings has remained the same between 1919 and 1980, only the nature of these findings has changed [7,8]. Autopsies may provide useful clinical data, reveal diagnostic discrepancies, accumulate knowledge and be useful educational resources in burn centres. Autopsies also serve as quality control [3,5,6,9,10]. Fish et al. recently determined 94 burn patients’ autopsy findings and discovered that 18% of the deaths causes were unknown and 4.5% of those would have changed therapy if properly known [3]. Finland is one of the leading countries in autopsy rates; approximately 30% of deaths undergo autopsies each year. burns 34 (2008) 595–602 article info Article history: Accepted 19 December 2007 Keywords: Burn injury Autopsy Diagnostic accuracy Goldman criteria Hot air sauna burn abstract Introduction: Despite the diagnostic advancements, some clinically important diagnoses remain undetected during intensive care in burn patients. The aim of this study was to compare the premortem clinical diagnoses and autopsy findings. Patients and methods: A retrospective review of all burn deaths during 1995–2005 was conducted. The clinical diagnoses and autopsy reports were reviewed, and diagnostic discrepancies were classified into four categories, according to the impact on the treatment. Results: Overall mortality during the study period was 5.4%. Altogether 74 deaths were recorded, of which 71 were included in the study. Typical patient was a 58-year-old male with flame burn of %TBSA 49, ABSI 10. Clinical diagnostic discrepancies were found in 14.1% of the patients; one diagnostic discrepancy was recorded in each of the patients. Of these diagnostic discrepancies, 8.5% were considered major, and 5.6% would have altered the clinical outcome or therapy, if known at the time. Diagnostic discrepancies consisted of one cardiovascular, seven respiratory and two gastrointestinal missed diagnosis. The most common missed diagnosis was pneumonia. Conclusion: This study emphasizes the usefulness of autopsies to provide valuable clinical data for the treatment of burn patients. It also highlights the few missed diagnoses which may occur in burn patients. # 2008 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author at: Department of Plastic Surgery, To ¨o ¨ lo ¨ Hospital, P.O. Box 266, FIN 0029 HUS, Finland. Tel.: +358 50 427 1983; fax: +358 9 471 87 217. E-mail address: virve.koljonen@hus.fi (V. Koljonen). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$34.00 # 2008 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2007.12.010