Objetivo: Avaliar a discordância entre diagnóstico clínico de óbito e achados de autópsias em adolescentes com doenças crônicas. Métodos: Estudo transversal de uma amostra de autópsias de adolescentes que faleceram em um hospital terciário de crianças e adolescentes ao longo de 18 anos consecutivos. Nesse período, ocorreram n=2.912 óbitos e n=581/2.912 (20%) ocorreram em adolescentes. Destes, n=85/581 (15%) tinham autópsias e foram analisadas. Os resultados foram divididos em dois grupos: Goldman classes I ou II (alta discordância entre diagnóstico clínico principal de óbito e achados anatomopatológicos, n=26) e Goldman classes III, IV ou V (baixa ou nenhuma discordância entre esses dois parâmetros, n= 59). Resultados: A mediana da idade no óbito [13,5 (10-19) vs. 13 (10-19) anos, p=0,495] e duração da doença [22 (0-164) vs. 20 (0-200) meses, p=0,931], e as frequências para sexo masculino (58% vs. 44%, p=0,247) foram semelhantes entre classes I/II versus classes III/IV/V. As frequências de pneumonia (73% vs. 48%, p=0,029), abscesso pulmonar (12% vs. 0%, p=0,026), bem como isolamento de levedura (27% vs. 5%, p=0,008) e vírus (15% vs. 2%, p=0,029) identificados na autópsia foram significantemente maiores nos adolescentes com classes Goldman I/II em comparação com aqueles com classes Goldman III/IV/V. Em contrapartida, o edema cerebral foi significantemente menor nos adolescentes do primeiro grupo (4% vs. 25%, p=0,018). Conclusões: Este estudo mostrou que 30% dos adolescentes com doenças crônicas apresentaram grande discrepância entre diagnóstico clínico do óbito e achados da necropsia, causados principalmente por infecções. Pneumonia, abscesso pulmonar, bem como isolamento de leveduras e vírus foram identificados nos achados da autópsia nos grupos com maiores discrepâncias

Objectives: To evaluate disagreement between clinical diagnosis of death and autopsy findings in adolescents with chronic diseases. Methods: A cross-sectional study included a sample of adolescents autopsies who died in a childrens and adolescents 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 classes I/II versus classes 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 classes I/II compared to those with Goldman classes 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 discrepancy between clinical diagnosis of death and autopsy findings, mainly caused by infections. Pneumonia, pulmonary abscess, as well as isolation of yeast and virus were identified at autopsy findings in the groups with major discrepancies