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PubMed2000

Neonatal autopsies: a 10-year experience.

OBJECTIVES: To identify trends in neonatal autopsy rates at a tertiary care hospital during the last decade, to determine the concordance between antemortem and post-mortem diagnoses, and to describe patient characteristics that influenced diagnostic yield on autopsy. DESIGN: Retrospective review of medical records. SETTING: Tertiary care children's hospital. PATIENTS: All neonatal deaths between January 1, 1984, and December 31, 1993. MAIN OUTCOME MEASURES: For those with autopsies, data included length of stay, diagnostic imaging studies, antemortem diagnoses, and autopsy findings. Autopsy diagnoses were compared with antemortem findings and classified according to concordance. RESULTS: Of 487 neonatal deaths, autopsies were performed in 296 (61%). The autopsy rate declined significantly during 10 years from 71.2% (1984-1988) to 47.7% (1989-1993). New diagnoses were made at autopsy in 44% of cases. Major discordancies were identified in 35 infants (12%); minor discordancies in 95 (32%). Autopsies were more likely to reveal new diagnoses in infants born at 28 to 36 weeks' gestation and in those whose mothers had no prenatal care. Major findings at autopsy were more likely in infants whose mothers had no prenatal care and in infants who died within 6 hours of birth. There was no relationship between new findings at autopsy and age, length of hospital stay, or antemortem imaging studies. CONCLUSIONS: This study reveals a significant decline in neonatal autopsies during a 10-year period. This study also demonstrates that neonatal autopsy continues to provide clinically significant data and remains a valuable tool in perinatal medicine.

Adult↗
PubMed1996

High autopsy rates at a university medical center. What has gone right?

OBJECTIVE: Identification of factors that contribute to a high autopsy rate at our institution. DESIGN: An objective analysis of the Autopsy Service's organization, functions, and process flow to identify factors that impact the autopsy rate. SETTING: The University of Texas Medical Branch at Galveston, Tex. METHODS: Statistics were collected using the autopsy log book and computerized data bank. The events starting at the time of a patient's death through the completion of the autopsy report were reviewed. The role of each significant event was analyzed. RESULTS AND CONCLUSIONS: The annual autopsy rates between 1981 and 1995 ranged between 45% and 59%. The largest number of nonmedicolegal autopsies were received from the Department of Internal Medicine. The Texas Department of Criminal Justice Hospital contributed the largest number of medicolegal autopsies. We conclude that the following key factors contribute to our high autopsy rates: (1) the organization and multiple functions of the Autopsy Service, particularly the presence of a Decedent Affairs Office, dedicated resident assignments, and internal and external quality control of the autopsies; (2) close interactions with clinicians, including timely communication of autopsy results to clinicians and a fostering of positive attitude among clinical residents and faculty; and (3) other factors such as the contributions to hospital risk management, disproving the idea that there may be increased litigation related to high autopsy rates, and support by the hospital administration.

Academic Medical Centers↗
PubMed1998

The likely implications of the 1997 Coroners Ordinance on the autopsy service of a teaching hospital.

The new Hong Kong Coroners Ordinance was published in April 1997. It introduced an expanded set of guidelines for reporting deaths to the coroner as well as the threat of criminal proceedings for non-compliance. The Ordinance is due to be implemented in early 1998. The aim of this study is to determine the likely effect of the new law on the relative proportion of coroner's and hospital (consent) autopsies. A total of 352 consecutive autopsy cases were reviewed; 170 (48.3%) were referred for coroner's autopsies and 182 (51.7%) for hospital autopsies. But applying the criteria of the current ordinance, there should have been 213 (60.5%) coroner's cases and 139 (39.5%) hospital autopsies-that is, 43 hospital autopsies should have been coroner's autopsies. Under the new Coroners Ordinance, there would be 300 (85.2%) coroner's autopsies and only 52 (14.8%) hospital autopsies. The new Coroners Ordinance is likely to result in a greater number of requests for coroner's autopsies with a corresponding decline in hospital autopsies---in our case, a shift from 48.3% of all autopsies performed to 85.2%! This increase would be due largely to the requirement for reporting stillbirths but would also be due to increased reporting for fear of 'criminal proceedings' for non-compliance. An absolute increase in the number of autopsies is also anticipated, although the magnitude cannot as yet be predicted.

Journal Article↗
PubMed1998

Autopsy in children with cancer who die while in terminal care.

BACKGROUND: The purpose of this study was to find out whether autopsy of children with cancer should be recommended after terminal care, or whether in those circumstances it could be abandoned. PATIENTS AND METHODS: One hundred pediatric patients with cancer treated at the Children's Hospital, University of Helsinki, Finland, died during 1987-92. Seventy children died while in organized terminal care. The underlying diagnoses were brain tumors (21), other solid tumors (24), and leukemias (25). The method was a retrospective analysis of patients' records and autopsy reports, in addition to a structured interview of the two parents separately. RESULTS: Autopsy was performed in 40 (57%) of these 70 cases. It was more often performed on children dying in hospital (69%) than in those dying at home (39%). The autopsy rate also varied with the underlying disease: 68% of patients with leukemia, 50% of those with solid tumors, and 52% of those with brain tumors were autopsied. Autopsy afforded totally new medical information in 20% of cases, and important additional information in 55%. Nothing unexpected was found in 25%. Almost all the parents (94%) who agreed to autopsy felt that it was appropriate. Of both mothers and fathers, 50% felt that knowing the findings at autopsy was helpful for them, and all the parents except one mother thought that the autopsy of their child would at least be helpful to other patients. CONCLUSIONS: Autopsy often provides important and even unexpected information in those dying after terminal care. The majority of our parents felt that autopsy was an acceptable and appropriate practice. We recommend that autopsies should be performed, with the parents' consent, even after terminal care.

Adolescent↗
PubMed1998

Effect of postmortem sampling technique on the clinical significance of autopsy blood cultures.

Our objective was to investigate the value of postmortem autopsy blood cultures performed with an iodine-subclavian technique relative to the classical method of atrial heat searing and antemortem blood cultures. The study consisted of a prospective autopsy series with each case serving as its own control relative to subsequent testing, and a retrospective survey of patients coming to autopsy who had both autopsy blood cultures and premortem blood cultures. A busy academic autopsy service (600 cases per year) at University of Texas Medical Branch Hospitals, Galveston, Texas, served as the setting for this work. The incidence of non-clinically relevant (false-positive) culture results were compared using different methods for collecting blood samples in a prospective series of 38 adult autopsy specimens. One hundred eleven adult autopsy specimens in which both postmortem and antemortem blood cultures were obtained were studied retrospectively. For both studies, positive culture results were scored as either clinically relevant or false positives based on analysis of the autopsy findings and the clinical summary. The rate of false-positive culture results obtained by an iodine-subclavian technique from blood drawn soon after death were statistically significantly lower (13%) than using the classical method of obtaining blood through the atrium after heat searing at the time of the autopsy (34%) in the same set of autopsy subjects. When autopsy results were compared with subjects' antemortem blood culture results, there was no significant difference in the rate of non-clinically relevant culture results in a paired retrospective series of antemortem blood cultures and postmortem blood cultures using the iodine-subclavian postmortem method (11.7% v 13.5%). The results indicate that autopsy blood cultures obtained using the iodine-subclavian technique have reliability equivalent to that of antemortem blood cultures.

Adult↗
PubMed2006

Clinical utility of fetal autopsy and comparison with prenatal ultrasound findings.

OBJECTIVES: To present a comprehensive analysis of autopsy findings in 206 fetuses referred to our genetic center and to assess the clinical utility of fetal autopsy in reaching a final diagnosis, which is essential for counseling regarding the risk of recurrence. We also compared the autopsy findings with prenatal ultrasound findings to evaluate the potential benefit of fetal autopsy in fetuses terminated after prenatal diagnosis of malformations. STUDY DESIGN: Retrospective review of patient records in a tertiary referral genetic center in North India during 5-year period (April 2000-March 2005). This includes 206 fetuses, 138 terminated after detecting an anomaly in ultrasonogram and 68 spontaneous fetal losses. In all cases, fetal autopsy was carried out and complimented by radiography, karyotype wherever possible and histopathological examination wherever necessary. In fetuses with prenatally diagnosed malformations, ultrasound findings were compared with autopsy findings. RESULTS: Fetal autopsy was able to provide a definite final diagnosis in 59% (122/206) cases. Fetal autopsy confirmed the ultrasound findings in all cases but two. Moreover, autopsy provided additional findings in 77 cases and of these, 24 cases had a significant change of recurrence risk. CONCLUSION: This study confirms the utility of fetal autopsy in identifying the cause of fetal loss, which will help in the genetic counseling of the couple. In cases with prenatally diagnosed anomalies, the new information from fetal autopsy changes the predicted probability of recurrence in 18% cases. Even though the prenatal ultrasonogram reasonably predicts the malformations, fetal autopsy gives significant additional malformations in one-third of the cases and is essential for genetic counseling.

Abnormalities, Multiple↗
PubMed1997

Declining autopsy rate in Sweden: a study of causes and consequences in Malmö, Sweden.

OBJECTIVE: In Sweden there has been a continuous decrease in the autopsy rate during the last 15-20 years. The autopsy rate in the city of Malmö has declined from 81% in 1984 to 34% in 1993. The intention of this study was to improve our understanding of the causes of the decline, and to assess its consequences with regard to cause of death surveillance and case retrieval in epidemiological and clinical research. DESIGN: A retrospective study. SETTING: The University Hospital in Malmö, a city in southern Sweden with 230000 inhabitants. SUBJECTS: All deceased in 1984 (2900) and 1993 (3198). Cancer incidence 1984 and 1993. MAIN OUTCOME MEASURES: Changes in autopsy rate in relation to age, sex, place of death and cause of death 1984 and 1993. Changes in the distribution of underlying causes of death in cases submitted and not submitted for a post mortem 1984 and 1993. Changes in cancer incidence and the number of incidentally-detected new tumours 1984 and 1993. RESULTS: Patients who died in nursing homes were less often sent for a post mortem than were patients who died at the hospital. From 1984 to 1993 the percentage of people dying in nursing homes increased from 1 to 29%. Care of the elderly has been reorganized, and the number of terminally ill patients who die in nursing homes has increased during the last 20 years in Sweden. This shift in place of death seems to be the single major explanation of the declining autopsy rate in Malmö. The overall autopsy rate in 1993 remained, however, lower than it was in 1984 when a shift in place of death was taken into account. During the period of study there was a decline in the autopsy rate at all departments within the hospital. The distribution of underlying causes of death according to the death certificates was similar in 1984 and in 1993. However, in cases not submitted for autopsy in 1993 there were greater proportions dying from pulmonary and circulatory diseases, respectively, than there were in 1984. The lower autopsy rate in 1993 was for several cancer sites also associated with a reduced number of new cancer cases. The percentage of tumours incidentally detected at autopsy went down in men from 40 to 19% and in women from 39 to 17%. CONCLUSION: Patients submitted for autopsy represented, with regard to age, sex, cause and place of death, a selected group of all deceased. The declining autopsy rate was associated with a difference in the distribution of underlying cause of death and of the incidence of cancer. It is concluded that the changes in the autopsy rate have to be taken into account in studies dealing with time trends of causes of death and incidence of cancer.

Adult↗
PubMed2003

A head and neck cancer patient dies! Why perform an autopsy: for the relatives, for the clinicians or for the pathologists?

It is no secret that autopsy rates at most hospitals worldwide--both teaching and community hospitals--have declined precipitously in recent decades, but is this a desirable state of affairs? This article explores this issue from three viewpoints: that of the family members who grant permission for autopsies; that of the clinicians who seek permission for the autopsy to be carried out; and that of the pathologists who actually perform the post-mortem examination. Family concerns about (the sometimes tangential) matter of organ retention following autopsy have recently been highlighted in Europe, with an accompanying negative overall impression of the autopsy being conveyed by many outlets of the popular media. Clinicians will often concede that they feel somewhat distanced from the whole process of autopsy, and so do not hold it in such high esteem as their predecessors once did decades ago. Pathologists at present often perform autopsies as "additional duties" to be fitted in around their central functions, and so do not see them as a primary task to be accomplished. However, there are reasons why this may be detrimental to patient care, including in particular the fact that clinical/radiographic diagnoses are sometimes not confirmed by the results of a complete autopsy. Suggestions for improving the autopsy rate--in particular amongst head and neck cancer patients--are discussed, and include performance of a more rapid limited autopsy and the designation of specialist pathologists in head and neck cancer to carry out autopsies of these patients as an extension of their clinical duties. One conclusion seems inescapable: to increase autopsy rates, the status of the procedure will necessarily have to be upgraded from that of "afterthought/perfunctory task" to that of "consultation", with all of the shifts in attitude such a modification would entail.

Attitude of Health Personnel↗
PubMed2006

Death certificates are not reliable: revivification of the autopsy.

BACKGROUND: Medicine assumes that vital statistics are accurate, but they are only as good as the death certificates. OBJECTIVE: To evaluate the accuracy of death certificates in reporting vital statistics with an emphasis on cardiac deaths. DESIGN: A population-based retrospective study within one community hospital. PATIENTS: During the study period, 1,619 patients expired during hospitalization, of which 223 underwent autopsy. INTERVENTIONS: Clinical diagnoses were determined from the death certificate and autopsy results from the final pathology reports. MEASUREMENTS: Concordance of myocardial infarction as the underlying cause of death between the death certificate and the autopsy was measured. New diagnoses uncovered by the autopsy were tabulated. RESULTS: The death certificate missed acute myocardial infarction in 25 of 52 autopsy-proven cases (48% errors of omission). Conversely, it erroneously asserted the presence of an acute myocardial infarction in 9/36 cases (25% errors of commission). Autopsy showed these nine cases actually were pneumonia (5), sepsis with ARDS (2), cerebral hemorrhage (1), and cardiac tamponade (1). Autopsy proved 52 myocardial infarctions causing death, while death certificates accurately reported only 27. Myocardial infarction was more likely to be unsuspected in extreme ages, in women, when found in right ventricle or posterior wall, and in the presence of sepsis or ARDS. Death certificates were frequently inaccurate and in 21.5% of cases were of no value because of an inadequate diagnosis, ie, cardiopulmonary arrest, arrhythmia or respiratory failure. CONCLUSION: Major discrepancies of commission and omission occur frequently between the death certificate and autopsy. 1) Death certificates are often wrong. 2) The time-honored autopsy is more valuable than ever. 3) Physicians need to write better death certificates and correct them. 4) Death certificate-based vital statistics should be corrected with autopsy results. 5) Vital statistics should note deaths confirmed by autopsy. 6) More autopsies would improve vital statistics and the practice of medicine.

Adult↗
PubMed2007

Autopsy data in the peer review process improves outcomes analysis.

BACKGROUND: The value of autopsy findings has been questioned in peer review at mature trauma centers. We sought to determine the impact of autopsy data on the peer-review process. METHODS: This was a retrospective study. Data analyzed included mortality type (immediate/dead on arrival [DOA]; early [< or =48 hours]; late [>48 hours]), Injury Severity Scale (ISS) score, Trauma and Injury Severity Score-generated probability of survival (PS), peer-review judgment of preventability, and findings at autopsy. Deaths were assigned to a category; then pre- and postautopsy ISS score, PS, and outcomes of the peer- review process (percent nonpreventable [%NP]) were compared. Paired t tests (alpha = 0.05) were performed to determine whether changes in ISS score and PS were statistically significant. All descriptive and inferential analyses were based on cases with pre- and postautopsy data for the relevant variables. RESULTS: Of the 170 deaths, 126 deaths had an autopsy performed (74.1%) and 112 autopsy reports were available (89.9%). Autopsy data resulted in statistically significant changes in ISS score for each mortality category and in PS for the immediate/DOA and early categories. There were also autopsy- related changes in peer-review outcomes for immediate/DOA and late deaths but not for early deaths. The proportion of overall agreement between pre- and postautopsy outcomes for the immediate/DOA category was 94.3% (50/53); three deaths initially deemed NP were reclassified as potentially preventable (PP) after autopsy. Overall agreement for the late category was 87% (20/23); one PP was reclassified as NP and two NPs were reclassified as PP. CONCLUSION: Autopsy data enhanced peer review in immediate/DOA and late death after injury but did not impact peer review in early deaths. Autopsy data were most important to the analysis of late deaths. Targeting autopsy performance to these mortality categories is an effective strategy for centers with constrained access to autopsy data.

Autopsy↗
PubMed2005

Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review.

The autopsy is in decline, despite the fact that accurate mortality statistics remain essential for public health and health service planning. The falling autopsy rate combined with the Coroners Review and Human Tissue Act have contributed to this decline, and to a falling use of autopsy histology, with potential impact on clinical audit and mortality statistics. At a time when the need for reform and improvement in the death certification process is so prominent, we felt it important to assess the value of the autopsy and autopsy histology. We carried out a meta-analysis of discrepancies between clinical and autopsy diagnoses and the contribution of autopsy histology. There has been little improvement in the overall rate of discrepancies between the 1960s and the present. At least a third of death certificates are likely to be incorrect and 50% of autopsies produce findings unsuspected before death. In addition, the cases which give rise to discrepancies cannot be identified prior to autopsy. Over 20% of clinically unexpected autopsy findings, including 5% of major findings, can be correctly diagnosed only by histological examination. Although the autopsy and particularly autopsy histology are being undermined, they are still the most accurate method of determining the cause of death and auditing accuracy of clinical diagnosis, diagnostic tests and death certification.

Age Distribution↗
PubMed1991

Autopsy rates in medical schools and hospitals in Japan.

The autopsy rates in Japanese medical schools and hospitals were reviewed. Although moderate autopsy levels have been maintained in medical schools (50%) and large training hospitals (30%), a slight tendency towards a decrease was demonstrated recently. Since autopsy is important in education, research and the quality control of medicine, it is essential to keep the autopsy rate high. Our analyses indicate that autopsy gives satisfaction to clinicians if clinical data are correlated in detail with pathological findings. Thus, efforts should be directed to strengthening the training of pathologists in the analysis of clinical data, which are essential for correct pathological diagnoses. In order to cope with the rapid progress in all fields of medicine, pathologists must collaborate with clinical staff to obtain all the information necessary for interpretation of autopsy data. This action also helps to keep the autopsy rate high. No international guidelines are available on autopsy. Autopsies are carried out for different purposes at different levels. An internationally agreed set of rules would allow efficient use of autopsy data for epidemiological studies. Genetic analysis of autopsy material is now feasible, and this may be useful in tracing etiological factors, such as infections and genetic predisposition. Various aspects of autopsy must be reconsidered in the light of modern science.

Autopsy↗
PubMedDate not supplied

Characteristics of infants who undergo neonatal autopsy.

To identify factors associated with the performance of a neonatal autopsy, we surveyed autopsy practice patterns in a tertiary care neonatal intensive care unit for 1 year. After 56 neonatal deaths, 33 (59%) autopsies were performed. We used multivariable analysis to compare the clinical and demographic characteristics of infants who had an autopsy with those who did not. We found two variables to be negatively correlated with having an autopsy performed: birth asphyxia (p < 0.05) and Medicaid coverage (p < 0.05). Early neonatal death (< or = 2 days of age) was not correlated with lack of an autopsy. Pulmonary hypoplasia occurred more often in the group having autopsy. However, only birth asphyxia was significantly correlated with lack of an autopsy after adjusting for other variables in the analysis. The primary cause of death was not associated with performance of an autopsy. We found no significant association between consent for autopsy and the characteristics of the physician requesting it. These data suggest that the infant's socioeconomic status and diagnosis may influence parental consent for autopsy. There may be other characteristics of physicians who request it, parents who consent, or other socioeconomic factors influencing consent for the neonatal autopsy.

Adult↗
PubMed2004

Clinical and autopsy diagnoses in the intensive care unit: a prospective study.

BACKGROUND: Autopsy rates have declined worldwide, but recent retrospective intensive care unit (ICU) data indicate major discrepancies between more than 25% of clinical and autopsy diagnoses. METHODS: We conducted a 3-year prospective study of all consecutive autopsies performed on patients who died in a university hospital medical-surgical ICU to determine how many might have benefited from a different level of care, had the autopsy diagnosis been made before death. All clinical diagnoses were compared with autopsy findings at monthly clinical-pathological meetings. Major and minor diagnostic discrepancies were categorized according to the criteria of Goldman et al. RESULTS: Of 1492 patients admitted to the ICU, 315 died, of whom 167 (53.0%) were autopsied. The most common reason (79.7%) for not obtaining an autopsy was family refusal. The mean +/- SD clinical characteristics were similar for autopsied vs nonautopsied patients, except for shorter length of ICU stay (13 +/- 17 vs 20 +/- 27 days, P =.006), shorter duration of mechanical ventilation (13 +/- 16 vs 19 +/- 25 days, P =.01), and lower percentage of postcardiac surgery patients (38.9% vs 50.0%, P =.05). Among the intensivists' 694 clinical diagnoses, 33 (4.8%) were refuted and 13 (1.9%) were judged incomplete by autopsy findings. Autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli, and 9 endocarditis, among others. Major diagnostic errors (class I and class II discrepancies) were made in 53 (31.7%) of 167 patients, with a high percentage of immunocompromised patients also observed among these. Similar percentages of patients with class I and class II errors vs other patients had undergone modern diagnostic techniques during their ICU stay. CONCLUSION: Even in the era of modern diagnostic technology, regular comparisons of clinical and autopsy diagnoses provide pertinent information that might improve future management of ICU patients.

Aged↗
PubMed1994

Attitudes of pediatricians and pediatric residents toward obtaining permission for autopsy.

OBJECTIVE: To investigate attending physician and resident attitudes and factors affecting autopsy consent. METHODS: A validated, self-report, multiple-choice questionnaire was administered to 158 physicians. RESULTS: The overall response rate was 113 (72%), with 57 (85%) of 67 pediatric residents and 51 (56%) of 91 attending physicians responding. The status of five respondents was unknown. Most respondents (98%) believed autopsies provide valuable information; physicians who had graduated before 1980 were more likely to believe that the benefits of autopsy should be taught (P < or = .002). Autopsy was considered unnecessary by 20% (22/112) when the disease was known before death and by 11% (12/112) when the patient was designated "do not resuscitate." Physicians who did not attend an autopsy while in training were less likely to believe in the benefits of autopsy (P < or = .02). Factors that influenced the failure to obtain consent for an autopsy were physician belief that the family felt the body would be desecrated (30/81 [37%]); physician belief that the family would be upset (36/104 [35%]); and physician belief that little information would be obtained (19/104 [18%]). Fourteen (17%) of 81 physicians indicated that they do not ask permission for autopsy if the family is upset. CONCLUSION: Most physicians believe autopsies have benefit. If the autopsy rate is to improve, physicians in training will require increased exposure to autopsies, education regarding the potential benefits, and enhancement of interpersonal skills for successful communication with families in crisis.

Attitude of Health Personnel↗
PubMed2002

Value of the perinatal autopsy: critique.

In consenting to a perinatal autopsy, the primary motive of parents may be to find the exact cause of death. A critical review on the value of perinatal autopsies was performed to see whether parents could be counseled regarding their main motive. A literature search was performed in MEDLINE, EXCERPTA MEDICA, and the Cochrane library. We evaluated the value of the autopsy by comparing the clinical and autopsy diagnoses in stillbirths, neonatal deaths, and therapeutic terminations. Clinicopathologic concordance was divided into four categories: (1) change in diagnosis, (2) additional findings, (3) complete confirmation, and (4) inconclusive. We sought information on factors that may influence the value of perinatal autopsies: the type and definitions of perinatal loss; autopsy rate; level of hospital; expertise of pathologists; autopsy protocol used; whether patients were inborn or referred; and antenatal diagnosis. From the 27 articles that met our review criteria, the autopsy revealed a change in diagnosis or additional findings in 22% to 76% of cases. If confirmation of clinical findings is included, then the value of the perinatal autopsy was as high as up to 100%. Factors that could influence this rate were reported variably by investigators. When centers report their experience of the value of the perinatal autopsy, information on the factors that may influence their reports should be provided as well. Clinicians can confidently advise parents of the usefulness of the perinatal autopsy in ascertaining the cause of death or for counseling their future pregnancies.

Autopsy↗
PubMed1986

To redeem them from death. Reactions of family members to autopsy.

Attitudes towards autopsy were examined in family members of 102 subjects who died in a university teaching hospital. The majority of responding families (88 percent) considered autopsy beneficial. Families permitting autopsy identified advancement of medical knowledge, comfort in knowing the cause of death, and reassurance that all appropriate care was given as the most important benefits. Fifty-five percent of the families of 40 subjects not undergoing autopsy declined permission and 45 percent had not been asked for such permission. The most frequent reasons given for not wanting autopsy were disfigurement of the body, stress of permitting autopsy, lack of information about autopsy, and family members' objections. Twenty-seven percent of 62 families permitting autopsy did not learn its results. Family members receiving results complained about long delays in receiving and complex terminology of autopsy reports. These findings suggest need for improvement in obtaining consent for autopsy, reporting autopsy results, and educating and counseling families of dying patients.

Attitude to Death↗
PubMed1997

The autopsy: still important in cardiac surgery.

BACKGROUND: This study examined the ability of autopsy to confirm or dispute presumptive cause of death among cardiac surgery patients. METHODS: Autopsy reports were compared with mortality conference notes that were dictated prospectively before autopsy results were available. Between January 1985 and December 1995, there were 600 hospital deaths among 13,029 adult cardiac surgery patients (4.6% mortality). Of these 600 deaths, 147 (24.5%) had postmortem examination. RESULTS: Annual autopsy rate remained constant over the course of the study. Autopsied patients were younger (60.4 +/- 15 versus 66.7 +/- 13 years [mean +/- standard error of the mean]; p < 0.0001), but their race and sex distributions were similar to deceased patients not having autopsy. Autopsy confirmed clinical presumptive cause of death in 52% (76), disputed clinical diagnosis in 9.5% (14), provided definitive diagnosis in the absence of clinical diagnosis in 13.6% (20), and failed to provide definitive diagnosis in 25% (37). One third of autopsies (39%; 57) provided information that was clinically unrecognized and might have altered therapy and outcome if known premortem. As determined by autopsy, common causes of death were cardiac (27%; 39), unknown (25%; 37), sepsis (14%; 21), stroke (8.8%; 13), cholesterol embolism (4.1%; 6), pulmonary embolism (4.1%; 6), and adult respiratory distress syndrome (4.1%; 6). CONCLUSIONS: Autopsy reveals or confirms cause of death in nearly three quarters of cardiac surgical deaths and provides information that differs significantly from premortem clinical impression more than 20% of the time. As such, the autopsy remains important to quality assurance in cardiac surgical care.

Aged↗