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PubMed1993

Attitudes of relatives to autopsies of elderly patients.

The attitudes of 233 relatives to autopsy of elderly medical patients (mean age 82 years) who died in a district general hospital were examined prospectively. Forty-three (18%) relatives were asked permission for autopsy, 24 (56%) agreed and 19 (44%) refused. Of 190 (82%) relatives whose permission was not sought, 109 (57%) would have agreed and 81 (43%) would have refused permission had they been asked. Advancement of medicine and reassurance about the correct diagnosis were the main reasons for consent, while dislike of autopsy, family distress at disfigurement of the body and the patient 'having suffered enough' were the main reasons for refusal. Living near rather than with the deceased (64% vs 45%; chi 2 = 6.985, p = 0.01) and being a male rather than female relative (63% vs 49%; chi 2 = 3.879, p = 0.05) were predictive of a positive response to autopsy. Of the 39 autopsies performed, 24 (9.6%) followed relatives' permission and 15 (6%) were at the request of the coroner. The overall autopsy rate of 16% was lower than the rate recommended for medical audit (35%). Although there is a need for educating relatives about the benefits of autopsy, a more urgent study is required to find reasons for the low request by medical staff.

Aged↗
PubMed1989

Professional attitudes toward the autopsy. A survey of clinicians and pathologists.

One hundred six clinicians and 20 pathologists at a pediatric hospital and an adult general hospital in Halifax, Nova Scotia, were surveyed by way of a mailed questionnaire on their attitudes toward the autopsy. Approximately two-thirds of both groups rated the overall usefulness of the autopsy as high, but most limited its benefits to ascertaining the cause of death and as a tool for medical education. The autopsy was rated more highly by pathologists; those who worked in the pediatric hospital; medical rather than surgical specialists; and medical staff rather than housestaff. Personal attitudes toward authorization of an autopsy on a member of the respondent's family or on his or her own body did not differ from declared professional attitudes. It is unclear whether clinicians' and pathologists' negative attitudes toward the autopsy are related to lack of knowledge, lack of hospital and community support of the autopsy, or barriers to the practice of autopsy pathology.

Attitude of Health Personnel↗
PubMed1990

An attempt to motivate internal medicine housestaff to obtain consent for autopsies.

The impact that a 50-minute lecture on the value of the autopsy had on the subsequent obtaining of autopsies by housestaff training in internal medicine at a teaching hospital was examined in a prospective one-year clinical trial from mid-1987 to mid-1988. The group that attended the lecture (n = 27) did not subsequently obtain a greater mean number or frequency of permissions for autopsies than did the control group (n = 26), whose members did not attend, and did not indicate more frequently in the patients' charts that autopsies had been sought. In addition, in the total group of 53 housestaff, five (9.4%) did not write a pronunciation-of-death entry, and 26 (49%) did not obtain permission for a single autopsy during the study period. Future efforts to enhance the appreciation for the autopsy among physicians in training may need to use more sophisticated techniques than a lecture in order to increase housestaff motivation to obtain consent for autopsies.

Attitude of Health Personnel↗
PubMed1994

The utility of autopsies in a pediatric emergency department.

The role of the autopsy in verifying clinical diagnosis and as a quality assurance tool in pediatric emergency medicine has not been studied. We reviewed the charts of all children who died soon after arriving at to the pediatric emergency department between October 1985 and December 1989. Opinions as to clinical diagnoses and cause of death were obtained by presenting a summary of patient data, in a blinded fashion, to three emergency pediatricians. Clinical diagnoses were then compared with autopsy diagnoses using the Class Error System. Major diagnostic errors (Class I, Class II) were examined to determine if the autopsy was more useful in any particular patient group. There were 69 children: 36 (52%) were female, and 30 (43%) were infants. Autopsies were performed on 52 (75%) patients. Autopsy diagnoses were categorized as follows: sudden infant death syndrome (SIDS) 14 (27%); underlying disease 15 (29%); trauma 13 (25%); sepsis 8 (16%); and aspiration 2 (4%). No errors were made in 67% of cases. The autopsy confirmed the major clinical diagnosis in 85% of patients. There were no Class I errors. Class II error rate was 15%. Most Class II errors occurred in patients between one and five years of ate (57%), and in patients who had sepsis or underlying disease (95%). Our data show that autopsy is useful in determining the cause of death and may be useful for education and quality assurance in pediatric emergency medicine.

Autopsy↗
PubMed2004

Severity of injury is underestimated in the absence of autopsy verification.

BACKGROUND: Trauma disproportionately affects young, productive citizens. To decrease the preventable death rate and morbidity, and to save society some of the estimated 230 million dollars per day revenue loss attributable to these injuries, trauma systems were developed. New York State instituted a population-based regional trauma registry to enter all patients meeting appropriate International Classification of Diseases, Ninth Revision diagnostic codes. METHODS: We evaluated the registry records deaths in a single New York State trauma region. We compared the medical records used for registry entry to the autopsy records from the County Medical Examiner's Office to determine accuracy of diagnostic coding. On the basis of autopsy data, the records were then recoded and the extent of the trauma rescored. RESULTS: One hundred thirty-four deaths from 1993 to 1998 were recorded. Twelve records (9%) were accurately entered. One hundred twenty-two records had 452 errors. The mean Injury Severity Score (ISS), based on the medical record face sheet, was 29.93. The revised ISS, based on autopsy review, was 34.44 (p = 0.0108, two-tailed t test). The 95% confidence interval of the difference was 1.05 to 7.96. Z scores were -14.36 before autopsy review and -13.21 after autopsy review (p = 0.4395, not significant). We demonstrated a significantly higher ISS in the patients who died when the autopsy findings were included for coding. This information was not available from the medical record. CONCLUSION: To accurately compare trauma center performance and injury severity, the inclusion of autopsy data is critically important. Present state law does not permit sharing of this information with the trauma centers. When comparing mortality rates of New York State trauma centers, data must be carefully interpreted.

Autopsy↗
PubMed1987

An autopsy study of lung cancer in University of Tokyo for the last 27 years, from 1958 to 1984, with special reference to the characteristics of lung cancer in Japan.

Four hundred and sixty-five male and 159 female consecutive autopsy cases of lung cancer, autopsied over the 27 years from 1958 to 1984, were analysed and were compared with other materials and mortality statistics, including statistics from other countries. Malignant tumor autopsy cases are gradually increasing and now comprise more than 60% of total autopsy cases. The percentage of lung cancer cases among all autopsy cases was 7% in males and 4% in females. The percentage of lung cancer in autopsies of patients with malignancies was about 13% for males and 9% for females. The most frequent fatal malignant tumors were gastric cancer, lung cancer, and leukemia. The relative incidence of gastric cancer was decreasing, while that of lung cancer was increasing. In the distribution of the histological types of lung cancer, adenocarcinomas were the most frequent types in both sexes. As has been noted in mortality statistics, we noticed a gradual shift in the peak age of lung cancer autopsy cases towards older patients. During the period under study, the peak shifted from patients in their sixties to patient in their seventies; this was true for most of the major histological types in both sexes. The male/female ratio of all lung cancer cases was 2.9, which was much lower than the ratio found in the United States and Europe, and very similar to the ratio of the mortality rates in Japan and other Asian countries. It was pointed out that the male/female ratios by age-group in each country is a very good reflection of the histological distribution.

Adult↗
PubMed1998

Autopsy-verified venous thromboembolism within a defined urban population--the city of Malmö, Sweden.

OBJECTIVE: To analyse the frequency of autopsy-proven venous thromboembolism within a defined region and evaluate if certain risk groups not earlier recognized could be found. The incidence of objectively diagnosed venous thromboembolism was also calculated. SETTING: The city of Malmö, Sweden, with 230,000 inhabitants. MAIN OUTCOME MEASURE: Analysis of 2,356 autopsies for the year 1987 of deceased inhabitants from the city of Malmö (2,981 deceased, autopsy frequency 79.0%) regarding venous thromboembolism. RESULTS: 25% of autopsies revealed venous thromboembolism. At the acute-care hospital 31%, at the chronic hospital 37%, but in forensic autopsies of non-hospital deaths only 5% (p<0.001) revealed venous thromboembolism. Major pulmonary embolism was seen in 13% and was more frequent in in-hospital deaths (p<0.001). Two in-hospital and two non-hospital deaths due to pulmonary embolism and fractures were found: two patients with knee fractures, one hip fracture and one ankle fracture patient. The incidence of objectively diagnosed venous thromboembolism (autopsy, phlebography, perfusion scintigraphy) was calculated and an incidence of 42.5/10,000 inhabitants/year was found, (strongly age-dependent). CONCLUSION: Venous thromboembolism is a common finding in autopsies of hospitalized patients. Patients with fractures other than hip fractures are less well studied as regards venous thromboembolic complications. Further studies on these fracture patients are warranted.

Adult↗
PubMed2003

Infectious diseases detected at autopsy at an urban public hospital, 1996-2001.

Previous studies have demonstrated significant discrepancy rates between clinical and autopsy diagnoses. However, infectious diseases have not received emphasis in these studies. We conducted a study to determine whether the clinical and autopsy diagnoses of infectious diseases are concordant or discrepant and to determine discrepancy rates. Retrospective reviews of the records of 276 patients (adults, 182; fetuses and neonates, 94) who underwent autopsy during the years 1996 through 2001 were performed. Comparison of clinical and autopsy diagnoses was performed using the Goldman classification scheme. Of 182 adult patients, 137 (75.3%) had an infectious disease at autopsy. In 59 (43.1%) of 137 patients, the infectious disease diagnoses were unknown clinically. Of 94 fetuses and neonates, 45 (48%) had an infectious disease at autopsy. In 26 (58%) of 45 patients, the infectious disease diagnoses were unknown before death. There are substantial discrepancies between clinical and autopsy diagnoses of infectious diseases. In adults, acute bronchopneumonia is the infectious disease most often missed clinically; in fetuses and neonates, it is acute chorioamnionitis.

Adult↗
PubMed2003

Discrepancies between clinical diagnoses and autopsy findings.

Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.

Autopsy↗
PubMed1997

Postmortem fetal MR imaging: comparison with findings at autopsy.

OBJECTIVE: The purpose of this study was to prospectively compare findings from postmortem fetal MR imaging with findings at autopsy. SUBJECTS AND METHODS: Twenty-six fetuses were imaged on a 1.5-T MR scanner using two-dimensional and high-resolution three-dimensional fast spin-echo techniques immediately before autopsy. The MR images were reviewed independently by three radiologists who evaluated then for major and minor malformations. These findings were then compared with those at autopsy. RESULTS: The 26 subjects had 47 major and 11 minor malformations. All three radiologists correctly identified 37 of the major malformations on the MR images (detection rate, 79%), and at least one of the three reviewers correctly identified 43 of the abnormalities (detection rate, 91%). Only one of the 11 minor anomalies was identified by any reviewer. Reviewers made six false-positive diagnoses. In two cases, both with major CNS malformations, MR imaging was superior to autopsy in defining in situ relationships. CONCLUSION: Although autopsy remains the study of choice for evaluating causes of fetal death, MR imaging is an excellent alternative when autopsy is refused. Additionally, MR imaging may be a valuable adjunct to autopsy for fetuses with CNS anomalies.

Abnormalities, Multiple↗
PubMed1994

Analysis of physician attitudes concerning requests for autopsy.

To quantify the role of failure to request consent as a determinant of the autopsy rate, questionnaires asking whether an autopsy had been requested and the reasons for that decision were distributed to primary physicians after each death in a consecutive series of 75 patient deaths. Autopsies were requested in only 56% of cases. Common reasons to request an autopsy included unanswered medical questions (37%), medical education (22%), research protocol participation (16%), or routine policy (14%). When autopsies were not requested, the most common reason was the belief that there were no outstanding medical questions (64%). Follow-up interviews with 14 oncologists and hematologists revealed that 8 generally request autopsies (usually to contribute to medical education or to discover unexpected findings) and 6 generally do not (usually because no unexpected findings are anticipated). Attempts to increase the current low autopsy rate should address the question of when and why physicians are willing to request this procedure.

Attitude of Health Personnel↗
PubMed2004

What is a picture worth? Digital imaging applications in autopsy reports.

CONTEXT: An image-enhanced report (IER) containing color digital images can serve as an educational tool and document important gross and microscopic findings in anatomic pathology. OBJECTIVE: To determine the clinical impression of IERs on an academic autopsy service. DESIGN: Autopsy IERs were initiated at this institution in December 2001. From January 2002 to July 2003, 261 hospital-service autopsies were performed; color images were produced for 39 (15%) of these autopsies. Of these IERs, 29 were distributed to 74 hospital-employed physicians. Each hospital physician recipient was sent a 6-question e-mail survey to evaluate his or her impression of image quality and added value. RESULTS: Of the 74 hospital-employed physicians sent an IER, 41 responded to the survey (response rate, 55%). Twenty-one respondents recalled receiving a report with color images. Image quality was uniformly rated as good or excellent. Ninety-five percent thought the images increased their understanding of the report, and 76% thought that the images increased the utility of the report. All respondents stated they would (or did) use the images for educational purposes. Twenty-one percent of all respondents thought the presence of color images would increase their likelihood of requesting a future autopsy. CONCLUSIONS: Color digital images are perceived as a valuable addition to the autopsy report. Although clinicians did not consider color images a strong motivator to request a future autopsy, most thought that the images enhanced their understanding and the utility of the report. All respondents stated they would use the images to educate themselves, medical students, residents, and/or the patient's family.

Autopsy↗
PubMed1999

[Clinical autopsy evaluation].

The hospital autopsy rate in Japan dropped from 63.5 per cent in 1972 to 20.9 per cent in 1995. This reduction is attributable to declining interest by clinicians, surgeons and pathologists. The decline is a very serious problem, because the autopsy contributes to what has been called "quality control" of medical care. However, the method of autopsy should change along with advances in diagnostic technology or various changes in the circumstances surrounding medical practice. The most important problem at present is that autopsies require both time and effort. Delayed autopsy reports by pathologists may result in declined interest by clinicians and thus limit the benefits. To shorten the time delay for autopsy reports, clinicians must clarify their clinical questions concerning the deceased patient so that pathologists can readily identify the patients' problems and determine the causes more promptly, clearly and diplomatically. Other suggestions for improvement include the following: the reports should be simpler; the concept that all autopsies must be complete should be eliminated; a hospital accreditor must emphasize that clinicians intend to gain more precise diagnoses by obtaining post-mortem tissues of various organs using biopsy instruments. In addition, communication between pathologists and clinicians must be active to determine the pathogenesis of disease.

Autopsy↗
PubMed1999

[The hospital autopsy. An important factor in hospital quality assurance].

The frequency of hospital autopsies declined after a new autopsy law was introduced in 1990. The purpose of the study was to evaluate the frequency of autopsy over a six month period in Copenhagen county. We compared the causes of death recorded on death certificates with autopsy findings. One thousand seven hundred and four hospital deaths were followed by 534 (31%) autopsies. Neither age of the decreased nor length of the admission seemed to influence the autopsy frequency. In 20% of the autopsies we found valuable new informations compared to the causes of death recorded on the death certificates.

Autopsy↗
PubMed2000

ANCA-associated vasculitis--an autopsy study.

The purpose of the study was to analyse the autopsies of 31 patients (20 female, mean age 67 years, range 28-87 years; and 11 male, mean age 66 years, range 47-80 years) with antineutrophil cytoplasmic antibodies (ANCA)-positive vasculitis, which was clinically confirmed in 25 patients and suspected in 6 patients, who had been treated and had died between 1989 and 1999. Kidney biopsy was performed in 22 patients on average 33 months (range, 1-132 months) prior to death. Biopsy and autopsy tissue specimens were examined by standard light and immunofluorescence microscopy techniques. Pauci-immune extracapillary glomerulonephritis was found in nearly the same percentage of 22 renal biopsies and 31 autopsies, namely in 91% and 84%, respectively. Active necrotising extracapillary glomerulonephritis was the prevailing lesion in 75% of biopsies, while advanced sclerosing glomerular lesions prevailed in 69% of autopsies. In the biopsies, necrotising lesions predominated in patients with ANCA of proteinase 3 specificity, while sclerotic lesions were more often associated with myeloperoxidase-ANCA. In the autopsies, florid necrotising systemic vasculitis coexisted in 2 patients with advanced sclerosing glomerulonephritis. Autopsies revealed the actual expansion of vasculitic disease, disclosed clinically silent vasculitic involvement of unusual locations and, in 3 patients, confirmed the clinically suspected vasculitis. The final diagnoses in 31 patients were as follows: Wegener's granulomatosis (5 men, 2 women), microscopic polyangitis (10 women, 2 men), pauci-immune crescentic glomerulonephritis (4 women, 3 men), a single case each of polyarteritis nodosa and isolated cutaneous vasculitis. In 3 patients, suspected vasculitis was not confirmed at autopsy. Nineteen of 31 patients died from septic infections or necrotising pneumonias, and 6 patients from progressive or recurrent vasculitis with complications, altogether nearly 80%. Cardiovascular failure, including pulmonary thrombembolism, caused death in 6 patients.

Adult↗
PubMed2001

[The significance of the autopsy--now and in the future].

The significance of the autopsy is reflected in the quality control of medical diagnosis and therapy, as well as in the social relevance of the autopsy findings for the individual, family and society in general ("individual" and social epidemiology). Contemporary statistics from research of the literature and internet will be presented and interpreted in a modern context. A pre-requisite for a quality control function is an adequately high autopsy rate, which should be a factor taken into consideration for the registration und certification of a clinic or hospital. There are some valuable studies cited which assess the significance of autopsy as a means of quality control in clinical surgery, oncology and general internal medicine. There is, on the other hand, a decline of autopsy rates worldwide, but especially in the Federal Republic of Germany since the beginning of the 90ties. In addition, the causes will be demonstrated and discussed briefly. The attitude of medical colleagues and health insurance companies, as well as public opinion and politics, all influence the significance of and attitude to the autopsy, including the readiness to create and maintain a transparent legal and cost-covering framework. A spectrum of the differing opinions, obtained from various discussions, will be given. In addition, the necessary legal and financial regulations to facilitate and sustain the autopsy service at a sufficiently high rate (at least 30%, based on statistical considerations) will be discussed in the context of desirable short- and long-term solutions.

Attitude to Health↗
PubMed2002

Medicolegal autopsy--what, why and how.

By the term autopsy means medicolegal autopsy, though there is another one called clinical autopsy. The term is synonymous with postmortem examination. Autopsy is conducted to ascertain the cause of death, manner of death, time since death, to establish the identity of the deceased and so on. As per Mysore Police Manual Order No 1380, a civil surgeon or medical officer or other qualified registered medical person approved by the State Government is entitled to conduct an autopsy. Generally an autopsy is conducted by medical officer concerned on requisition from concerned authority in any unexpected, unexplained, unnatural, suspicious or sudden death. Autopsy is conducted at the body in its entirety and the mutilated body or skeletal remains. After having complied with the medical and legal obligations, eventually the medical officer has to furnish his opinion based on examination findings and investigation results.

Attitude of Health Personnel↗
PubMed1992

[Do we need an autopsy law?].

The clinical autopsy serves the purpose of identifying the underlying disease as well as the immediate cause of death. It is the major instrument of quality control in the field of medical diagnosis and treatment. In addition, autopsies are of great importance with regard to the epidemiology of diseases, to the identification of hitherto unknown disease entities and to modified clinical courses of well-known disorders. Moreover, clinical autopsies have a significant impact on the medical education of students as well as of physicians. The description of the conditions permitting autopsies in the Federal Republic of Germany is followed by a review of the rules governing autopsy practice in the european countries. It is emphasized that the clinical autopsy and its practice should be regulated by a codified law. This law, however, should ensure that the autopsy's objectives may be realized and may indeed contribute to the well-being of the population, to the expansion of scientific knowledge and to the further development of the health care system.

Autopsy↗