SEARCH · Search PubMed

Results for “AUTOPSIES”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 397 records · Page 22Linked to original sources

PubMed1990

Autopsies and death certificates in the chronic care setting.

All autopsies (n = 34) performed over a period from July 1, 1981 to June 30, 1988 in a teaching nursing home were reviewed to determine the autopsy rate, to evaluate premortem versus postmortem diagnostic discrepancies, and to see if educational efforts could improve each. The autopsy rate was 3.5%. Major discrepancies appeared in 47.1% of cases. Pneumonia was the most frequent and most frequently missed diagnosis. Only 23 of 34 death certificates reflected the cause of death as documented in the chart, and only 12 had concordant diagnoses with those from autopsy. After a collective educational effort, the autopsy rate increased from a rate (average of initial six years) of 2.4% to 10.8% in the last year. The autopsy rate is low, but can be improved with educational efforts. Death certificates, in this population, may be misleading when used for general statistical purposes.

Adult↗

PubMed1993

Cerebrovascular disease at autopsy and in the death statistics for the county of Hordaland, Norway.

Between 1975 and 1984 a decrease in deaths from cerebrovascular disorders was found both at autopsy and in the official mortality statistics. In the autopsy material (662 cases) the decrease was seen mainly in patients dying of cerebral hemorrhage. Concordance between autopsy and mortality statistics was best in the 30 to 79-year age group. Discordance rose with age, being highest in those above 80 years. This was mainly due to use of the diagnosis "undetermined vascular lesion" given as the clinical cause of death. The diagnosis was not upheld at autopsy. In such cases the presence of a cerebral lesion was rarely confirmed at autopsy. The decrease in acute cerebrovascular deaths was not accompanied by an increase in the number of patients in the category "stroke with sequelae", assessed as a fall in number. Thus mortality statistics can be directly misleading in geriatric patients; and the autopsy frequency in this age group is too low to give a satisfactory picture of events.

Adult↗

PubMed2006

Virtual autopsy: preliminary experience in high-velocity gunshot wound victims.

PURPOSE: To retrospectively assess virtual autopsy performed with multidetector computed tomography (CT) for the forensic evaluation of gunshot wound victims. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant study and did not require informed consent of the next of kin. Thirteen consecutive male gunshot wound victims (mean age, 27 years) were scanned with 16-section multidetector CT prior to routine autopsy. Retrospectively, the total-body nonenhanced scans were interpreted at a three-dimensional workstation by radiologists blinded to autopsy findings. Images were evaluated for lethal wound, number and location of wound tracks, injured structures, and metal fragment location. After image review, autopsy reports and photographs were compared with the images and interpretations to validate the multidetector CT determinations. RESULTS: Multidetector CT aided in correct identification of all lethal wounds, and metallic fragment location was always precise. In four cases, multidetector CT aided in accurate assessment of organ injuries and lethal wounds but led to underestimation of the number of wounds if comingling paths occurred. In two cases of a chest wound, multidetector CT aided in accurate assessment of the chest as having the lethal wound but failed to help identify specific sites of hemorrhage. In two cases of craniofacial injury, the path of the wound was not clear. Autopsy revealed a total of 78 wound tracks (mean, 6; range, 1-24). Ten (13%) wound tracks were not identified at multidetector CT (six upper extremity wounds and four thigh wounds). In two cases, findings missed at autopsy (fracture of the cervical spine, bullet fragments in the posterior area of the neck) were identified at multidetector CT. CONCLUSION: Multidetector CT can aid prediction of lethal wounds and location of metallic fragments.

Adult↗

PubMed2006

Barriers to autopsy: Creutzfeldt-Jakob disease in New York state.

Surveillance of Creutzfeldt-Jakob disease (CJD) monitors trends and ensures timely identification of variant CJD and other emergent prion diseases. Brain tissue is needed to definitively diagnose these diseases. A survey of neurologists and pathologists in New York State was conducted to understand neurologists' and pathologists' views on autopsy and CJD. Neurologists reported using autopsy rarely or never. Over half of the pathologists worked in facilities that did not perform autopsies when CJD was suspected. Barriers to autopsy included family reluctance, infection control concerns, and local facilities unable to perform brain autopsy. More accurate, complete recognition of CJD and variant forms depends on physician awareness of the manifestations of CJD and its diagnosis, access to pathologists and facilities willing and able to perform brain biopsies and autopsies, and family acceptance of such procedures.

Attitude of Health Personnel↗

PubMed1978

Correlation of angiographic and autopsy left ventricular dimensions in children.

To evaluate controlled pressure coronary artery perfusion fixation of hearts as a means of obtaining meaningful cardiac measurements at autopsy, left ventricular (LV) autopsy measurements were correlated with in vivo end-diastolic (D) and end-systolic (S) angiographic (angio) values from biplane cineangiograms in the same patients. Mitral (MV) and aortic valve (AV) circumferences, LV equatorial circumference (Circ), spatial inflow and outflow lengths, wall thickness (W) and LV volume (Vol) were measured in 34 children with congenital heart disease. All dimensions showed significant correlation of angiographic and autopsy data from which linear regression equations were derived. The r values obtained were: MV 0.74; AV 0.85; D Circ 0.83; S Circ 0.82; D inflow 0.92; S inflow 0.90; D and S outflow 0.96; W 0.78; D Vol 0.92; S Vol 0.86. Mean angio and autopsy values were not significantly different for AV, S inflow, and S Vol. Autopsy values were lower than all D angio values and MV (P less than 0.001 for all), and higher than angio W and S outflow (P less than 0.001 for both). The data show that changes of LV morphology with this fixation method are predictable, making estimation of in vivo values from autopsy measurements possible using the derived linear regression equations.

Angiocardiography↗

PubMed1991

The value of the autopsy in congenital heart disease.

We reviewed autopsies in 50 consecutive cases of congenital heart disease between 1980 and 1988. Autopsy results were compared to premortem clinical diagnosis. The patients ranged in age from two days to 66.5 years with a mean age of 6.42 years; 68% were less than one year of age. The most common diagnoses were hypoplastic left heart syndrome in 16 (32%) and ventricular septal defect in five (10%). Other common diagnoses included coarctation of the aorta, hypoplastic right heart syndrome, tetralogy of Fallot, transposition of the great vessels and tricuspid atresia. No patient had a missed diagnosis that would have changed survival (Class 1). Four (8%) of the patients had one missed major diagnosis that did not change their survival because they were already being symptomatically treated or because no clinical treatment was available (Class 2). The majority of autopsy derived data were missed minor diagnoses that were related [14 (28%)-Class 3] or unrelated [12 (24%) - Class 4] to the terminal disease process. However, despite the small percentage of autopsy findings that would have directly affected survival, the autopsy provided important additional clinical information in 30 (60%) patients. This information could be used to correct management errors and to develop protocols for prophylaxis against known complications. The pediatric autopsy can provide useful clinical data that may be a guide to altering clinical therapy and is essential in providing genetic counseling.

Adolescent↗

PubMed1994

An audit of autopsy rates in an inner London general hospital.

Low autopsy rates are of continuing concern to pathologists. The aim of this study was to investigate the reasons why autopsy did not happen, and to determine whether carrying out the investigation and providing some feedback of the results would have any effect on autopsy rates. The main reasons why autopsy did not happen were that junior doctors considered it unnecessary because the diagnosis and cause of death appeared to be well established, and that patients' relatives declined to give permission for autopsy. No increase in autopsy rates was demonstrated, but possible avenues of approach were suggested and these are being implemented.

Attitude of Health Personnel↗

PubMedDate not supplied

The autopsy: a professional responsibility in assuring quality of care.

Forty years ago, the value of autopsies was widely recognized as new diseases were discovered or clarified and scientific technology advanced greatly. Despite the autopsy's strong foundation, its value is not currently being properly conveyed to physicians or patients. Although autopsy-related policy exists, these policies have had little effect on increasing or even maintaining adequate autopsy rates. More recently, the autopsy has fallen on hard times, with US hospital rates now below 5%. The reasons for the decline in rates are multifaceted and include a lack of direct reimbursement for the procedure, lack of defined minimum rate standards, overconfidence in diagnostic technology, and the fear of litigation. Regardless of the reasons for the declining rates, the ethical and professional reasons for increasing the number of autopsies are far more important.

Autopsy↗

PubMed2004

Verbal autopsy of 80,000 adult deaths in Tamilnadu, South India.

BACKGROUND: Registration of the fact of death is almost complete in the city of Chennai and not so in the rural Villupuram district in Tamilnadu, India. The cause of death is often inadequately recorded on the death certificate in developing countries like India. A special verbal autopsy (VA) study of 48,000 adult (aged >or= 25 yrs) deaths in the city of Chennai (urban) during 1995-97 and 32,000 in rural Villupuram during 1997-98 was conducted to arrive at the probable underlying cause of death to estimate cause specific mortality. METHODS: A ten day training on writing verbal autopsy (VA) report for adult deaths was given to non-medical graduates with at least 15 years of formal education. They interviewed surviving spouse/close associates of the deceased to write a verbal autopsy report in local language (Tamil) on the complaints, symptoms, signs, duration and treatment details of illness prior to death. Each report was reviewed centrally by two physicians independently. Random re-interviewing of 5% of the VA reports was done to check the reliability and reproducibility of the VA report. The validity of VA diagnosis was assessed only for cancer deaths. RESULTS: Verbal autopsy reduced the proportion of deaths attributed to unspecified and unknown causes from 54% to 23% (p < 0.0001) in urban and from 41% to 26% (p < 0.0001) in rural areas in Tamilnadu for adult deaths (>or= 25). The sensitivity of VA to identify cancer was 95% in the age group 25-69. CONCLUSION: A ten day training programme to write verbal autopsy report with adequate feed back sessions and random sampling of 5% of the verbal autopsy reports for re-interview worked very well in Tamilnadu, to arrive at the probable underlying cause of death reliably for deaths in early adult life or middle age (25-69 years) and less reliably for older ages (70+). Thus VA is practicable for deaths in early adult life or middle age and is of more limited value in old age.

Adult↗

PubMed1995

Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy.

PURPOSE: The purpose of this investigation is to estimate the prevalence of acute pulmonary embolism (PE) in a general hospital, its frequency among patients who died, and the ability of physicians to diagnose PE antemortem. METHODS: The prevalence of acute PE among 51,645 patients hospitalized over a 21-month period was assessed in 1 of the 6 clinical centers (Henry Ford Hospital) that participated in the collaborative study, prospective investigation of pulmonary embolism diagnosis (PIOPED). The diagnosis of PE was made by pulmonary angiography, or in those who did not undergo pulmonary angiography because they declined or were ineligible for randomization to angiography in PIOPED, the diagnosis was based on the ventilation/perfusion (V/Q) lung scan. Based on data in PIOPED, PE was considered to be present in 87% of patients with high probability V/Q scam interpretations, 30% with intermediate probability interpretations, 14% with low probability interpretations, and 4% with nearly normal V/Q scans. RESULTS: The estimated prevalence of acute PE in hospitalized patients was 526 of 51,645 (1.0%; 95% confidence interval [CI], 0.9 to 1.1%). Based on extrapolated data from autopsy, PE was estimated to have caused or contributed to death in 122 of 51,645 (0.2%; 95% CI, 0.19 to 0.29%). Pulmonary embolism was observed at autopsy in 59 of 404 (14.6%; 95% CI, 11.3 to 18.4%). Among patients with PE at autopsy, the PE caused or contributed to death in 22 of 59 (37.3%; 95% CI, 25.0 to 50.9%) and PE was incidental in 37 of 59 (62.7%; 95% CI, 49.1 to 75.0%). Among patients at autopsy who died from PE, the diagnosis was unsuspected in 14 of 20 (70.0%; 95% CI, 45.7 to 88.1%). Most of these patients had advanced associated disease. In these patients, death from PE occurred within 2.5 h in 13 of 14 (92.9%; 95% CI, 66.1 to 99.8%). CONCLUSION: Pulmonary embolism is common in a general hospital. The prevalence of PE at autopsy has not changed over 3 decades. The frequency of unsuspected PE in patients at autopsy has not diminished. Even among patients who die from PE, the PE is usually unsuspected. Such patients, however, typically have advanced disease. Among moribund patients, incidental PE is rarely diagnosed. Patients who suffer sudden unexplained catastrophic events in the hospital are a group in whom the diagnosis might be suspected more frequently if physicians maintain a high index of suspicion.

Acute Disease↗

PubMed2000

Secondary infections of AIDS autopsy cases in Japan with special emphasis on Mycobacterium avium-intracellulare complex infection.

In order to study the frequency of secondary infections of AIDS autopsy cases in Japan, especially the frequency of Mycobacterium aviumintracellulare complex (MAC) infection, retrospective autopsy study was conducted between 1986 and 1997 at the affiliated hospital of Institute of Medical Sciences, University of Tokyo. Secondary infections of various organs from 43 AIDS autopsy cases were examined using histopathology, genetic diagnosis of tuberculosis, Ziehl-Neelsen stain for acid-fast bacilli and immunohistochemistry. Nontuberculous mycobacterial infection (Mycobacterium avium) was observed in 17 cases (40%) out of 43 using polymerase chain reaction (PCR), but M. tuberculosis infection was not observed. Ziehl-Neelsen staining showed a positive reaction in lung and spleen tissues of 7 AIDS autopsy cases. Immunohistochemistry using anti-BCG antibody revealed positivity in 7 AIDS autopsy cases. CD4 counts of 17 AIDS patients with mycobacterial infection were less than 18.7/microl. Other opportunistic infections were also examined by histopathology. Secondary infections were present in every case, and these included cytomegalovirus infection (32 cases), Pneumocystis carinii (15 cases), Candida (16 cases), Aspergillus (12 cases), Cryptococcus (6 cases), Toxoplasma (6 cases), methicillin-resistant Staphylococcus aureus (3 cases), herpes virus (1 case) and Entamoeba histolytica (1 case). Malignant lymphoma was recognized in 14 cases and Kaposi's sarcoma in 6. This is the systemic report on secondary infections of AIDS autopsy cases in Japan. In diagnosis of mycobacterial infections, PCR was more useful than staining for acid-fast bacilli and immunohistochemistry. Secondary infections (especially mycobacterial infection) were closely associated with the low CD4 count.

AIDS-Related Opportunistic Infections↗

PubMed1996

Hanging and poisoning autopsies in Fiji.

OBJECTIVE: Fiji is a Pacific nation with roughly equal numbers of indigenous Fijians and Indians. Previous studies, using police and medical records, have suggested significant racial, regional, age and gender differences in suicidal behaviour. The objective of the present study is to use a unique data set (autopsy reports) in the evaluation of earlier reports and to identify groups at greater risk. METHOD: Hanging and poisoning autopsy reports from two distinct regions were examined. RESULTS: The rate of autopsy (per 100000 population per year) among Indians (19.5) is significantly greater (p < 0.0001) than among Fijians (1.53). In the north, among the Indians, there are more autopsies in females (21.2) than males (16.8), and hanging constitutes 85% of total suicides, while in the Central and Eastern Divisions hanging constitutes only 58% of the total. These are regional influences. Among Fijians, the rates of hanging autopsy are significantly greater (p < 0.001) in males (1.98) than females (0.40); however, among Indians there is no significant difference. This is a racial difference. Hanging remains the preferred option for all groups. The mean age at autopsy is 31.7. There is no significant difference between the mean ages of the races, the sexes or the regions. There is no significant difference between the mean age of poisoning (31.5) and hanging (31.8). CONCLUSION: There is a significant racial difference in rates of suicide but the influences of region, age and method are relatively slight.

Adult↗

PubMedDate not supplied

Prevalence of the neonatal autopsy: a report of the Study Group for Complications of Perinatal Care.

Neonatal autopsy findings are valuable additions to the information base for current cases and future perinatal care, so the reported decline in the autopsy rate is disturbing. In order to estimate the prevalence of the neonatal autopsy among a large population of deaths, we surveyed participating institutions of the Study Group for Complications of Perinatal Care. Investigators from 37 neonatal intensive care units, located in 9 children's hospitals, 4 hospitals for women and infants, and 24 full-service pediatric and adult care hospitals, reported their neonatal death and autopsy rates for 1989. The overall neonatal autopsy rate was 51% among 1645 neonatal deaths. The rate was variable, ranging from 22 to 100%. We found the neonatal autopsy rate to be lower than previously reported and not apparently influenced by the type of center or by the type of medical staff at the centers. In order to assess and potentially reverse the current low rate, the influence of neonatal demographic and clinical factors, as well as physician-related factors, must be studied.

Autopsy↗

PubMed2000

Comparison of premortem clinical diagnoses in critically iII patients and subsequent autopsy findings.

OBJECTIVE: To determine whether our practice of requesting an autopsy for patients who die in the medical intensive care unit (MICU) continues to be a valid approach to obtain clinically and educationally relevant findings. METHODS: In this retrospective study conducted in an adult MICU population of a university hospital, the clinical diagnoses and postmortem major diagnoses of 100 patients who died in 1996 (autopsy rate of 93%) were compared. RESULTS: Eighty-one percent of the clinical diagnoses were confirmed at autopsy. In 16%, autopsy findings revealed a major diagnosis that, if known before death, might have led to a change in therapy and prolonged survival (class I missed major diagnoses). The most frequent class I missed major diagnoses were fungal infection, cardiac tamponade, abdominal hemorrhage, and myocardial infarction. Another 10% of autopsies revealed a diagnosis that, if known before death, would probably not have led to a change in therapy (class II error). CONCLUSIONS: Autopsy remains an important tool for education and quality control. In contrast with historical series of 1 to 2 decades ago, there is a clear shift in the type of class I missed major diagnoses toward opportunistic infections. Bedside-applicable techniques such as electrocardiography with supplemental posterior leads, echocardiography, and meticulous abdominal ultrasonography might improve the outcome in selected MICU patients.

Adolescent↗

PubMed2002

Verbal autopsy in establishing cause of perinatal death.

INTRODUCTION: Perinatal mortality is a sensitive indicator of health status of a community and is also highly amenable to intervention. The causes of perinatal deaths in developing countries are often difficult to establish. Verbal autopsy has been used in several countries for children and adults, but seldom for perinatal cause. OBJECTIVE: To establish the cause of perinatal deaths using verbal autopsy. DESIGN: Community-based cross-sectional, retrospective study to identify perinatal death over a one year period from July 1996-June 1997. Comparison was made with hospital records. An algorithm of signs and symptoms was used by trained personnel to identify the cause of perinatal death. The duration of collection of data was six months (August 1996-January 1997). SETTING: Hai district of Kilimanjaro region in Tanzania. SUBJECTS: All perinatal deaths within one year. RESULTS: The perinatal mortality was 58 per 1000 (121 deaths and 2088 live births). Verbal autopsy could establish the cause of death in 105 of the 121 deaths. Hospital records showed 79 deaths indicating that 42 deaths probably occurred at home. Among the 79 available hospital records, the cause of death could be established in only 30 (38%). The causes of postnatal death were compared between the verbal autopsy and hospital records. There was a good correlation between the same, however only 18 records were available from hospital among the total 31 postnatal deaths. The specificity of determining cause of death using verbal autopsy was 100% and sensitivity 61%. CONCLUSION: The commonest causes of perinatal deaths were related to obstetric care, therefore interventions to curb perinatal mortality should be directed to improvement of obstetric care. Verbal autopsy is a simpler and more sensitive tool in establishing the cause of perinatal death than hospital records in a rural district of Tanzania. Large-scale studies are needed to validate this.

Autopsy↗

PubMed1992

The perinatal autopsy: its conduct and reporting in Australia.

OBJECTIVE: To assess the conduct and reporting on death certificates of perinatal autopsies in Australia. DATA SOURCES: (i) Medical certificates of cause of perinatal death in all States and Territories; (ii) registrations of perinatal deaths in New South Wales in 1985 and 1986. DATA EXTRACTION: Death certificates are assessed on three criteria: (i) an indication that an autopsy was performed; (ii) an indication whether the stated causes of death were based on autopsy findings; and (iii) an indication whether the clinical diagnosis was confirmed by autopsy. DATA SYNTHESIS: Perinatal death certificates give insufficient information in all three areas. Assessment of the accuracy and usefulness of autopsies requires better information. CONCLUSION: A two-part death certificate is suggested. The first part would report clinical diagnoses of the causes of death. The second part would compare these results with those of any autopsy.

Australia↗

PubMed2001

Quality improvement on an academic autopsy service.

CONTEXT: Autopsy rates continue to decline in the United States. OBJECTIVE: Although many of the causes of this decline are external to pathology departments, we hypothesized that intradepartmental efforts to improve the quality of the service we provide to our clinical colleagues could increase our autopsy rate. METHOD: We developed a multifaceted quality improvement program for our autopsy service aimed at increasing the visibility of the service, improving the service's reporting, and increasing the amount and quality of data available from the service. SETTING: A large academic medical center that performs approximately 250 autopsies each year. RESULTS: After implementation of our quality improvement program, the decline in our autopsy rate has not only stopped, but rates have even begun to increase. Additionally, physician satisfaction surveys conducted before and after implementation of our quality improvement initiatives showed an across-the-board improvement in clinician perception of the service. CONCLUSION: Pathologists can and should be proactive in addressing the declining autopsy rate, rather than viewing it as someone else's problem or hoping that someone else will protect this important quality assurance tool for medical care.

Attitude of Health Personnel↗

PubMed2004

Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings.

BACKGROUND: The American-European Consensus Conference definition for the acute respiratory distress syndrome (ARDS) has never been validated. OBJECTIVE: To compare clinical criteria for ARDS with autopsy findings. DESIGN: Independent comparison of autopsy findings with clinical characteristics retrospectively abstracted from medical records. SETTING: Tertiary medical-surgical intensive care unit. PARTICIPANTS: 382 patients who underwent clinical autopsy. MEASUREMENTS: Sensitivity, specificity, and likelihood ratios for clinical criteria were calculated in 3 cohorts by using diffuse alveolar damage at autopsy as the reference standard. The 3 cohorts were 1) all patients, 2) patients with any risk factor for ARDS, and 3) patients who were separated according to their pulmonary or extrapulmonary risk factors. RESULTS: 127 patients (33%) met the clinical criteria, and 112 (29%) had diffuse alveolar damage. In all patients, the sensitivity of the clinical definition was 75% (95% CI, 66% to 82%) and the specificity was 84% (CI, 79% to 88%). In 284 patients with risk factors, the sensitivity was 76% (CI, 67% to 83%) and the specificity was 75% (CI, 68% to 81%). Compared with patients with pulmonary risk factors, patients with extrapulmonary risk factors had significantly higher sensitivity (61% vs. 85%; P = 0.009) and the specificity did not statistically significantly differ (69% vs. 78%; P > 0.2). LIMITATIONS: Only patients who died and underwent autopsy could be included in this study, so these results may not apply to less severe cases of ARDS. CONCLUSIONS: In a series of autopsy patients, the accuracy of the American-European Consensus Conference definition of ARDS was only moderate. The definition was more accurate for patients with extrapulmonary risk factors than for patients with pulmonary risk factors.

Aged↗