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PubMed1990

The autopsy in acquired immunodeficiency syndrome. How and why.

The autopsy on the patient who has died of acquired immunodeficiency syndrome (AIDS) can be of great value to the physicians who cared for the patient and to society in general. Although the AIDS virus has been shown to be significantly contagious in the clinical setting, there is no evidence thus far that it is particularly contagious in the autopsy room. Indeed, there is no documentation of a pathologist or autopsy room assistant having contracted AIDS or having seroconverted because of the performance of an autopsy on a patient with AIDS. Procedures to follow in the autopsy of the patient with AIDS are described. The hospital pathologist can safely examine the patient who has died of AIDS by using the well-established techniques for performance of the autopsy.

Acquired Immunodeficiency Syndrome↗

PubMed1989

[The high autopsy rate in Vienna].

In 1983 34% of all persons who died in the Republic of Austria were autopsied. We examined the frequency of postmortem examinations in the capital city, Vienna, between 1983 and 1987 in view of this high overall autopsy rate. The annual autopsy rate in all 9 pathology institutes and the department of legal medicine of the University of Vienna was on average 51 to 53%. There was a slight statistically verifiable decline in 1987. The reason for this high necropsy rate is that Austrian law permits the autopsies without the consent of next of kin if it appears indicated for medical, scientific or educational reasons; further more the fact, that the chairman of the department is at the same time the coroner for the hospital. A high autopsy rate is necessary to maintain a high standard of diagnostic accuracy even in modern medicine. The diagnoses were inaccurate or incomplete in 15% of all cases. The high autopsy rate is the basis for extremely accurate mortality and morbidity statistics and provides the basis for long range public health planning. Medical students develop an insight in disease patterns, which cannot be gained in any other way. The pathology departments of Vienna introduce a new city-wide computer-supported diagnostic file system, which will provide a baseline for comparative scientific studies.

Austria↗

PubMed1986

Perinatal autopsy: its clinical value.

The clinical value of the routine autopsy was studied in 172 sequential cases of perinatal deaths. Of these cases 139 (81%) were autopsied including 52 fetal deaths and 87 neonatal deaths. The clinically assigned cause of death was compared with the cause of death as identified by the autopsy. In 26% (nine fetal and 27 neonatal deaths) the autopsy was the sole means of establishing the cause of death. A need for specific genetic counseling or evaluation was identified in 62 of the 139 perinatal deaths. In 30 (48%) cases the autopsy was the sole source of information highlighting this need. The autopsy is an important clinical tool providing useful information to the perinatal clinician. Besides providing specific causes of death, it can correct clinical impressions and identify genetic factors that require further assessment and counseling.

Autopsy↗

PubMed1984

Potential of the autopsy.

The autopsy was originally performed to understand anatomy. It still has relevance in correlating physiologic and pathologic processes with anatomic structures. In the first half of this century, it was an important tool in experimental investigations, the discovery of new diseases, and the identification and correlation of known clinical entities with particular cells, tissues, and organs. Since the early 1950s, the autopsy has suffered a regression in terms of interest, the number of competent autopsy physicians and of autopsies, financial reimbursement, and a lack of support from the medical community. Simultaneously its relevance to teaching, the ensuring of accurate diagnoses for therapy, and providing material for the investigation of unique human diseases, has increased. It will take a decade of support to produce a reversal of this trend. The leadership resides in the academic institutions that have the most resources. Academic pathologists could help rejuvenate the autopsy by emphasizing the utilization of human tissue for research and for transplantation, giving new significance to the autopsy and reinforcing its roles in patient care and graduate education.

Academic Medical Centers↗

PubMed1995

Organ-limited autopsies. Obtaining permission for postmortem examination of the urinary tract.

OBJECTIVE: To develop a systematic pre- and postmortem program for obtaining permission for autopsies limited to the urinary tract. DESIGN: Comparison versus historical control of autopsy permission using a new process comprising premortem education, modification of the permission process, and autopsy limited to the urinary tract. PARTICIPANTS AND SETTING: Patients, family members, and healthcare providers associated with a nursing home. INTERVENTION: Education of healthcare providers and family members and modification of autopsy consent and performance. MAIN OUTCOME MEASURE: Permission rate and demographic characteristics of patients and family members giving permission. RESULTS: Of the 361 patients who died during the study, we received permission for postmortem examination of the urinary tract for 129 (36%). This was substantially better than the autopsy rate in the year prior to the study, 0.6%. A significantly higher permission rate was associated with patients and contact persons of white race, a higher level of education of the contact person, a nonrelative contact person, and two or fewer individuals making the decision. CONCLUSION: Permission for organ-limited autopsies can be obtained with a systematic approach.

Aged↗

PubMed1995

[Attitudes to autopsy among critically ill patients and the general population].

Attitudes towards autopsy were investigated by a questionnaire given to 60 cancer patients, 30 patients with severe cardiac disease and 132 healthy people without known disease. Eighty-five percent of the patients and 82% of the healthy people had a positive attitude towards autopsy. A majority (65-72%) found that permission should be given by the patient rather than the family. Only 6% of patients and 13% of the healthy people would refuse to give permission to autopsy, 71% and 47% would give permission and 10% and 25% would consent to autopsy under certain conditions. both groups were more reluctant to give consent to the performance of an autopsy on a relative. It is concluded that hospital routine should be changed so that patients should be asked whether they would permit an autopsy to be performed in event of their decease.

Autopsy↗

PubMed1994

[Justification of routine autopsies after postoperative death].

Over a period from September 1981 to January 1983 data were collected from 97 autopsies following postoperative death (non-cardiac surgery). The autopsy rate was 73%. In 40% of the autopsies discrepancies were found between the clinical diagnosis and the cause of death found at autopsy. In 9% of the autopsies knowledge of the lesions that caused death might have changed the management of the patient and thus possibly also the prognosis. Since clinical practice has not changed considerably despite a ten year interval we consider the findings still valid today. Taking into account the decreasing rate of autopsy we want to stress that an important possibility of quality control of diagnosis and treatment in hospitals is about to be lost.

Adult↗

PubMed1994

Autopsy evidence of pulmonary thromboembolism.

OBJECTIVE: To determine the prevalence of pulmonary thromboembolism (PE) and underlying risk factors at autopsy, compared with clinical diagnosis. DESIGN: Retrospective review of autopsy records, death certificates and medical histories. PATIENTS AND SETTING: All 132 patients who underwent autopsy at St Vincent's Hospital, Melbourne, in 1992. RESULTS: Sixteen cases (12% of autopsies) of PE were found at autopsy. In only two had PE been recorded on the death certificate; in one other, diagnosis had been made before death. Associated pulmonary infarction and/or haemorrhage was found in only six patients with PE. All 16 had at least one underlying risk factor: advanced age, cancer, heart disease, or recent pelvic or abdominal surgery. In four patients with missed PE, clinical records showed episodes consistent with PE. There were four false-positive diagnoses. CONCLUSIONS: Significant undiagnosed pulmonary embolism is not uncommon at autopsy. Many episodes are clinically silent, but the diagnosis should be suspected in at-risk patients with unexplained episodes of dyspnoea and tachycardia.

Aged↗

PubMed1993

Correlation between clinical diagnoses and autopsy findings in critically ill children.

STUDY OBJECTIVE: To examine the correlation between clinical diagnoses and autopsy findings in children who die in the pediatric intensive care unit (PICU). DESIGN: Retrospective chart review. SETTING: PICU of a university-affiliated hospital. PATIENTS: A consecutive sample of patients who died in the PICU and had autopsies performed. MEASUREMENTS AND MAIN RESULTS: Of 193 patients who died during the 7 1/2-year study period, 50 (26%) had autopsies performed. The mean age was 34.7 months (range 15 hours to 17 years), and the mean length of stay in the PICU was 12.2 days (range 2 hours to 60 days). Major admitting diagnoses included postoperative cardiac surgery (19), nonoperative cardiac disease (7), hematologic/malignant disorder (5), and acquired immunodeficiency syndrome (5). There were 5 cases (10%) where autopsy revealed a major finding that, if known prior to death, would have altered clinical management and might have resulted in cure or prolonged survival. In another 9 patients (18%) the autopsy revealed major findings that, if known prior to death, would not have altered management. Eight of these findings related to the cause of death and 2 of them involved the basic disease. There was no correlation between new findings and either patient age or length of stay in the PICU. CONCLUSIONS: Despite modern diagnostic techniques, the autopsy continues to reveal valuable and unsuspected information.

Adolescent↗

PubMed1996

Enhancing autopsy performance and reporting. A system for a 5-day completion time.

OBJECTIVE: To develop a system for enhancing the performance and reporting of autopsies in an effective and clinically useful manner. DESIGN: Twelve steps were defined as essential for the completion of the autopsy. Each step of the process was evaluated for usefulness and effectiveness. SETTING: Autopsies performed in a university hospital from 1992 through 1994. PARTICIPANTS: Pathology residents and staff, clinicians, and clinical team house staff. INTERVENTION: Participants followed the 12-step process, with emphasis on involving the clinical team in the interview, prosection, and final rounds. The final rounds conference was designated a working conference, where the perfused-fixed brain was cut, histologic sections of the case were submitted, and the provisional diagnosis was written with the clinicians. A next-day microscopic slide review session was scheduled to "sign out" the case. Establishing a philosophy of status equal to all other department functions facilitated implementation. MAIN OUTCOME MEASURE: All autopsies performed for a period of 3 years (2 retrospective and 1 prospective) were included. RESULTS: The autopsy completion time was reduced from a mean of 57 days (range 7 to 174) in 1992 to 4.8 days (range 1 to 16) in 1994. CONCLUSION: The autopsy completion time was reduced, increasing its usefulness for teaching and quality assurance. Relationships with the clinical staff were enhanced with consultation-style final reports. Enthusiasm for, and satisfaction with, the new process was expressed by clinicians, pathology staff, residents, and technical support staff.

Autopsy↗

PubMed1996

[Spectrum of the renal pathology in HIV infection: description of 85 autopsies and clinico-pathologic correlation].

A descriptive cross-sectional study was conducted on the prevalence and histologic characteristics of renal lesions found in the autopsies of 85 patients with HIV infection: also, a retrospective analysis of clinico-biological characteristics in 56 of these patients in order to establish the factors associated with the histological findings. A total of 85 autopsies were made from 1985 to 1993; 50 autopsies (58.8%) showed renal changes: 23 (27%) infections, 13 (15.2%) acute tubular necrosis (ATN), 6 (7%) tumors, 5 (5.8%) intersticial nephritis (IN), 5 (5.8%) nephrocalcinosis (NC), 10 (11.7%) others. In an additional study: group IIc (n = 37, study group with nephropathy) had a higher incidence in the hepatitis B surface marker (HBsAg) than in group Ic (n = 19, control group, without nephropathy) (0 vs 10, p < 0.05). The presence of disseminated mycobacteriosis in the autopsy was significantly higher in the group with nephropathy than in the group without nephropathy (11 vs 1, p < 0.05). No consistent data were observed between the clinical diagnosis of nephropathy and autopsic findings. In summary, a high incidence of nephropathy was found in the autopsies of HIV infected patients, although it was not previously suspected. Renal lesions in autopsies of HIV infected patients had a tubular-intersticial predominance over glomerular lesions. The use of potentially nephrotoxic drugs, the presence of HBsAG, and some opportunist infections apparently influenced on the development of renal lesions among these patients.

AIDS-Associated Nephropathy↗

PubMed1997

A national survey of autopsy cost and workload.

We mailed survey questionnaires to a random sample of medicolegal offices throughout the USA. The survey asked how many forensic pathologists were used, their American Board of Pathology forensic examination (Board) status, how many autopsies they performed, and, if payment were fee-for-service, what fees were paid for medicolegal autopsies. Response rate was 61%, with 188 offices returning questionnaires. The average fee, was $518 with a standard error of $27. The number of fee-for-service autopsies was split evenly between Board qualified and Board ineligible pathologists, accounting for about one-third of medicolegal autopsies nationwide. Although smaller offices used more pathologists ineligible for forensic Boards, they paid a premium for such qualification. Larger offices used more forensic Board qualified pathologists, but paid them less than those ineligible to take the examination! Overall there was no significant premium paid for Board qualification. The average fee paid is far less than the published estimates of the cost of an autopsy. The low fees paid may reflect: (1) the value of the teaching experience supplied to medical students and/or residents; (2) pathologists performing medico-legal examinations as community service; and (3) the lower marginal cost of additional autopsies.

Autopsy↗

PubMed1997

Rapid brain autopsy. The Joseph and Kathleen Bryan Alzheimer's Disease Research Center experience.

OBJECTIVE: To develop a system for retrieving brain tissue within 1 hour after death in an effective and useful manner. DESIGN: Nurse clinicians were employed as study co-ordinators and were available to families 24 hours each day. SETTING: Autopsies were performed at Duke University Medical Center, Durham, NC, from 1985 through 1995. PARTICIPANTS: Neuropathology faculty, fellows, and residents, autopsy technicians; and brain bank staff. RESULTS: Fifty-one rapid autopsies with a postmortem interval of less than 1 hour have been performed. Four of these were normal controls, three were disease controls, and 44 represented Alzheimer's disease patients. Tissue retrieved at rapid autopsy has been distributed to 93 research teams, 30 of these located at Duke University Medical Center. Many researchers have received multiple shipments of tissue. CONCLUSIONS: The Bryan Alzheimer's Disease Research Center Rapid Autopsy Program at Duke University Medical Center has been successful in retrieving tissue from individuals with dementia and also from controls within 1 hour of death. The critical features of the success of this program have been the use of nurse clinicians who work closely with patients and their families to ensure a successful autopsy at the time of death and the maintenance of a 24-hour call schedule for nurses and neuropathology staff. Similar programs can be implemented for experimental work into the pathogenesis of a wide variety of human diseases in which the examination of human tissue is required.

Aged↗

PubMed1997

Forensic autopsies from 1984 to 1993 in Vienna, Austria.

In Austria every death is subject to an examination by a medical doctor authorized by the local health authority. If death is suspected to be natural and/or perpetrated by another person, this doctor has to report it to the police. Depending on the investigation results, the examining magistrate in charge demands a judicial autopsy at the Institute of Forensic Medicine. In 1989, 41 murders of old patients by nursing assistants in a Viennese public hospital were disclosed. The main aim of this retrospective study was to determine any change in the demand for forensic autopsies by the Viennese health authority, as well as by the criminal court, after 1989. Furthermore, it was of interest to analyze the reporting practices of medical doctors examining corpses, as well as thr reaction of the criminal court during the study period. After 1989, there was a significant increase of non-judicial and judicial autopsies, performed by Viennese forensic pathologists. In addition, there was a significant increase of reports to the police by coroners as well as by forensic pathologists, paralleled by a higher rate of forensic autopsies demanded by the examining magistrate. This increase of forensic autopsies took place even though the overall rate of deaths in Vienna significantly decreased during the 10-year study period. Thus, the disclosure of 41 murders in the Viennese hospital in 1989 can be assumed as a turning point in the reporting practices of Viennese coroners, as well as the autopsy rate handled by Viennese forensic pathologists.

Austria↗

PubMedDate not supplied

[Characteristics of medical care related to autopsy authorization in a pediatric hospital].

OBJECTIVE: To identify some differences of patients and medical characteristics related to autopsy authorization. DESIGN: Observational, cross-sectional study. SETTING: Third-level medical care in a pediatric hospital. METHODS: A specific mortality questionnaire was analyzed by members of the mortality staff, because they reviewed deaths which occurred between January 1994 and December 1995. Descriptive statistic and non-parametric tests (X2) were calculated to analyze data. RESULTS: A total of 408 deaths were evaluated, in which 116 autopsies were done (28.4%). Children less than 18 months of age had the highest frequencies of autopsies (33.3%-30.7%). The patients referred by other units and the autopsy application done by a medical resident, had the highest frequencies of acceptance (32.5%, 35.3%, p < 0.05). The detection of diagnostic and therapeutic problems were related with high frequencies of autopsies (37.7%, 36% p < 0.05). CONCLUSIONS: The results show us that some medical care factors are related to higher frequencies of autopsies. It is important to consider them in order to increase the capacity of teaching that a postmortem study has.

Age Factors↗

PubMed1998

The validity of verbal autopsies for assessing the causes of institutional maternal death.

This report presents data from a study carried out in three African countries to assess the validity of verbal autopsies--based on information about symptoms and signs observed antemortem by relatives or associates of deceased individuals--for determining the causes of institutional maternal death. The validity of the verbal autopsy was assessed for each cause of death; and for groups of "direct" and "indirect" maternal causes, by comparing the verbal autopsy diagnoses with the reference diagnoses and calculating their sensitivity, specificity, and positive predictive value. Verbal autopsies were found to be highly specific (98 percent specificity for all causes of maternal death) but not very sensitive (< or = 60 percent sensitivity for all causes except ante/postpartum hemorrhage). Verbal autopsy estimates of cause-specific mortality were comparable to expected values for most of the causes. The study shows that certain direct causes of hospital-based maternal mortality can be determined by means of verbal autopsies with a reasonable level of confidence.

Adolescent↗

PubMed2001

Psychological autopsy studies--a review.

Psychological autopsy is one of the most valuable tools of research on completed suicide. The method involves collecting all available information on the deceased via structured interviews of family members, relatives or friends as well as attending health care personnel. In addition, information is collected from available health care and psychiatric records, other documents, and forensic examination. Thus a psychological autopsy synthesizes the information from multiple informants and records. The early generation of psychological autopsies established that more than 90% of completed suicides have suffered from usually co-morbid mental disorders, most of them mood disorders and/or substance use disorders. Furthermore, they revealed the remarkable undertreatment of these mental disorders, often despite contact with psychiatric or other health care services. More recent psychological autopsy studies have mostly used case-control designs, thus having been better able to estimate the role of various risk factors for suicide. The future psychological autopsy studies may be more focused on interactions between risk factors or risk factor domains, focused on some specific suicide populations of major interest for suicide prevention, or combined psychological autopsy methodology with biological measurements.

Comorbidity↗

PubMedDate not supplied

Infectious causes of death in patients with rheumatoid arthritis: an autopsy study.

OBJECTIVE: To study mortality from infections and accuracy of pre-mortem diagnoses in patients with rheumatoid arthritis (RA) autopsied during a 40-year period. METHODS: We investigated infectious causes of death, findings at autopsy, and clinicians' estimation of cause of death in 369 consecutively autopsied RA and 371 autopsied non-RA patients with same sex, age at death, and year of autopsy. We also compiled clinical features of RA patients from medical records available and examined the association between these and infectious causes of death. RESULTS: Deaths from any infection were more frequent in RA (36%) than in non-RA (26%) patients. In both groups, respiratory and urinary tract infections were the most common infectious causes of death. More RA patients died from urinary tract infections than non-RA patients. In approximately half of the patients in both groups, infection as a cause of death was unrecognized before death, with no major change occurring over the 40-year study period. CONCLUSIONS: Infections, especially respiratory and urinary tract infections, are frequent causes of death in RA patients. The high proportion of undiscovered infections as a cause of death highlights the diagnostic difficulty. With a decreasing number of autopsies being performed at present, greater numbers of infections may be under-reported.

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