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PubMedDate not supplied

[Effect of serotonin-adipinate on the ultrastructure and synthetic activity of endotheliocytes of microhemocirculatory bed of human brain (autopsy material, early autopsies)].

Electron-microscopic and radioautographic investigation showed the ability of brain capillary endotheliocytes for retaining functional activity in total ishemia. Administration of serotonin adipinate in an early postoperative period supports intracellular processes and plays a protective role.

Adipates↗
PubMed1992

Attitudes of funeral directors and embalmers toward autopsy.

Although physician and family attitudes toward autopsy have been suggested as factors leading to declining autopsy rates, attitudes of funeral directors and embalmers toward autopsy have not been studied. We surveyed members of the Illinois Funeral Directors Association concerning beliefs about the purposes of autopsy, problems they experienced with autopsied cases, and the advice they gave to family members about permitting autopsy. Three hundred eight (42.2%) of 730 funeral directors and embalmers responded to the questionnaire. Although 80.3% believed that autopsy served a purpose, 46.4% had counseled families not to permit autopsy, and 16.6% did so more than half the time. Perceived difficulty in embalming autopsied cases (odds ratio, 2.3), family concern about the risk of disfigurement (odds ratio, 1.9 to 2.2), having attempted to talk to a pathologist or hospital administrator about a poorly performed autopsy (odds ratio, 2.0), and belief in the purpose of autopsy (odds ratio, 0.38), were significant independent predictors of counseling against autopsy. Of funeral directors who counseled against autopsy, 28.3% reported that families never permitted autopsy, and 39.4% reported that families only occasionally permitted autopsy, in cases where they had counseled against it. Funeral directors from Illinois counties with 1989 medical certificate case autopsy rates of less than 5% counseled against autopsy more frequently than funeral directors from counties with higher autopsy rates. We conclude that although most funeral directors and embalmers believe in the purposes of the autopsy, difficulties in embalming autopsied cases, and family concern about the risk of disfigurement, may lead members of the funeral profession to counsel against autopsy, and that such advice may influence families not to permit an autopsy.

Attitude↗
PubMed2004

How the pediatric autopsy yields valuable information in a vertically integrated health care system.

CONTEXT: Although autopsy rates have declined significantly in recent decades, studies continue to validate the autopsy as an important source of clinically relevant information, a teaching tool, and a quality assurance measure. A recent review of autopsy series showed a decline in the number of serious errors likely to have affected clinical outcome detected at autopsy during the past 46 years, with a current major error rate of 8.4% to 24.4%. OBJECTIVE: Our hypothesis was that the pediatric autopsy would uncover a significant number of major unexpected findings at the high end of the spectrum predicted by a recent review. This study assesses the unexpected findings at a pediatric hospital whose autopsy service handles both in-house (tertiary care) and referral (mostly perinatal) cases for a vertically integrated health care system. DESIGN: Data were analyzed from an autopsy effectiveness report completed for all autopsies performed in 2000. The data from this series include concordance of premortem and postmortem diagnoses, with the autopsy considered the criterion standard. The autopsy effectiveness report also provided logistic information, such as problems with consents, medical records, specimen identification, and prosection. SETTING: Pediatric autopsies were performed by members of the Pediatric Pathology Division in a freestanding children's hospital in the Intermountain West of the United States with a large rural catchment area. This hospital is part of a large health maintenance organization serving the surrounding urban and rural areas. PATIENTS: A sample of all in-house and referral autopsies for the year 2000 was examined. MAIN OUTCOME MEASURE: The percentage of cases with a major or minor diagnostic discrepancy or unexpected pathologic finding using the autopsy as the criterion standard. RESULTS: The overall autopsy rate was 40% (39 hospital autopsies and 15 forensic autopsies per 135 total deaths) and was 32% excluding forensic cases. Twenty-two additional referral autopsies from outside institutions were performed. Of 61 autopsies, 12 (20%) revealed a major diagnostic discrepancy or unexpected pathologic finding, 17 (28%) had a minor unexpected finding or additional diagnosis, 41 (67%) clarified the differential diagnosis, 46 (75%) confirmed or verified a major diagnosis, and 21 (34%) provided information regarding treatment effects. Additionally, 3 (5%) had problems with identification, and 12 (20%) had problems with consent, all of which were resolved prior to initiation of the autopsy. CONCLUSIONS: These data confirm the value of the pediatric autopsy in a children's hospital and a vertically integrated health care system. It is an important medical and quality assurance procedure for assessing the accuracy of diagnoses, clarifying differential diagnoses, yielding unexpected findings, and providing feedback regarding therapeutic outcomes.

Autopsy↗
PubMed1999

Autopsy result utilization: a College of American Pathologists Q-probes study of 256 laboratories.

OBJECTIVES: To document the level of involvement and communication with nonpathology clinical personnel regarding autopsies and to document the destination of autopsy reports. DESIGN: The College of American Pathologists Q-Probes format was used to collect information on 15 consecutively performed autopsies per institution or for 6 months, whichever occurred first. The following information was recorded for each autopsy: decedent's age, hospital service, length of hospital stay, whether organs were donated, who was present at autopsy, methods of communicating preliminary and final autopsy results, special techniques used to arrive at a preliminary diagnosis, activities for which the autopsy was used, and destination of final report. PARTICIPANTS: Two hundred fifty-six laboratories collected information on 2755 autopsies. RESULTS: The aggregate autopsy rate was 12.4% (median 8.5%). Nonpathology clinical personnel attended 35.8% of all autopsies. A clinical physician was more likely to attend an autopsy if the patient was from a surgical service. Three primary methods were used to communicate preliminary autopsy results, namely, written reports (82.5%), telephone calls (50.6%), and meetings (11.5%). The primary care physician was sent the autopsy report in 91.1% of cases. Approximately half of the autopsy cases were used in both pathology departmental and extradepartmental activities. Aggregate autopsy data were distributed in the majority of cases to various departmental chairpersons and institutional quality assurance committees. CONCLUSIONS: This study provides a comparative multiinstitutional database for the utilization of autopsy results by clinicians and clinical departments. Although autopsy rates are low, autopsy results are routinely being used for hospital quality assurance activities and for educational purposes.

Autopsy↗
PubMed2002

[Recent data for frequency of autopsy in Germany].

BACKGROUND AND OBJECTIVE: : Today clinico-pathological autopsies serve as a measure of quality assurance in clinical medicine. Furthermore reliable information on the distribution of different causes of death can only be gained by a significant autopsy rate. Medicolegal autopsies are essential for the discovery of non-natural or violent deaths. This study provides information on changes in clinico-pathological and medicolegal autopsy rates between 1994 and 1999. METHODS: : A survey of autopsy rates in 1994 and 1999 was undertaken covering all German pathological and medicolegal institutes. The autopsy figures of the different states were analysed separately. Most autopsies performed in pathological institutes were clinico-pathological autopsies and almost all autopsies performed in Institutes of Legal Medicine were medicolegal autopsies. RESULTS: Between 1994 and 1999 the frequency of clinico-pathological autopsies decreased from about 4 % to 3 % of all deaths. The medicolegal autopsy rate remained stable on a low level at about 2 %. The differences between various states are up to 4-fold for clinico-pathological autopsies and up to 5-fold for medicolegal autopsies. CONCLUSIONS: : The autopsy rates in Germany are frighteningly low compared to other European countries. Considering the dramatic decline of clinico-pathological autopsy rates the role of the post-mortem examination as a control of clinical medicine and death statistics cannot be fulfilled properly. The low medicolegal autopsy rate is responsible for the high number of undetected non-natural or violent deaths.

Autopsy↗
PubMed1993

Decreasing autopsy rate in Sweden reflects changing attitudes among clinicians.

The autopsy rate has declined in the last 20 years in Sweden and is now approximately 30%. Clinical autopsies constitute about 18% and medico-legal autopsies somewhat more than 10%. There is an obvious geographical variation in clinical autopsy rate, whereas the variation in medico-legal autopsy rate is narrower. The difference in autopsy frequency between males and females seemed to be mainly dependent on the higher number of medico-legal autopsies among males. In order to explore the reasons behind the decline in autopsy rate we accomplished a study of the autopsy rate in 1986 and 1991 in three Swedish hospitals of various types and sizes. The hospitals studied were one university hospital and two community hospitals of different sizes. The autopsy rate varied between 0 and 100% among the different departments within these hospitals and also varied considerably between wards within the same department. The number of clinical autopsies declined between 1986 and 1991 in all three hospitals. The fall was greatest in the university hospital and in the larger of the two community hospitals. However, in these two hospitals departments with active research of clinico-pathological relevance maintained or even increased their autopsy rate during this period. The decline in autopsy rate in general and the difference in rate between hospitals, departments and wards could be explained neither by the Autopsy Act of 1976, or by the reluctance of relatives to give consent to the autopsy of a relative. A change in attitude toward and interest in the autopsy activity of clinicians seemed to be the major explanation for the decline of the autopsy.

Adolescent↗
PubMed2000

The epidemiological study on registered cases of sudden infant death syndrome (SIDS) in Tokyo: examination of the effect of autopsy on diagnosis of SIDS and the mortality statistics in Japan.

In the United States and most of European countries, a diagnosis of sudden infant death syndrome (SIDS) may be given only after an autopsy has been performed. Under the new definition of SIDS in Japan, an autopsy is now mandatory for the diagnosis of SIDS. However, according to the official records on autopsies, the proportion of autopsy for sudden infant death in Japan is still low (less than 30%). If a physician suspects SIDS from a review of the patient's medical history and medical findings, he can write 'suspected SIDS' as the cause of death on the death certificate without performing an autopsy. Such a clinical diagnosis is entered in the Vital Statistics section by the Japanese Ministry of Health and Welfare. In this report, a comparative epidemiological survey of registered cases of SIDS--after autopsy and with no autopsy--was carried out by examining the data from the death certificates registered by the Japanese Ministry of Health and Welfare (vital statistics in Tokyo from January 1979 to December 1996). There were 369 cases of SIDS registered in Tokyo. We found 247 diagnosed after autopsy (66.9%) and 122 with no autopsy (33.1%). The following epidemiological variables were used: address of the deceased (a specific area in Tokyo), sex, year of death, time of death, month of death, age at death, occupation of householders, and place of death. There were epidemiological differences at the 0.05 significance level between registered cases diagnosed after autopsy and those diagnosed without autopsies, as follows: year (P=0.016) and place of death (P=0.037). In addition, there were slight epidemiological differences at the 0.10 significance level between registered cases diagnosed after autopsy and with no autopsy, as follows: month of death (P=0.076) and age at death (P=0.082). This suggests that the quality of diagnosis of SIDS is not completely guaranteed. With respect to the area of residence, the incidence of SIDS is high in those areas where autopsy is performed frequently. In Tokyo, the medical examiner system is enforced only in the urban area and there is a possibility that SIDS is being underdiagnosed in the rural area of the Metropolitan Tokyo. It is likely that the diagnosis of SIDS without autopsy will influence the quality of SIDS diagnoses. The administrative inadequacy in the autopsy system in Japan should be corrected to improve the accuracy of SIDS diagnosis.

Age Factors↗
PubMed1998

Autopsies in children: are they still useful?

BACKGROUND: Autopsy has traditionally been the criterion for determining cause of death and has played a major role in medical education and quality control. With increasing use of bedside technology, however, autopsy rates have steadily declined. OBJECTIVE: To identify (1) trends in pediatric autopsy rates during the past decade, (2) concordance between antemortem and postmortem diagnoses, and (3) patient characteristics influencing autopsy rates or diagnostic yield. METHODS: All pediatric deaths between January 1, 1984, and December 31, 1993, were retrospectively reviewed. Data collection included demographics for all patients, and length of stay, diagnostic imaging studies, antemortem diagnoses, and autopsy findings for patients with autopsies. Autopsy diagnoses were compared with antemortem findings and classified according to their concordance. RESULTS: Of 297 pediatric deaths, autopsies were performed on 107 patients (36%). Autopsy rates did not change significantly during the study period. Autopsies were not associated with patient gender, race, or insurance status, but increased significantly with age. Autopsies were performed in 26% of infants 12 months or younger, 60% of children between 13 to 60 months of age, and 100% of children 61 months or older (chi2; P <.001). In 34% of cases, new diagnoses were made at autopsy, including 7 cases where new findings, if known before death, would likely have resulted in a change in treatment or improved survival. There was no relationship between new findings at autopsy and age, length of hospital stay, or antemortem imaging studies. CONCLUSIONS: Autopsy can provide additional information in more than one third of pediatric deaths. Pediatric autopsy continues to provide clinically significant data and remains a valuable tool in modern pediatric practice.

Adolescent↗