Autopsies and quality of cause of death diagnoses

Objective: The consequences of a low autopsy rate are not considered in determining the cause of death. Method: We have analyzed the Cause of Death Register of the Swedish National Board of Health and Welfare since it started 1969 to and including 2016 to visualize the decline in the frequency of clinical autopsies over time and evaluated the effect on the quality of the cause of death diagnoses. Results: Over the five decades studied, the frequency of clinical autopsies declined from almost 40% to less than 5%. The rate of decline was not even. Political decisions and changes of healthcare organization in Sweden affected the slope of decline of autopsies superimposed on a linear decline over time reflecting changes in clinical routines. A request of clinical autopsies was highly dependent on the level of care at the time of death, with the lowest number of requests for persons who died in nursing homes. The age at the time of death was a major factor affecting the number of autopsies, resulting in an autopsy rate of less than 1% in the ages where most persons die. Although men were autopsied more often than women, a gender-specific difference was not seen after correction for the age of death. We also found a higher rate of unspecific and irrelevant diagnosis in the cases not autopsied and we know from earlier studies by us and other authors that the cause of death diagnoses were missed in between 30% and 50% of the cases not autopsied. Conclusion: The decline in the clinical autopsy rate reduced the value of the death certificate register. An increase in the number of autopsies performed will improve the understanding of disease and cause of death, as well as to better inform next of kin.

Utilization of clinical autopsy services in a Nigerian teaching hospital

Objectives: The aim of this study was to ascertain the rate of uptake of clinical autopsy services in our hospital and also determine the associated factors. Autopsy is an important part of clinical practice. It serves as an audit and quality control for diagnosis and treatment of diseases. It also provides families with “informed grieving” by giving clearer understanding of the nature of illness and cause of death and may reveal inheritable or communicable diseases among other benefits. Despite these benefits, the rate of autopsy is low and declining globally. Material and Methods: A retrospective study of hospital autopsies performed from January 2013 to December 2017 was carried out. The mortuary and autopsy records of our hospital over the period were retrieved and reviewed. Deaths reported to the police, namely, coroner deaths and deaths before arriving at the hospital (brought in dead, BID) were excluded from the study. Results: A total of 1976 bodies was studied, 1078 males and 898 females (M:F = 1:1.2). Consent for autopsy was sought in 22 (1.1%) cases: 13 (0.66%) from pediatrics, 5 (0.25%) from internal medicine, and the rest from surgery and obstetrics and gynecology. Consent was granted and autopsy performed in 6 (0.3%) cases giving an average of 1.2 autopsies/year. Average hospital stay was 12.6 days and 36.3 days for those consenting to and those declining autopsy, respectively. Consenting persons belong to diverse socioeconomic strata. Conclusion: Autopsy rate is very low in our center. Attending clinicians and relatives of the deceased contribute to this trend. Vigorous education for all stakeholders about the benefits of hospital autopsy is recommended.

Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study

AimThe aim of this implementation study was to assess the effect of postmortem CT (PMCT) and postmortem sampling (PMS) on (traditional) autopsy and postmortem examination rates. Additionally, the feasibility of PMCT and PMS in daily practice was assessed.MethodsFor a period of 23 months, PMCT and PMS were used as additional modalities to the autopsy at the Department of Internal Medicine. The next of kin provided consent for 123 postmortem examinations. Autopsy rates were derived from the Dutch Pathology Registry, and postmortem examination rates were calculated for the period before, during and after the study period, and the exclusion rate, table time, time interval to informing the referring clinicians with results and the time interval to the Multidisciplinary Mortality Review Board (MMRB) meeting were objectified to assess the feasibility.ResultsThe postmortem examination rate increased (from 18.8% to 32.5%, p<0.001) without a decline in the autopsy rate. The autopsy rate did not change substantially after implementation (0.2% decrease). The exclusion rate was 2%, the table time was 23 min, and a median time interval of 4.1 hours between PMCT and discussing its results with the referring clinicians was observed. Additionally, more than 80% of the MMRB meetings were held within 8 weeks after the death of the patient.ConclusionsOur study shows that the implementation of a multidisciplinary postmortem examination is feasible in daily practice and does not adversely affect the autopsy rate, while increasing the postmortem examination rate.

Factors Associated with Stillbirth Autopsy in Georgia and Utah, 2010–2014: The Importance of Delivery Location

Objective This article determines whether demographic, delivery, and medical factors are associated with stillbirth autopsy performance in Georgia and Utah. Study Design This study used fetal death certificates from 2010 to 2014 to determine which factors are associated with stillbirth autopsy performance in Georgia and Utah. Analyses were conducted using logistic regression with a predicted margins approach. Results The stillbirth autopsy rate was low in both states: 11.9% in Georgia (N = 5,610) and 23.9% in Utah (N = 1,425). In Utah, the autopsy rate significantly declined during the study period (p = 0.01). Stillbirths delivered outside of large metropolitan areas were less likely to receive an autopsy (medium/small metropolitans: prevalence ratioGA [PR] = 0.57, 95% confidence interval [CI]: 0.48–0.68 and PRUT = 0.48, CI: 0.38–0.59; nonmetropolitans: PRGA = 0.57, CI: 0.43–0.75 and PRUT = 0.37, CI: 0.21–0.63). In Georgia, autopsies were less common among stillbirths of Hispanic (vs. white) women (PR = 0.57, CI: 0.41–0.79), at earlier (vs. later) gestational ages (PR = 0.59, CI: 0.51–0.69), and of multiple birth pregnancies (PR = 0.71, CI: 0.53–0.96). Conclusion Despite strong evidence supporting the value of stillbirth autopsies, autopsy rates were low, especially outside metropolitan areas, where approximately half of stillbirths were delivered.

Academic autopsies in Brazil - a national survey

Objective: To investigate the number and rate of academic autopsies, general organization, educational and research in Brazilian academic services. Methods: Standardized questionnaires were sent to Brazilian medical schools (n=177) and active pathology residency programs (n=53) from March to June 2009. Data were collected for years 2003 to 2008. Results: Thirty-two academic services in 11 Brazilian states answered the survey. Twenty-one (65.6%) perform less than a hundred autopsies for natural causes and less than fifty pediatric or fetal autopsies/year. Twenty-four (75%) perform less than a hundred adult autopsies/year. Many institutions (46.9%) reported a drop in the number of autopsies in a six-year period. The total autopsy count and autopsy rate in 2008 ranged 1-632 (median = 80), and 0-66% (mean = 10.6%), respectively. A steady decrease in the total count of autopsies in a pool of 19 institutions was observed (p<0.01). Median autopsy rates have fallen from 19.3%, in 2003, to 10.6%, in 2008 (p=0.07). Significant discrepancies at autopsies led to changes in institutional healthcare practice in 37.5% of the services. The low number of autopsies was a limiting factor in undergraduate education for 25% of respondents. A minimum number of autopsies is required to complete the pathology residency program in 34.6% of the services. Conclusion: The total number and the rate of academic autopsies have decreased in Brazil between 2003 and 2008. The number of autopsies and the general organization of academic services must be enhanced to improve medical education, research, and the quality control of patient care.

Assessment of health care quality in the tertiary level pediatric hospitals in Serbia

Background/Aim. It is necessary to improve the quality of health care for children. Assessment data would provide new insights into better treatment outcomes. The aim of this descriptive study was to estimate and to compare applied quality indicators in five pediatric inpatient tertiary level institutions in Serbia during the period from January 1st to December 31st 2008. Methods. Quality data and indicators were collected in the Institute for Public Health of Serbia ?Dr. Milan Jovanovic Batut?. Descriptive statistics and chisquare test were used for data analysis. Results. The average length of stay (ALOS) in pediatric departments was 7.51 ? 1.30 days (5.88-8.91 days). In the same period, ALOS in pediatric surgery departments was 5.85 ? 1.50 days (3.58-7.57 days). The average number of nurses per occupied bed was 0.76 ? 0.20 and 1.09 ? 0.36 in pediatric and in pediatric surgery departments, respectively. The number of operated patients per surgeon was in the range 51.0-160.5. The annual case fatality rate in pediatric departments was estimated to 0.72% ? 0.20%, whereas in pediatric surgery departments it was 0.34% ? 0.25%. The autopsy rate was estimated to 0.00%-63.16% in pediatric departments, and 37.14%-80.00% in pediatric surgery departments. There was statistically significant difference among the five hospitals regarding the following indicators of quality of work: total annual mortality rate of patients, autopsy rate, number of rate of patients, autopsy rate, number of patients referred to other institutions, both in pediatric and pediatric surgery departments. Conclusion. There is a significant difference among the five hospitals regarding indicators of quality of work. Obligatory set of quality indicators on the basis of legislative acts are the indicators of general quality of work in hospital. It is necessary to establish specific pediatric quality indicators and to define national standards related to these indicators.