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Alfsen GC, Gulczyński J, Kholová I, Latten B, Martinez J, Metzger M, Michaud K, Pontinha CM, Rakislova N, Rotman S, Varga Z, Wassilew K, Zinserling V. Code of practice for medical autopsies: a minimum standard position paper for pathology departments performing medical (hospital) autopsies in adults. Virchows Arch 2021; 480:509-517. [PMID: 34888730 PMCID: PMC8660654 DOI: 10.1007/s00428-021-03242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/17/2022]
Abstract
The medical autopsy (also called hospital or clinical autopsy) is a highly specialised medical procedure, which requires professional expertise and suitably equipped facilities. To ensure high standards of performance, the Working Group of Autopsy Pathology of the European Society of Pathology (ESP) suggests a code of practice as a minimum standard for centres performing medical autopsies. The proposed standards exclusively address autopsies in adults, and not forensic autopsies, perinatal/or paediatric examinations. Minimum standards for organisation, standard of premises, and staffing conditions, as well as minimum requirements for level of expertise of the postmortem performing specialists, documentation, and turnaround times of the medical procedure, are presented. Medical autopsies should be performed by specialists in pathology, or by trainees under the supervision of such specialists. To maintain the required level of expertise, autopsies should be performed regularly and in a number that ensures the maintenance of good practice of all participating physicians. A minimum number of autopsies per dedicated pathologist in a centre should be at least 50, or as an average, at least one autopsy per working week. Forensic autopsies, but not paediatric/perinatal autopsies may be included in this number. Turnaround time for final reports should not exceed 3 weeks (14 working days) for autopsies without fixation of brain/spinal cord or other time-consuming additional examinations, and 6 weeks (30 working days) for those with fixation of brain/spinal cord or additional examinations.
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Affiliation(s)
- G Cecilie Alfsen
- Department of Pathology, Akershus University Hospital, Loerenskog, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jacek Gulczyński
- Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdansk, Poland
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Bart Latten
- Department of Forensic Pathology, Netherlands Forensic Institute, The Hague, The Netherlands.,Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Javier Martinez
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León (CAULE), Leon, Spain
| | - Myriam Metzger
- Department of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne, Switzerland.,Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carlos M Pontinha
- Department of Anatomical Pathology, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Spain
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Vsevolod Zinserling
- Department of Pathomorphology, Institute of Experimental Medicine V.A. Almazov National Research Center, Saint Petersburg, Russian Federation
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Factors Influencing Acceptance of Post-Mortem Examination of Children at a Tertiary Care Hospital in Nairobi, Kenya. Ann Glob Health 2019; 85. [PMID: 31276331 PMCID: PMC6634467 DOI: 10.5334/aogh.2504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Clinical autopsies are not often part of routine care, despite their role in clarifying cause of death. In fact, autopsy rates across the world have declined and are especially low in sub-Saharan Africa. OBJECTIVES We set out to identify factors associated with acceptance of pediatric autopsies among parents of deceased children less than five years old, and examined local preferences for minimally invasive tissue sampling (MITS) procedures during post-mortem (PM) examinations. METHODS From December 2016 to September 2017, we contacted 113 parents/next of kin who had been previously approached to consent to a PM examination of their deceased child as part of a Kenyan study on cause of death. Interviews occurred up to three years after the death of their child. FINDINGS Seventy-three percent (83/113) of eligible study participants were enrolled, of whom 62/83 (75%) had previously consented to PM examination of their child. Those who previously consented to PM had higher levels of education, were more likely employed, and had more knowledge about certain aspects of autopsies than non-consenters. The majority (97%) of PM consenters did so because they wanted to know the cause of death of their child, and up to a third believed autopsy studies helped advance medical knowledge. Reasons for non-consent to PM examination included: parents felt there was no need for further examination (29%) or they were satisfied with the clinical diagnosis (24%). Overall, only 40% of study participants would have preferred MITS procedures to conventional autopsy. However, 81% of autopsy non-consenters would have accepted PM examination if it only involved MITS techniques. CONCLUSION There is potential to increase autopsy rates by strengthening reasons for acceptance and addressing modifiable reasons for refusals. Although MITS procedures have the potential to improve autopsy acceptance rates, they were not significantly preferred over conventional autopsies in our study population.
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Restoration of an academic historical gross pathology collection—refreshed impact on current medical teaching? Virchows Arch 2018; 473:219-228. [DOI: 10.1007/s00428-018-2369-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/07/2018] [Accepted: 04/29/2018] [Indexed: 01/19/2023]
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Schlageter M, Quagliata L, Matter M, Perrina V, Tornillo L, Terracciano L. Clinicopathological Features and Metastatic Pattern of Hepatocellular Carcinoma: An Autopsy Study of 398 Patients. Pathobiology 2016; 83:301-7. [DOI: 10.1159/000446245] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/13/2016] [Indexed: 11/19/2022] Open
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Hospital autopsy audit: discordant primary clinical diagnoses are found in 20% of cases in a reducing autopsy case load. Selection bias or significant findings? Pathology 2015; 47:499-502. [DOI: 10.1097/pat.0000000000000297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Eka I, Rowan C, Osborn M. Mind the gap: are NHS trusts falling short of recommended standards for consent to autopsy? J Clin Pathol 2013; 67:10-3. [DOI: 10.1136/jclinpath-2013-201869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Henry J, Nicholas N. Dead in the water--are we killing the hospital autopsy with poor consent practices? J R Soc Med 2012; 105:288-95. [PMID: 22843647 DOI: 10.1258/jrsm.2012.110288] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
It is now a recognized fact that the practice of conducting a consent (or hospital) post-mortem examination is in decline. There have been many reasons put forth to explain this demise, but the quality of the consenting process is frequently cited as having a high impact. This article focuses on consent practices for post-mortem examinations in England and Wales, and considers if our consent techniques are adversely affecting post-mortem examination uptake. We examine the regulatory compliance of trusts with their statutory obligations by analyzing the Human Tissue Authority's compliance and inspection reports. We further analyze 21 publicly available NHS Trust policies on post-mortem examination consent procedures, and consider whether these are fit for the purpose of meeting the dual needs of clinicians and the bereaved. Despite more Human Tissue Authority inspections, there is a disproportionate rise in enforcement actions, with up to 48% of sampled Trusts exhibiting shortcomings in their legal duties. Additionally, only 52.4% of sampled trusts follow the Human Tissue Authority best-practice model, with 23.8% having no documented procedures. Despite the well founded evidence base for best-practice models, consent practices for post-mortem examinations remains poor and is likely to have a gross adverse effect on the rate of post-mortem examinations. We recommend that NHS Trusts rigorously review their protocols and introduce a team-approach between clinicians and trained bereavement staff in core-consent teams, as the Human Tissue Authority suggests, whilst at the same time placing a strong emphasis on education for junior and senior colleagues alike.
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Affiliation(s)
- Jaimie Henry
- Imperial College School of Medicine, c/o Dr Mike Osborn, Department of Cellular Pathology, St Mary's Hospital, London, W2 1NY, UK.
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Wittschieber D, Klauschen F, Kimmritz AC, von Winterfeld M, Kamphues C, Scholman HJ, Erbersdobler A, Pfeiffer H, Denkert C, Dietel M, Weichert W, Budczies J, Stenzinger A. Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin. PLoS One 2012; 7:e37460. [PMID: 22629399 PMCID: PMC3358345 DOI: 10.1371/journal.pone.0037460] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 04/20/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Autopsy rates in Western countries consistently decline to an average of <5%, although clinical autopsies represent a reasonable tool for quality control in hospitals, medically and economically. Comparing pre- and postmortal diagnoses, diagnostic discrepancies as uncovered by clinical autopsies supply crucial information on how to improve clinical treatment. The study aimed at analyzing current diagnostic discrepancy rates, investigating their influencing factors and identifying risk profiles of patients that could be affected by a diagnostic discrepancy. METHODS AND FINDINGS Of all adult autopsy cases of the Charité Institute of Pathology from the years 1988, 1993, 1998, 2003 and 2008, the pre- and postmortal diagnoses and all demographic data were analyzed retrospectively. Based on power analysis, 1,800 cases were randomly selected to perform discrepancy classification (class I-VI) according to modified Goldman criteria. The rate of discrepancies in major diagnoses (class I) was 10.7% (95% CI: 7.7%-14.7%) in 2008 representing a reduction by 15.1%. Subgroup analysis revealed several influencing factors to significantly correlate with the discrepancy rate. Cardiovascular diseases had the highest frequency among class-I-discrepancies. Comparing the 1988-data of East- and West-Berlin, no significant differences were found in diagnostic discrepancies despite an autopsy rate differing by nearly 50%. A risk profile analysis visualized by intuitive heatmaps revealed a significantly high discrepancy rate in patients treated in low or intermediate care units at community hospitals. In this collective, patients with genitourinary/renal or infectious diseases were at particularly high risk. CONCLUSIONS This is the current largest and most comprehensive study on diagnostic discrepancies worldwide. Our well-powered analysis revealed a significant rate of class-I-discrepancies indicating that autopsies are still of value. The identified risk profiles may aid both pathologists and clinicians to identify patients at increased risk for a discrepant diagnosis and possibly suboptimal treatment intra vitam.
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Affiliation(s)
- Daniel Wittschieber
- Institute of Pathology, Charité University Hospital, Berlin, Germany
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | | | | | | | - Carsten Kamphues
- Department of General, Visceral and Transplantation Surgery, Charité University Hospital, Berlin, Germany
| | | | | | - Heidi Pfeiffer
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité University Hospital, Berlin, Germany
| | - Manfred Dietel
- Institute of Pathology, Charité University Hospital, Berlin, Germany
| | - Wilko Weichert
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Budczies
- Institute of Pathology, Charité University Hospital, Berlin, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, Charité University Hospital, Berlin, Germany
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
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[Public perceptions of hospital autopsies: results of a representative survey]. DER PATHOLOGE 2012; 32:345-8. [PMID: 21533595 DOI: 10.1007/s00292-011-1428-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The number of hospital autopsies has been declining for many years-in Germany as well as in other western countries. One possible reason for this could be the public's negative view of autopsies. METHODS Therefore, a representative survey was conducted to study the attitudes of the German population on postmortem examinations. RESULTS In total, 84% of respondents generally accept hospital autopsies, while only 10% are in principle opposed to this practice. Many respondents (72%) would agree to the autopsy of their own dead body and 65% to the autopsy of relatives. Altogether, 9% of respondents had already been in a situation where a relative had died in a hospital and they were asked for permission to perform an autopsy. Of these 90, 56% agreed to and 44% refused autopsy. CONCLUSION The data suggest that the attitudes of the public are surprisingly positive and do not explain declining autopsy rates. Medical and institutional reasons must be considered instead as the possible cause of declining autopsy rates.
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[Documentation of the diagnostic quality of hospitals: evaluation of autopsy reports]. DER PATHOLOGE 2011; 32 Suppl 2:282-6. [PMID: 21938498 DOI: 10.1007/s00292-011-1521-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Multiple factors have affected the decline in autopsy rates. Discrepancies between clinical diagnoses and findings at autopsy are frequently used as an argument for a high autopsy rate. However, the quality of the diagnosis is independent of the autopsy rate. A long-term study covering the years 1972-2002 in the University Hospital Zurich has documented a significant reduction of diagnostic errors in internal medicine. Major diagnostic errors (class 1) declined from 16% (1972), to 9% (1982), to 7% (1992) to 2% (2002). The main reason is the availability of new diagnostic procedures. In 2010 the analysis of class 1 diagnostic errors throughout the hospital documented class 1 discrepancies in only 1%. This low number of diagnostic errors has been published in the annual quality report of the University Hospital Zurich. The documentation of this improvement in the quality report of the hospital provides the opportunity to convince clinicians, health politicians and the hospital administration to support autopsies in teaching as well as non-teaching hospitals.
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Abstract
In many countries, including the UK, where relatives' consent is required, clinical autopsy rates (i.e. autopsies other than those required by law) have been declining since the 1950s. In the UK, even in teaching hospitals, the clinical autopsy rate has fallen to only 10% of deaths or less. At this rate of decline, clinical autopsies - and the pathologists who perform them - face extinction. The future practice of medicine will be blind to the many adverse consequences of clinical actions or omissions. The reasons for this decline are manifold and these have to be addressed if autopsy is to stand a chance of survival. The future of autopsy lies in promoting public support for autopsies, in some cases adapting the autopsy to address specific questions, thus making more effective use of information from autopsies. Only by ensuring that the next generation of doctors have experienced the powerful educational benefit of examining the body after death will the importance of autopsy to modern medicine be understood.
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Affiliation(s)
- Tariq Ayoub
- Foundation Year 1 F1, Conquest Hospital Hastings, UK.
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Abstract
The autopsy is now often regarded as of marginal use in modern clinical practice. In this Review we contend that the autopsy remains an important procedure with substantial, if largely underused, potential to advance medical knowledge and improve clinical practice. Many doctors lack familiarity with autopsy practices, and are insufficiently aware of the benefits for not only bereaved families but also present and future patients. In this Review, which has an international perspective, we consider the ascent and decline of the autopsy, the legal frameworks that govern its use, the value and potential pitfalls of alternatives to the conventional method, and the autopsy's role in undergraduate medical education. We also draw attention to the continuing ability of autopsies to improve the completeness and reliability of death certification, which is important for public-health strategies and for some bereaved families.
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Affiliation(s)
- Julian L Burton
- Academic Unit of Pathology, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.
| | - James Underwood
- Academic Unit of Pathology, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
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Limacher E, Carr U, Bowker L, Ball RY. Reversing the slow death of the clinical necropsy: developing the post of the Pathology Liaison Nurse. J Clin Pathol 2006; 60:1129-34. [PMID: 17172474 PMCID: PMC2014846 DOI: 10.1136/jcp.2006.044420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The adult clinical necropsy has been declining for many years and is nearing extinction in many hospitals. In Norwich, to prevent this from occurring, a Pathology Liaison Nurse (PLN) was appointed, resulting in a modest reversal of the trend. In 2005, the number of adult clinical necropsies increased to 58 (clinical necropsy rate = 2.4%) from its nadir of 34 (clinical necropsy rate = 1.4%) in 2003. Moreover, consent is now much more likely to be full and to allow histopathological and other studies. The PLN ensures that consent is properly and fully obtained, in line with current legislation. She also plays an important role in arranging for feedback to be given by clinicians to the families after the examination, and in teaching and training Trust staff about death, bereavement, and related matters. This paper describes how the role of PLN was established and evaluated, and gives details of the current state of the adult clinical necropsy in Norwich.
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Affiliation(s)
- Eileen Limacher
- The Bereavement Office, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
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Abstract
Previous studies have consistently shown that autopsy examination after surgery can identify a significant rate of discrepant and/or erroneous diagnoses. Findings gleaned from autopsies can be invaluable for the medical community and science as a whole, ultimately leading to improvements in quality surgical care. Despite the proven benefits of this underused tool, the number of autopsies carried out in Australian hospitals is declining dramatically, with autopsy rates plummeting from 21% in 1992-1993 to 12% in 2002-2003. This notable decline ought to be a genuine source of concern and deserves further examination. This review seeks to address the reasons for decline, while reasserting the value and relevance of autopsies within modern surgical practice Down Under.
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Affiliation(s)
- V Swetha Jeganathan
- Department of Surgery and Department of Forensic Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
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The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia. Med J Aust 2004; 180:281-5. [PMID: 15012566 DOI: 10.5694/j.1326-5377.2004.tb05926.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 02/09/2004] [Indexed: 11/17/2022]
Abstract
Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports from 1996 to 2002 found autopsies detected, on average, 23.5% of clinically missed diagnoses involving the principal or underlying cause of death, and 9% of errors that would or could have affected the patient's outcome. We surveyed pathology laboratories and hospital administrators across Australia, and found a decline in the hospital autopsy rate from 21% (210/1000 deaths) in 1992-93 to 12% (118/1000 deaths) in 2002-03. This decrease is in adult autopsies (66% of all autopsies in 1992-93; 39% in 2002-03). Perinatal autopsies increased from 29% to 58% of all autopsies in this period, mainly due to more examinations of fetuses less than 20 weeks' gestation. Factors contributing to this decline may include community attitudes, clinicians' reluctance to request autopsy (partly because of administrative burdens in making the request), hospital concern about legal action if a misdiagnosis is detected, and funding priorities. Reversing this decline will require cooperative action at several levels of the healthcare system, and from government bodies.
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Bombí JA, Ramírez J, Solé M, Grau JM, Chabas E, Astudillo E, Nicolás JM, Balasch J. Clinical and autopsy correlation evaluated in a university hospital in Spain (1991-2000). Pathol Res Pract 2003; 199:9-14. [PMID: 12650512 DOI: 10.1078/0344-0338-00346] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors present a 10-year retrospective study (1991-2000) of all autopsies performed at the Hospital Clinic, Barcelona (Catalonia, Spain) studied by a multidisciplinary committee. The clinicopathologic correlation of the primary underlying disease with the immediate cause of death was reviewed. Between 1991 and 2000, 2,495 autopsies were performed, 1933 of which were evaluated by the committee. The autopsy rate fell from 20% in 1993 to 9.1% in 2000. The clinicopathologic correlation in underlying primary disease was correct in 92.67% of the cases; there was a major discrepancy in 3.51% and a minor discrepancy in 3.82%. As regards the immediate cause of death, major errors were found in 5.89% of cases and minor errors in 6.17%. Despite the scientific and technologic advances in medicine, we have seen that there are still clinicopathologic discrepancies. The postmortem examination continues to play an important role in auditing clinical practice and diagnostic performance, and also for educational purposes. Evaluation by a multidisciplinary committee is the more reliable system for the study of the clinicopathologic correlation.
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Affiliation(s)
- Josep Antoni Bombí
- Department of Pathology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain.
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Burton JL, Underwood JCE. Necropsy practice after the "organ retention scandal": requests, performance, and tissue retention. J Clin Pathol 2003; 56:537-41. [PMID: 12835301 PMCID: PMC1769997 DOI: 10.1136/jcp.56.7.537] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS After the so called "organ retention scandal" in the UK this study set out to assess the impact on death certification and hospital (consent) necropsies, including the postmortem retention of tissues and organs. METHODS Data were prospectively gathered over a one year period for all deaths occurring at the Royal Hallamshire Hospital, Sheffield, UK to determine the frequencies with which death certificates were completed and necropsies were requested. The seniority of the clinician undertaking these duties was recorded. Pathologists were asked to record the extent of every necropsy during the study period. The type and planned uses of tissues retained were recorded. RESULTS Death certificates were issued for 88.5% of the 966 deaths for which clinicians completed proformas. Of these, 88.9% were issued by preregistration and senior house officers. Consent was sought for a necropsy in 6.2% of cases (usually by non-consultant staff) and was granted in 43.4% of these. The overall, medicolegal, and hospital necropsy rates were 13.4%, 9.9%, and 3.5%, respectively. Tissues were retained from 55.4% of necropsies for diagnostic purposes, although sampling does not appear to be systematic. CONCLUSIONS Death certification and seeking consent for a necropsy are frequently delegated to junior clinical staff. This may explain the low standard of death certification reported by others and the low necropsy rate. The decline in the necropsy rate and the low rate of sampling for histological examination highlight the decline of the hospital necropsy and the lack of a systematic approach to tissue sampling.
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Affiliation(s)
- J L Burton
- Academic Unit of Pathology, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
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Lishimpi K, Chintu C, Lucas S, Mudenda V, Kaluwaji J, Story A, Maswahu D, Bhat G, Nunn AJ, Zumla A. Necropsies in African children: consent dilemmas for parents and guardians. Arch Dis Child 2001; 84:463-7. [PMID: 11369557 PMCID: PMC1718810 DOI: 10.1136/adc.84.6.463] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a "waste of time," as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services.
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Affiliation(s)
- K Lishimpi
- The UNZA-UCLMS (University of Zambia-University College London Medical School Tuberculosis/HIV Research and Training Project), University of Zambia School of Medicine, Lusaka, Zambia
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Leitner C, Rogers SN, Lowe D, Magennis P. Death certification in patients whose primary treatment for oral and oropharyngeal carcinoma was operation: 1992-1997. Br J Oral Maxillofac Surg 2001; 39:204-9. [PMID: 11384117 DOI: 10.1054/bjom.2000.0603] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to report the cause and place of death of patients with oral cancer as recorded by death certification and their survival with regard to comorbidity and age. From the departmental head and neck oncology database, 322 patients were identified with previously untreated oral and oropharyngeal squamous cell carcinoma diagnosed between 1992 and 1997 inclusive. Three-hundred were matched with the Office for National Statistics (ONS) and copies of death certificates generated on 6 March 1999. Of the 286 patients primarily treated by operation, 203 were alive and 83 had died. In 56 (68%), oral cancer was a contributory factor to the patient's death. Patients with a medical history recorded on their admission for operation had similar survival curves compared to those having no problems recorded. Although most patients (n= 46 55%) died in hospital, only 13 (16%) died in the Regional Maxillofacial Unit. Almost half of those patients who died were not recorded as dead on the departmental oncology database. This study shows that it is useful to link with the ONS to obtain accurate data on date and place of death. The death certificate also gives a useful indication of the cause of death and this seems unrelated to preoperative comorbidity.
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Affiliation(s)
- C Leitner
- University of Liverpool School of Dentistry, Liverpool, UK
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Affiliation(s)
- J H Baron
- Gastroenterology Division, Mount Sinai School of Medicine, New York 10029-6574, USA
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