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Singh D, Tiwari RC, Kumar A, Bhute AR, Meshram RP, Mittal B. The Role of Pathological Examination of the Liver in Medicolegal Autopsy: A Tertiary Care Center Study From North India. Cureus 2023; 15:e48131. [PMID: 38046739 PMCID: PMC10692315 DOI: 10.7759/cureus.48131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The pathological examination of a medicolegal autopsy is a great learning opportunity for a pathologist as well as for a forensic expert, where the cause of death remains unknown. Liver disease epidemiology differs from one geographic area to another. MATERIAL AND METHODS This was a prospective observational study with 100 medicolegal autopsy cases over a one-year period conducted in the Department of Forensic Medicine and Toxicology (FMT) and Pathology. Representative tissue from the liver was collected in 10% neutral buffered formalin and sent for histopathological examination. RESULTS The mean age of the cases was 41.98 ± 15.39 years, and ages ranged from 20 to 90 years with male preponderance. The most common histopathology and gross findings noted were mild to moderate chronic hepatitis (CH) (54%) and fatty change (36%), respectively. There was a significant association (p ≤ 0.05) between histopathology and gross findings, cause, and manner of death. CONCLUSION Gross and histopathological examination of the liver in a medicolegal autopsy has a significant role in ascertaining the cause and manner of death.
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Affiliation(s)
- Dezy Singh
- Department of Toxicology and Medical Jurisprudence (Agad Tantra Evam Vidhi Vaidyak), Uttarakhand Ayurved University (UAU) Rishikul Campus, Haridwar, IND
| | - Ramesh C Tiwari
- Department of Toxicology and Medical Jurisprudence (Agad Tantra Evam Vidhi Vaidyak), Uttarakhand Ayurved University (UAU) Rishikul Campus, Haridwar, IND
| | - Arvind Kumar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Ashish R Bhute
- Department of Forensic Medicine and Toxicology (FMT), All India Institute of Medical Sciences, Rishikesh, IND
| | - Ravi P Meshram
- Department of Forensic Medicine and Toxicology (FMT), All India Institute of Medical Sciences, Rishikesh, IND
| | - Bhawana Mittal
- Department of Toxicology and Medical Jurisprudence (Agad Tantra Evam Vidhi Vaidyak), Uttarakhand Ayurved University (UAU) Rishikul Campus, Haridwar, IND
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Singh D, Tiwari RC, Kumar A, Bhute AR, Meshram RP, Dikshit M, Sharma VB, Mittal B. A Comprehensive Review of Pathological Examination in Forensic Medicine: Past, Present, and Future. Cureus 2022; 14:e22740. [PMID: 35382189 PMCID: PMC8975612 DOI: 10.7759/cureus.22740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
Abstract
Pathological examination (PE) encompasses a gross or macroscopy and histopathological or microscopic examination. It is prudent in finding the cause of death (COD) in clinical and medicolegal autopsies. There are various auxiliary techniques in the form of clinical history, communication, specialized training, and protocols for consolidation of the PE results. After a thorough search of the literature in PubMed with relevant keywords along with further analysis of the results, it emerged that even with the modernization of forensic medicine, a PE is unbeatable in detecting the COD. It has various useful aspects, apart from regular finding the COD, such as in student teaching, epidemiology of disease, audit tool, and quality assurance. There are also limitations of PE, which should be dealt with great caution. Hence, limitations must be understood by a forensic expert as well as a pathologist. In this review, all factors that are related to PE in any manner are discussed in detail, and the scope for improving the quality of PE to be relevant in the present scenario is reviewed. It is a comprehensive reassessment of the literature review that also casts light on the future along with a critical analysis of the facts that deal with PE.
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Matkowski AFI, Benbow EW. Histopathology at autopsy: why bother? Histopathology 2021; 79:77-85. [PMID: 33445222 DOI: 10.1111/his.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS The frequency of histopathological sampling at autopsy varies, even though inadequate sampling may limit the value of autopsy reports. This study aims to investigate the contribution of histopathology at autopsy in a major teaching hospital. METHODS AND RESULTS A total of 532 coronial autopsy reports from Manchester Royal Infirmary were analysed retrospectively. Gross and microscopic diagnoses were compared and classified as concordant, discordant, histology needed (i.e. indeterminate or unremarkable gross findings) or autolysed. Revisions made to the cause of death following histopathology were categorised as: altered direct cause of death, altered indirect cause of death, concordant with supportive information, irrelevant or inconclusive. The study was limited to brain, heart, kidney, liver, lung and spleen. Histopathology had been requested in 141 cases (27%), which were further analysed. The greatest discordance between gross and microscopic findings was observed in the lung (11.6%). The organs most frequently requiring histopathology to provide a diagnosis were the kidney and lung, at 52.8 and 28.2%, respectively. Alterations were made to the direct cause of death in 45% of cases where histopathology was taken; it provided additional or supportive information in a further 38%. Diagnoses of primary malignancy had a sensitivity of 74% [confidence interval (CI) = 0.59-0.86] and bronchopneumonia had a sensitivity of 45% (CI = 0.29-0.62). CONCLUSION Histopathology has a major impact on the interpretation of organ pathology and determining a cause of death at autopsy.
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Affiliation(s)
| | - Emyr W Benbow
- School of Medical Sciences, University of Manchester, Manchester, UK.,Department of Histopathology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust (MFT), Manchester, UK
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Cirielli V, Bortolotti F, Cima L, De Battisti Z, Del Balzo G, De Salvia A, Laposata C, Raniero D, Vermiglio E, Portas M, Rodegher P, Ghimenton C, Martignoni G, Eccher A, Narayanasamy M, Vergine M, Turrina S, Tagliaro F, De Leo D, Brunelli M. Consultation between forensic and clinical pathologists for histopathology examination after forensic autopsy. MEDICINE, SCIENCE, AND THE LAW 2021; 61:25-35. [PMID: 33591882 DOI: 10.1177/0025802420965763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The magnitude of the diagnostic benefit conferred by performing histopathological examinations after medico-legal/forensic autopsies remains debatable. We have tried to address this issue by reviewing a series of histopathology referrals concerning medico-legal autopsies in real-world routine practice. We present an audit of the consultations provided to forensics by clinical pathologists at our institute between 2015 and 2018. Over this period, 493 post-mortem examinations were performed by forensic pathologists. Of these cases, 52 (11%) were referred for histopathology. Gross assessment was requested in 22/52 (42%) cases. Histopathology examination was performed on single organs in 15/52 (29%) cases, primarily on the lung and heart, whereas parenchymatous multi-organ analysis was carried out in 14/52 (27%) cases. Bone-marrow sampling was studied in 4/52 (8%) cases. Immunohistochemistry was needed in 16/52 (31%) cases, special stains in 9/52 (21%) cases and molecular analysis in 4/52 (8%) cases. Focusing on technical processes, standard methodology on pre-analytical procedures was changed in 10/52 (19%) cases in order to answer specific diagnostic questions. We showed that although most of the time the diagnosis is clear by the end of dissection on the basis of the macroscopic findings, histopathology can provide, modify or confirm the cause of death in many medico-legal/forensic cases. Therefore, it is desirable that forensic pathologists and clinical pathologists establish robust working relationships in a cooperative environment. We conclude that it is important to implement guidelines based on real-world routine practice in order to identify cases where histopathology can provide useful contributions, which in our experience applied to 11% of forensic cases.
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Affiliation(s)
- Vito Cirielli
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
- Department of Prevention, Legal Medicine Unit, Azienda ULSS 8 Berica, Italy
| | - Federica Bortolotti
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Luca Cima
- Department of Clinical Service, Pathology Unit, Santa Chiara Hospital, Italy
| | - Zeno De Battisti
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Giovanna Del Balzo
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Alessandra De Salvia
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Chiara Laposata
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Dario Raniero
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Elisa Vermiglio
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Margherita Portas
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Pamela Rodegher
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Claudio Ghimenton
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Guido Martignoni
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Italy
- Pathology Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Albino Eccher
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Italy
| | | | - Marco Vergine
- Pathology Department, Brighton and Sussex University, University Hospitals NHS Trust, UK
| | - Stefania Turrina
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Franco Tagliaro
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
- Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, Russia
| | - Domenico De Leo
- Department of Diagnostics and Public Health, Legal Medicine and Forensic Pathology Unit, University and Hospital Trust of Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Italy
- FISH Lab, Integrated University Hospital Trust of Verona, Italy
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Lanjewar DN, Sheth NS, Lanjewar SD, Wagholikar UL. Analysis of Causes of Death as Determined at Autopsy in a Single Institute, The Grant Medical College and Sir J. J. Hospital, Mumbai, India, Between 1884 and 1966: A Retrospective Analysis of 13 024 Autopsies in Adults. Arch Pathol Lab Med 2019; 144:644-649. [PMID: 31365286 DOI: 10.5858/arpa.2018-0229-hp] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Grant Medical College and Sir J. J. Hospital, Mumbai (India), have a long tradition of clinical autopsies, wherein autopsy records have existed since 1884. The old autopsy records from 1884 to 1966 were discovered during a refurbishing drive of the pathology department in 2007. OBJECTIVE.— To know the relative causes of deaths in Sir J. J. Hospital Mumbai from 1884 through 1966. To determine the rate of antemortem and postmortem discrepancies in the prehistology and posthistology era. DESIGN.— The reports of clinical autopsies in the archives of the Department of Pathology from January 1884 to December 1966 were reviewed. Data such as sex, age, and clinical and autopsy diagnoses were collected, based on the autopsy records of 13 024 patients. RESULTS.— Of 13 024 patients, 10 197 (78%) were male and 2827 (22%) were female. Most deaths (55%) involved individuals ages 21 to 40 years. Infections were the cause of death in 7281 of 13 024 patients (56%), followed by cardiovascular diseases in 2138 (16%) and neoplasms in 963 (7%). The overall disagreement between clinical diagnoses and postmortem findings was 4105 of 13 024 patients (31%). Discrepancy between antemortem and postmortem diagnoses in the prehistology era (before 1950) was found in 3053 of 8951 patients (34%), whereas in the posthistology era (after 1950), discrepancy was found in 1019 of 4073 patients (25%). CONCLUSIONS.— Historical collections provide baseline data against which modern observations can be compared. Such collections also offer a window on the past and often provide a less biased account of events. Historical collections of museum materials such as ours are valuable because they can serve as potential biorepository materials to facilitate future research. Apart from providing reliable data on the occurrence of diseases, the autopsy has an important role in providing information about conditions that are no longer prevalent. Medical institutes possessing old autopsy records, wet specimens, paraffin blocks, and slides should preserve such historical collections.
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Affiliation(s)
- Dhaneshwar Namdeorao Lanjewar
- From the Department of Pathology, Grant Medical College, and Sir J. J. Hospital, Mumbai, India. Dr DN Lanjewar is now with the Department of Pathology, Gujarat Adani Institute of Medical Sciences, Bhuj, India. Dr Sheth is now a consultant pathologist at Sterling Multispecialty Hospital, Mumbai, India. Dr SD Lanjewar is now with the Department of Pathology, Methodist University Hospital, University of Tennessee Health Science Center, Memphis
| | - Nikita Subhash Sheth
- From the Department of Pathology, Grant Medical College, and Sir J. J. Hospital, Mumbai, India. Dr DN Lanjewar is now with the Department of Pathology, Gujarat Adani Institute of Medical Sciences, Bhuj, India. Dr Sheth is now a consultant pathologist at Sterling Multispecialty Hospital, Mumbai, India. Dr SD Lanjewar is now with the Department of Pathology, Methodist University Hospital, University of Tennessee Health Science Center, Memphis
| | - Sonali Dhaneshwar Lanjewar
- From the Department of Pathology, Grant Medical College, and Sir J. J. Hospital, Mumbai, India. Dr DN Lanjewar is now with the Department of Pathology, Gujarat Adani Institute of Medical Sciences, Bhuj, India. Dr Sheth is now a consultant pathologist at Sterling Multispecialty Hospital, Mumbai, India. Dr SD Lanjewar is now with the Department of Pathology, Methodist University Hospital, University of Tennessee Health Science Center, Memphis
| | - Ulhas Laxman Wagholikar
- From the Department of Pathology, Grant Medical College, and Sir J. J. Hospital, Mumbai, India. Dr DN Lanjewar is now with the Department of Pathology, Gujarat Adani Institute of Medical Sciences, Bhuj, India. Dr Sheth is now a consultant pathologist at Sterling Multispecialty Hospital, Mumbai, India. Dr SD Lanjewar is now with the Department of Pathology, Methodist University Hospital, University of Tennessee Health Science Center, Memphis
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Kuijpers CCHJ, Fronczek J, van de Goot FRW, Niessen HWM, van Diest PJ, Jiwa M. The value of autopsies in the era of high-tech medicine: discrepant findings persist. J Clin Pathol 2014; 67:512-9. [PMID: 24596140 DOI: 10.1136/jclinpath-2013-202122] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have been declining over the last decades to <10%. The aim of this study was to investigate the value of autopsies in the high-tech medicine era by determining the frequency of discrepancies between clinical and autopsy diagnoses. METHODS We classified all adult autopsy cases (n=460), performed at Symbiant, Pathology Expert Centre, in 2007 and 2012/2013, as having major, or minor discrepancy or total concordance. The roles of possible contributory factors were analysed. Finally, we assessed the role of microscopic examination in identifying cause of death. RESULTS Major and minor discrepancies were found in 23.5% and 32.6% of the classifiable autopsies, respectively. Most commonly observed major discrepancies were myocardial infarction, pulmonary embolism and pneumonia. Improper imaging and discontinuation of active treatment were significantly associated with a higher and a lower frequency of major discrepancies, respectively. Comparing 2007 and 2012/2013, the frequency of minor discrepancies significantly increased from 26.8% to 39.3%. Final admission length of >2 days was significantly associated with a lower frequency of class III minor discrepancies. Microscopic examination contributed to establishing cause of death in 19.6% of the cases. CONCLUSIONS Discrepant findings persist at autopsy, even in the era of high-tech medicine. Therefore, autopsies still should serve as a very important part of quality control in clinical diagnosis and treatment. Learning from individual and system-related diagnostic errors can aid in improving patient safety.
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Affiliation(s)
| | - Judith Fronczek
- Symbiant Pathology Expert Centre, Alkmaar, The Netherlands Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands
| | | | - Hans W M Niessen
- Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands Department of Cardiac Surgery, VU Medical Centre, Amsterdam, The Netherlands ICaR-VU, VU Medical Centre, Amsterdam, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mehdi Jiwa
- Symbiant Pathology Expert Centre, Alkmaar, The Netherlands
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7
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Dettmeyer RB. The role of histopathology in forensic practice: an overview. Forensic Sci Med Pathol 2014; 10:401-12. [PMID: 24577850 DOI: 10.1007/s12024-014-9536-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 12/19/2022]
Abstract
The role of forensic histopathology in routine practice is to establish the cause of death in particular cases. This is achieved on the basis of microscopic analysis of representative cell and tissue samples taken from the major internal organs and from abnormal findings made at autopsy. A prerequisite of this is adherence to the quality standards set out for conventional histological/cytological staining and enzyme histochemical and immunohistochemical methods. The interpretation of histological findings is performed by taking into account macroscopic autopsy findings and information on previous history. Histological analysis may prompt postmortem biochemical and chemical-toxicological investigations. The results of histological analysis need to be classified by experts in the context of the available information and the need to withstand the scrutiny of other experts.
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Affiliation(s)
- R B Dettmeyer
- Institute of Forensic Medicine, Justus-Liebig University Giessen, Frankfurter Str. 58, 35392, Giessen, Germany,
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Fronczek J, Hollingbury F, Biggs M, Rutty G. The role of histology in forensic autopsies: Is histological examination always necessary to determine a cause of death? Forensic Sci Med Pathol 2013; 10:39-43. [DOI: 10.1007/s12024-013-9496-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/28/2022]
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Liebrechts-Akkerman G, Bovée JVMG, Wijnaendts LCD, Maes A, Nikkels PGJ, de Krijger RR. Histological findings in unclassified sudden infant death, including sudden infant death syndrome. Pediatr Dev Pathol 2013; 16:168-76. [PMID: 23331080 DOI: 10.2350/12-10-1262-oa.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Our objective was to study histological variations and abnormalities in unclassified sudden infant death (USID), including sudden infant death syndrome (SIDS), in The Netherlands. Two hundred Dutch USID cases between 1984 and 2005 were identified. The histology slides and autopsy reports of 187 cases were available for systematic review, including brain autopsy in 135 cases. An explanation for the cause of death in 19 patients (10.2%) was found. Twelve patients had bronchopneumonia, 3 showed extensive aspiration, 2 had signs of a metabolic disorder, 1 had sepsis, and 1 had meningitis. Frequent nonspecific findings were congestion (66%), edema (47%), small hemorrhages (18%), and lymphoid aggregates (51%) in the lungs; congestion of the liver (23%); and asphyctic bleeding in the kidney (44%), adrenal gland (23%), and thymus (17%). Statistical associations were found for infection with starry sky macrophages in the thymus (P = 0.004), with calcification (P = 0.023), or with debris in the Hassal's corpuscles (P = 0.034). In this study, in 10.2% of cases the histological findings were incompatible with SIDS or USID. Furthermore, several frequent nonspecific histological findings in the thymus that point toward an infection were found.
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Chatelain D, Hebert A, Trouillet N, Charfi S, Stephens P, Manaouil C, Defouilloy C, Braconnier L, Jarde O, Sevestre H. Intérêt de l’analyse anatomopathologique dans une série de 400 autopsies médicolégales. Ann Pathol 2012; 32:4-13. [DOI: 10.1016/j.annpat.2011.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 10/13/2011] [Accepted: 10/18/2011] [Indexed: 11/17/2022]
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Sanz-Ortiz J, Mayorga M, Martín A. [Autopsy in clinical oncology: is it in crisis?]. Med Clin (Barc) 2011; 137:317-20. [PMID: 20060547 DOI: 10.1016/j.medcli.2009.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/05/2009] [Accepted: 11/05/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Jaime Sanz-Ortiz
- Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España.
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de la Grandmaison GL, Charlier P, Durigon M. Usefulness of Systematic Histological Examination in Routine Forensic Autopsy. J Forensic Sci 2010; 55:85-8. [DOI: 10.1111/j.1556-4029.2009.01240.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Ordi J, Ismail MR, Carrilho C, Romagosa C, Osman N, Machungo F, Bombí JA, Balasch J, Alonso PL, Menéndez C. Clinico-pathological discrepancies in the diagnosis of causes of maternal death in sub-Saharan Africa: retrospective analysis. PLoS Med 2009; 6:e1000036. [PMID: 19243215 PMCID: PMC2646780 DOI: 10.1371/journal.pmed.1000036] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 01/10/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. METHODS AND FINDINGS A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n = 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). CONCLUSIONS Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.
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Affiliation(s)
- Jaume Ordi
- Department of Pathology Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomédiques August Pi I Sunyer, Barcelona, Spain.
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Koivuniemi R, Paimela L, Suomalainen R, Piirainen H, Karesoja M, Helve T, Leirisalo-Repo M. Causes of death in patients with rheumatoid arthritis autopsied during a 40-year period. Rheumatol Int 2008; 28:1245-52. [DOI: 10.1007/s00296-008-0685-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 08/03/2008] [Indexed: 12/01/2022]
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15
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Chatelain D, Brevet M, Guernou M, Manaouil C, Leclercq F, Bruniau A, Cordonnier C, Sevestre H. Les autopsies d’adultes au CHU d’Amiens durant la période 1975-2005. Ann Pathol 2007; 27:269-83. [DOI: 10.1016/s0242-6498(07)73896-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Abstract
BACKGROUND Medicine assumes that vital statistics are accurate, but they are only as good as the death certificates. OBJECTIVE To evaluate the accuracy of death certificates in reporting vital statistics with an emphasis on cardiac deaths. DESIGN A population-based retrospective study within one community hospital. PATIENTS During the study period, 1,619 patients expired during hospitalization, of which 223 underwent autopsy. INTERVENTIONS Clinical diagnoses were determined from the death certificate and autopsy results from the final pathology reports. MEASUREMENTS Concordance of myocardial infarction as the underlying cause of death between the death certificate and the autopsy was measured. New diagnoses uncovered by the autopsy were tabulated. RESULTS The death certificate missed acute myocardial infarction in 25 of 52 autopsy-proven cases (48% errors of omission). Conversely, it erroneously asserted the presence of an acute myocardial infarction in 9/36 cases (25% errors of commission). Autopsy showed these nine cases actually were pneumonia (5), sepsis with ARDS (2), cerebral hemorrhage (1), and cardiac tamponade (1). Autopsy proved 52 myocardial infarctions causing death, while death certificates accurately reported only 27. Myocardial infarction was more likely to be unsuspected in extreme ages, in women, when found in right ventricle or posterior wall, and in the presence of sepsis or ARDS. Death certificates were frequently inaccurate and in 21.5% of cases were of no value because of an inadequate diagnosis, ie, cardiopulmonary arrest, arrhythmia or respiratory failure. CONCLUSION Major discrepancies of commission and omission occur frequently between the death certificate and autopsy. 1) Death certificates are often wrong. 2) The time-honored autopsy is more valuable than ever. 3) Physicians need to write better death certificates and correct them. 4) Death certificate-based vital statistics should be corrected with autopsy results. 5) Vital statistics should note deaths confirmed by autopsy. 6) More autopsies would improve vital statistics and the practice of medicine.
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Affiliation(s)
- Keyvan Ravakhah
- Department of Medicine, Huron Hospital, Cleveland Clinic Health System, Cleveland, OH 44112, USA
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Roulson J, Benbow EW, Hasleton PS. Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. Histopathology 2006; 47:551-9. [PMID: 16324191 DOI: 10.1111/j.1365-2559.2005.02243.x] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The autopsy is in decline, despite the fact that accurate mortality statistics remain essential for public health and health service planning. The falling autopsy rate combined with the Coroners Review and Human Tissue Act have contributed to this decline, and to a falling use of autopsy histology, with potential impact on clinical audit and mortality statistics. At a time when the need for reform and improvement in the death certification process is so prominent, we felt it important to assess the value of the autopsy and autopsy histology. We carried out a meta-analysis of discrepancies between clinical and autopsy diagnoses and the contribution of autopsy histology. There has been little improvement in the overall rate of discrepancies between the 1960s and the present. At least a third of death certificates are likely to be incorrect and 50% of autopsies produce findings unsuspected before death. In addition, the cases which give rise to discrepancies cannot be identified prior to autopsy. Over 20% of clinically unexpected autopsy findings, including 5% of major findings, can be correctly diagnosed only by histological examination. Although the autopsy and particularly autopsy histology are being undermined, they are still the most accurate method of determining the cause of death and auditing accuracy of clinical diagnosis, diagnostic tests and death certification.
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Affiliation(s)
- J Roulson
- Department of Histopathology, Christie Hospital, Manchester, UK.
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Vos JH, Borst GHA, Visser IJR, Soethout KCJ, de Haan L, Haffmans F, Hovius MPJ, Goedendorp P, de Groot MAMH, Prud'homme van Reine FH, van Soest ILM, Willigenburg AHHS, van Woerden MA, Ziekman PGPM. Comparison of clinical and pathological diagnoses in dogs. Vet Q 2005; 27:2-10. [PMID: 15835279 DOI: 10.1080/01652176.2005.9695181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Clinical and pathological diagnoses were compared in a prospective study of 145 dogs. A diagnostic work up had been performed on all dogs of which 36 (24.8%) died and 109 (75.2%) were euthanatized. In 119 dogs (82.1%) both a clinical and patholical diagnosis was made, in 20 dogs (13.8%) no pathological diagnosis could be made and in 6 dogs (4.1%) no clinical diagnosis was established. In the 119 dogs the agreement level between clinical and pathological diagnosis was scored by the referring veterinarian together with a pathologist. Total agreement was found in 61 cases (51.3%) and disagreement in 31 cases (26.0%). In the remaining cases (27=22.7%) the pathological diagnosis further specified the clinical diagnosis. Consecutive submission appeared difficult to achieve by the participating veterinarians. However, no major differences in agreement level was present between the veterinarian which succeeded in almost consecutive submissions and the other veterinarians. At necropsy 42 cases were diagnosed as neoplasia, of which 52.4% had been diagnosed clinically. As to infectious diseases 55.0% of these diseases diagnosed at necropsy had been diagnosed clinically. In about 20% of the cases the differences were of clinical significance according to the referring veterinarians. In addition, it was indicated by the clinicians that about 50% of the necropsies revealed findings which could amend future patient care. The results of the study stress the relevance of postmortem examination as crucial part of continuing education and of quality monitoring and assurance in veterinary medicine.
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Affiliation(s)
- J H Vos
- Animal Health Service, Deventer, The Netherlands.
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Grade MHC, Zucoloto S, Kajiwara JK, Fernandes MTP, Couto LGF, Garcia SB. Trends of accuracy of clinical diagnoses of the basic cause of death in a university hospital. J Clin Pathol 2004; 57:369-73. [PMID: 15047739 PMCID: PMC1770265 DOI: 10.1136/jcp.2003.013235] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine the agreement between clinical and necropsy diagnoses of the basic cause of death, and to compare the results with those obtained in a previous study carried out at the same university hospital. METHODS In total, 4828 necropsies, performed between 1990 and 1995 in the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil, were reviewed. Examinations were concluded at the macroscopic part of the necropsy in nearly 35% of the cases. Statistical analysis was carried out using the kappa coefficient comparing the clinical diagnosis and the diagnosis obtained after necropsy. The jackknife method was used to identify comparable kappa values for the comparison of the two periods. RESULTS Compared with the 1978-80 period, a significant increase in diagnostic agreement was seen for the group submitted to complete necropsy, whereas no similar increase was detected when only the macroscopic step was analysed. CONCLUSIONS There was a discrete tendency to an improved correlation between clinical and postmortem data stated by full necropsy analysis. The findings show that microscopic analysis remains important to confirm the cause of death in many cases. Diagnostic discrepancies remained high, and therefore complete necropsy continues to be an essential instrument for the assessment of clinical diagnosis.
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Affiliation(s)
- M H C Grade
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Campus FMRP, USP, 14.049-000, Ribeirão Preto, Brazil.
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Abstract
Autopsy numbers in Australian hospitals have declined markedly during the past decade despite evidence of a relatively static rate of demonstrable clinical misdiagnosis during this time. The reason for this decrease in autopsy numbers is multifactorial and may include a general lack of clinical and pathologic interest in the autopsy with a possible decline in autopsy standard, a lack of clinicopathologic correlation after autopsies, and an increased emphasis on surgical biopsy reporting within hospital pathology departments. Although forensic autopsies are currently maintaining their numbers, it is incumbent on forensic pathologists to demonstrate the wealth of important information a carefully performed postmortem examination can reveal. To this end, the Pathology Division of the Victorian Institute of Forensic Medicine has instituted a program of minimum standards in varied types of coroner cases and commenced a system of internal and external audit. The minimum standard for a routine, sudden, presumed natural death is presented and the audit system is discussed.
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Affiliation(s)
- M P Burke
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Southbank, Australia
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