Autopsy rates in the Netherlands: 35 years of decline

Blokker, Britt M.; Weustink, Annick C.; Hunink, M. G. Myriam; Oosterhuis, J. Wolter

doi:10.1371/journal.pone.0178200

Cited by 49 publications

(38 citation statements)

References 30 publications

(40 reference statements)

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“…Reports from Australia, Denmark and Netherlands show similar trends of CDA decline in recent decades. [8][9][10] Evidence continues to show that, in the absence of CDA, the COD certification is often inaccurate 11 even when other diagnostic modalities are readily available. 12 Minimally invasive tissue sampling (MITS), a possible alternative to the CDA, 5 involves systematic tissue sampling that is designed to contribute to COD determination.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study

Hailu

Desta

Bekuretsion

et al. 2020

Global Pediatric Health

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Uncertainty about the causes of neonatal deaths impedes achieving global health targets to reduce mortality. Complete diagnostic autopsy (CDA) is the gold standard to determine cause of death. However, it is often difficult to perform in high-burden, low-income settings. Validations of more feasible methods to determine cause of death are needed. This prospective, multi-center study in Ethiopia assessed the validity of the minimally invasive tissue sampling (MITS) approach to contribute to causes of death in preterm neonates compared to CDA. The MITS and CDA of 105 cases were reviewed. The MITS sampling success for lungs and liver was 100% and 84%, respectively. The kidney and brain had sampling successes of 58% each. MITS showed good agreement with CDA for the diagnosis of hyaline membrane disease (kappa = 0.78), and moderate to substantial agreement for pneumonia and pulmonary hemorrhage (kappa = 0.59 and 0.68, respectively). Even though CDA is the gold standard in identifying the cause of death, we believe that the MITS method can be a useful alternative method in supporting determination of cause of death in low-resource settings.

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Section: Introductionmentioning

confidence: 99%

Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study

Hailu

Desta

Bekuretsion

et al. 2020

Global Pediatric Health

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“…However, autopsy in general has become less common over the last decades due to, among others, its invasive character. There has been a decrease of 0.7% per year for in-hospital deaths in the Netherlands between 1977 and 2011 [16]. It has been postulated that this decrease in post-mortem examinations might cause for important complications and disorders to be missed.…”

Section: Discussionmentioning

confidence: 99%

“…It has been postulated that this decrease in post-mortem examinations might cause for important complications and disorders to be missed. Consequently, this causes a decrease in accurate statistics and health care quality control [3,16,17]. The priority of death investigations in the Netherlands lies with differentiation between natural and non-natural deaths, with the actual cause of death secondary to that.…”

Section: Discussionmentioning

confidence: 99%

Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

et al. 2019

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The aim of this study was to investigate whether post-mortem computed tomography (PMCT) provides additional information regarding the cause of death and underlying diseases in a general practitioners' (GP), out-of-hospital population. Methods and materials Bodies donated to our anatomy department between January 2014 and January 2018, who consecutively underwent a total body PMCT and had given permission for retrieval of their medical records during life, were included. PMCT scans were assessed by a radiologist and compared with the cause of death as stated in the medical records. Discrepancies were analyzed with an adjusted Goldman classification. Results Ninety-three out of the 274 scanned donors during the inclusion period had given consent for the retrieval of their medical records, of which 79 GP's responded to the request thereof (31 men, 48 women, average age 72.8 years, range 36-99). PMCT identified 49 (62%) cases of cancer, 10 (12.7%) cardiovascular diseases, 8 (10.1%) severe organ failures, 5 (6.3%) cases with signs of pneumonia, 2 (2.5%) other causes, and 7 (8.9%) cases without an (underlying) definitive cause of death. Eleven major discrepancies on the Goldman classification scale, with possible relevance to survival between PMCT and GP records, were identified. Conclusion PMCT can have added value for the detection of additional findings regarding the cause of death in an out-ofhospital, GP's population, especially to identify or exclude major (previously non-diagnosed) underlying diseases.

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“…A defensive attitude is one of the contributing factors in the impressive reduction in the number of autopsies worldwide over the last few decades[ 26 , 27 ]. Some doctors fear that they could be sued should the findings prove a wrong diagnosis or a clinically missed pathology[ 28 ].…”

Section: Introductionmentioning

confidence: 99%

Defensive medicine: It is time to finally slow down an epidemic

Vento¹,

Cainelli²,

Vallone³

2018

WJCC

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Defensive medicine is widespread and practiced the world over, with serious consequences for patients, doctors, and healthcare costs. Even students and residents are exposed to defensive medicine practices and taught to take malpractice liability into consideration when making clinical decisions. Defensive medicine is generally thought to stem from physicians’ perception that they can easily be sued by patients or their relatives who seek compensation for presumed medical errors. However, in our view the growth of defensive medicine should be seen in the context of larger changes in the conception of medicine that have taken place in the last few decades, undermining the patient–physician trust, which has traditionally been the main source of professional satisfaction for physicians. These changes include the following: time directly spent with patients has been overtaken by time devoted to electronic health records and desk work; family doctors have played a progressively less central role; clinical reasoning is being replaced by guidelines and algorithms; the public at large and a number of young physicians tend to believe that medicine is a perfect science rather than an imperfect art, as it continues to be; and modern societies do not tolerate the inevitable morbidity and mortality. To finally reduce the increasing defensive behavior of doctors around the world, the decriminalization of medical errors and the assurance that they can be dealt with in civil courts or by medical organizations in all countries could help but it would not suffice. Physicians and surgeons should be allowed to spend the time they need with their patients and should give clinical reasoning the importance it deserves. The institutions should support the doctors who have experienced adverse patient events, and the media should stop reporting with excessive evidence presumed medical errors and subject physicians to “public trials” before they are eventually judged in court.

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Autopsy rates in the Netherlands: 35 years of decline

Cited by 49 publications

References 30 publications

Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study

Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study

Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

Defensive medicine: It is time to finally slow down an epidemic

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