Is necropsy obsolete - An audit of the clinical autopsy over six decades: A study from Indian sub continent

Sheth

Archives of Pathology &Amp; Laboratory Medicine

et al. 2019

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.

Section: Discussionmentioning

confidence: 99%

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

Sheth

Archives of Pathology &Amp; Laboratory Medicine

et al. 2019

“…A study from India [ 10 ] described the discrepancies between antemortem and postmortem diagnoses in 591 patients over the years 1947 to 2010 and concluded that the number of discrepancies had decreased significantly over time, but that the discrepancy rate in 2010 was still high at 9.3 %.…”

Section: The Value Of the Autopsy In The Early 21st Centurymentioning

confidence: 99%

The medical autopsy as quality assurance tool in clinical medicine: dreams and realities

Tweel

Wittekind

2015

Virchows Arch

The purpose of medical autopsy has changed to issues of quality assurance today. In addition, autopsies are considered valuable in medical education, e.g., delivering cases for problem-based learning for students. Many studies underscore the need for autopsies also in the era of technical progress emphasizing the continuing discrepancies between antemortem and post mortem diagnoses. Despite these important tasks, we face a decline of autopsy for several reasons with complex interactions. The role of all persons involved in this decline is evaluated and suggestions for changes are proposed. Last but not least, the future of the autopsy is in the hands of pathology itself.

“…A similar study 20 showed in 2010 a discrepancy between ante-mortem and post-mortem diagnoses of 23.1%. However only 591 autopsies out of more than 6,300 disclosed enough data to be included in the paper, showing that even in medical centres with high autopsy rates, this procedure is considered with lack of reliability.…”

Section: Discussionmentioning

confidence: 72%

“…Since other causes are also evoked to the same effect, it may be very difficult to single out the role of the imaging techniques. Independently, the diminishing number of autopsies in many countries is a well established observation 11 , 19 , 20 . A large scale investigation with medical, sociological and epidemiological repercussions may be needed to determine the role of each factor in this issue.…”

Section: Discussionmentioning

confidence: 99%

Computerized Tomography Scanning and Magnetic Resonance Imaging Will Terminate the Era of the Autopsy - A Hypothesis

et al. 2016

Background: Reports on a marked reduction of the number of autopsies performed worldwide to less than 5% of hospital deaths remain without a satisfactory explanation. The premature disappearance of the autopsy might represent a medical tragedy of a major order. One of the causes for the decrease in autopsies is poorly documented: we suspect that the attending physician might show some reluctance when requesting a consent for an autopsy from the bereaved family. Moreover, this officer might consider that the post mortem will add little information to that already obtained from the computerized tomography scanner or the magnetic resonance imaging.Methods: In order to confirm our hypothesis, we carried out a review of 300 articles indexed as "radiologic-histologic correlation", 118 of which were selected for a significant correlation. From the abstracts, we retrieved the type of the article, the degree of correlation as assessed by the authors and the form of imaging employed, and we computed them.Results & conclusions: The most striking correlation was observed in the small prospective series. An additional search for the "radiologic-autopsy correlation" supported a marked reduction in the number of post-mortems, especially those related with prospective studies. Based on the present study, we cannot determine precisely the role of the house officer in this tragedy. We may have demonstrated, however, that the modern radiologic methods have not yet reached a high enough performance quality to achieve the status of a candidate substitute for the autopsy.