Online survey of current autopsy practice

Biggs, Michael; Brown, Laurence; Furness, Peter

doi:10.1136/jcp.2008.062117

Cited by 10 publications

(7 citation statements)

References 4 publications

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“…The reasons suggested by the authors are related to lack of time, financial constraints, and the introduction of the Human Tissue Act. [16].…”

Section: Discussionmentioning

confidence: 95%

“…Of the respondents, 30.9% noted that testing is too expensive. When third party intervention is not suspected, 22.7% of respondents think that the molecular autopsy does not have juridical interest, 16.5% of respondents reported that the interpretation of the genetic results is too complicated, and 6.2% answered that the "molecular autopsy is too complicated from the legal and ethical point of view". Several respondents highlighted the fact that occasionally the forensic pathologist never receives the results of the genetic tests.…”

Section: Opinions About Genetic Testingmentioning

confidence: 96%

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Genetic analysis of sudden cardiac death victims: a survey of current forensic autopsy practices

2010

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Autopsy-negative sudden cardiac deaths (SCD) seen in forensic practice are most often thought to be the result of sudden arrhythmic death syndrome. Postmortem genetic analysis is recommended in such cases, but is currently performed in only a few academic centers. In order to determine actual current practice, an on-line questionnaire was sent by e-mail to members of various forensic medical associations. The questions addressed routine procedures employed in cases of sudden cardiac death (autopsy ordering, macroscopic and microscopic cardiac examination, conduction tissue examination, immunohistochemistry and electron microscopy, biochemical markers, sampling and storage of material for genetic analyses, toxicological analyses, and molecular autopsy). Some questions concerned the legal and ethical aspects of genetic analyses in postmortem examinations, as well as any existing multidisciplinary collaborations in SCD cases. There were 97 respondents, mostly from European countries. Genetic testing in cases of sudden cardiac death is rarely practiced in routine forensic investigation. Approximately 60% of respondents reported not having the means to perform genetic postmortem testing and 40% do not collect adequate material to perform these investigations at a later date, despite working at university hospitals. The survey demonstrated that many of the problems involved in the adequate investigation of SCD cases are often financial in origin, due to the fact that activities in forensic medicine are often paid by and dependent on the judicial authorities. Problems also exist concerning the contact with family members and/or the family doctor, as well as the often-nonexistent collaboration with others clinicians with special expertise beneficial in the investigation of SCD cases, such as cardiologists and geneticists. This study highlights the importance in establishing guidelines for molecular autopsies in forensic medicine.

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“…The reasons suggested by the authors are related to lack of time, financial constraints, and the introduction of the Human Tissue Act. [16].…”

Section: Discussionmentioning

confidence: 95%

Section: Opinions About Genetic Testingmentioning

confidence: 96%

Genetic analysis of sudden cardiac death victims: a survey of current forensic autopsy practices

2010

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“…Although the vast majority of autopsies undertaken in England, Wales and Northern Ireland are at the request of the coroner, the responsibility of the coroner to inform academic and public health interests is contentious 26,27 . The quality that pathologists should aim to achieve in context of coroner’s autopsy is unclear, and there is a longstanding need to reconcile expectations of the coroner and RCPath guidelines 5,10,12 . Pathologists report multiple administrative and self‐imposed barriers preventing compliance with RCPath histopathology guidelines, including time pressures, poor renumeration and concerns surrounding the Human Tissue Act 5,12 .…”

Section: Discussionmentioning

confidence: 99%

“…Many factors also discourage pathologists from taking histopathology, including workload, remuneration, insufficient training, reduced perception of value and perceived limitations imposed by the 2004 Human Tissue Act (stating that ‘the procedure [autopsy] should not be more extensive than is necessary to achieve its specific aim’, which is also open to interpretation) 5,12 …”

Section: Introductionmentioning

confidence: 99%

“…Ultimately, the level of accuracy required to provide a cause of death in the context of a coronial autopsy is unclear, and the standard expected by the coroner, and advisory bodies such as the Royal College of Pathologists (RCPath), may not align 5,8,12,13 . Where the balance of probability is the standard, it can be difficult to maintain academic integrity.…”

Section: Introductionmentioning

confidence: 99%

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Histopathology at autopsy: why bother?

Matkowski

Benbow

2021

Histopathology

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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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