Reaffirming the Value of the Autopsy

Sathirareuangchai, Sakda; Shimizu, David

doi:10.1093/ajcp/aqz045

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…A recent study published earlier this year showed that type II MI, resulting from an improper myocardial oxygen supply-demand ratio, accounted for 85% of the patients with MI in this series (8). We believe that type II MI could be exacerbated in critically ill patients needing ECMO in multiple ways.…”

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confidence: 52%

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Autopsy examination after extracorporeal membrane oxygenation: ‘Mortuis vivos docent’

et al. 2020

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confidence: 52%

“…Major discrepancy rates for MI range between 13% and 28.3% of all autopsy cases outside the ICU setting (8).…”

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confidence: 99%

Autopsy examination after extracorporeal membrane oxygenation: ‘Mortuis vivos docent’

et al. 2020

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“…Great efforts should be made in the future to improve this virtuous practice, and general practitioners need to be involved by relatives towards an awareness of the importance of autopsy [62,63]. The number of autopsies requested by families of the deceased is still low, and the promotion is needed in this respect.…”

Section: Discussionmentioning

confidence: 99%

Is Hospital Autopsy Auditing Suitable for Clinical Risk Manage ment? Actualities and Perspectives of Auditing in the Autopsy Room Following Italian Law 24/2017 on Patient Safety

Zanon

Valentinuz

Montanaro

et al. 2021

CPB

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Background: Autopsies are a valuable tool for understanding the physiopathology of a disease and it is the gold standard to assess the cause of death. The clinical autopsy is the ultimate medical service for a patient and plays a crucial role in the context of quality control, education of physicians and other medical personnel, as well as mitigation of risk of malpractice claims. Objective: This study aims to demonstrate the importance of improving an autopsy service and the relevance of this investigation procedure in daily clinical practice by evaluating the rate of major discrepancies between the assumed cause of death and the ascertained cause of death after a complete post mortem investigation. A further aim is to classify these discrepancies as class I or class II discrepancies according to Goldman’s criteria in order to asses performance quality. Methods: A retrospective study of the hospital autopsies performed from June 2018 to March 2020 was conducted by considering a diversified dataset, including age and sex of the deceased as well as the clinical and pathological causes of death. Results: 362 cases were taken into consideration. Major discrepancies were found in 71.3% of cases, with a class I error of 22.7% and a class II error of 48.6%. The most frequent misdiagnoses were cardiovascular disorder, embolism and aneurism rupture. Discussion: The rate of major discrepancies and the rate of class I and class II errors are way above the rate found in literature. Despite the high rate of major discrepancy evidences collected from hospital autopsies (i.e. certainty of the cause of death, unknown comorbidities) strengthened the legal defense in cases of medical malpractice litigation. In our experience, by accurately determining the cause of death, revealing new or unexpected findings and possible diagnostic or technical errors, postmortem examinations can significantly contribute to the improvement of team performance and quality of care. Conclusion: The presence of clinicians during autopsy and the early sharing of results can be considered a new auditing strategy for hard clinical cases. Finally, by providing a clearer understanding of the nature and cause of the illness, the autopsy results assisted in the grieving process by reassuring family members that action or inaction on their part had not contributed to the death.

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“…ІМ часто зустрічається під час патологоанатомічних розтинів [11,12], й діагностика може бути складною щодо виявлення різних типів ураження міокарда, особливо за відсутності гострої коронарної оклюзії. Належний посмертний діагноз, встановлення безпосередньої причини смерті вимагає сучасних знань про гострий ІМ та правильної інтерпретації посмертних змін з урахуванням клінічного епікризу.…”

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Retrospective Analysis of Clinical, Epidemiology and Pathomorphological Features of Myocardial Infarction

Tkachenko,

Protsenko,

Remnyova

et al. 2024

Act. Probl. of the Modern Med.

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The aim of this study is to conduct a retrospective analysis of the clinical, epidemiological, and pathomorphological features of myocardial infarction. Materials and methods: A retrospective analysis was conducted using data from medical records and autopsy results from the pathology department for the year 2023. Results. In 2023, the pathology department performed 182 autopsies, with 123 patients diagnosed with acute, repeated, or recurrent myocardial infarction (MI), accounting for 67.6% of all autopsies. The average age of the deceased was 74.4±0.9 years, with 81.3% being persons of incapacitated age. Women comprised the majority at 55.3% (T=2784.5; p=0.001). The highest proportion of MI-related deaths occurred in September, accounting for 12.2%. In the pathological diagnosis, myocardial infarction (MI) was the primary disease, with varying localization of the pathological process in the left ventricle. Transmural MI was detected in 95.9% of the deceased, while subendocardial MI was found in 4.1%. Acute MI developed against the background of a previously experienced MI in 43.9% of cases, and in 5.5% of cases, it was a repeated acute recurrent MI. Changes in the aorta, coronary vessels, and basal vessels of the brain were observed in 100.0% of the cases, with hypertensive disease detected in 95.9% of cases. Acute cardiopulmonary failure with the development of pulmonary edema was the immediate cause of death in 95.9% of cases. Macroscopic examination revealed hypertrophy of the left ventricle. The myocardium appeared reddish-brown and elastic, with white layers. Brown-gray infarct areas of different sizes were present in the left ventricular wall, while in cases of repeated acute myocardial infarction, the affected area was gray-white and hard to the touch. Microscopically, hypertrophy of cardiomyocytes of the left ventricle with perinuclear lipofuscinosis was observed in all deceased individuals. Sections of the infarct zone contained homogenized, anucleated, fragmented cardiomyocytes, dilated full blood vessels with small perivascular hemorrhages, and neutrophilic-macrophage infiltrates of varying intensity. Large centers of cardiosclerosis were detected in cases of repeated MI, while signs of angiogenesis with the formation of granulation tissue were observed in cases of recurrent MI. Conclusion. In 2023, 123 autopsies revealed a diagnosis of acute, repeated, or recurrent myocardial infarction (MI) in 67.6% of all cases. The average age of the deceased was 74.4±0.9 years, with 81.3% being individuals of incapacitated age. There was a predominance of women, accounting for 55.3% of cases. Acute MI developed against the background of a previously experienced one in 43.9% of the deceased, while repeated acute recurrent MI was detected in 5.5% of cases. Pathomorphological changes corresponded to the typical features of MI depending on its age.

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Reaffirming the Value of the Autopsy

Cited by 3 publications

References 25 publications

Autopsy examination after extracorporeal membrane oxygenation: ‘Mortuis vivos docent’

Autopsy examination after extracorporeal membrane oxygenation: ‘Mortuis vivos docent’

Is Hospital Autopsy Auditing Suitable for Clinical Risk Manage ment? Actualities and Perspectives of Auditing in the Autopsy Room Following Italian Law 24/2017 on Patient Safety

Retrospective Analysis of Clinical, Epidemiology and Pathomorphological Features of Myocardial Infarction

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