To Assess the Use of Ancillary Studies in the Determination of Cause of Death
Lindsey PM Clarke, Linda M Mulligan, Stephen F Crowther. Adelaide and Meath Hospital, Dublin, Ireland
Background: Our institution has a busy adult autopsy practice, situated in West Dublin, with a catchment area of almost one quarter of a million people. Approximately 270 autopsies are performed annually. Histology is taken routinely in all autopsies, with additional studies (toxicology, neuropathology, microbiology) being undertaken in specific cases, as per the guidelines of the Royal College of Pathologists. Due to the paucity of literature regarding the use of microbiology sampling in adult autopsy practice, a particular emphasis was placed on investigating the contribution of microbiology in the determination of cause of death.
Design: This case series includes all adult autopsies performed in our institution over a 2-year period. Basic demographics and clinical details including location of death (in-hospital, out of hospital) were recorded. The use of additional studies was recorded. Final reports were then compared with provisional and interim reports to evaluate the contribution of each additional study.
Results: 500 autopsies were carried out (35% female; 65% male). 21% of deaths occurred in the emergency department, 45% in hospital and 34% out of hospital. Microbiology testing, including blood cultures and tissue swabs, was carried out in 15% and toxicology was carried out in in 52% of cases.
Provisional reports were issued in 73% of cases, with determination of cause of death deferred pending additional studies in 27%.
Cause of death was changed in 13% of cases based on histology, toxicology or combined histology/toxicology results.
In cases in which determination of cause of death was deferred, histology established cause of death in 76%, toxicology in 16%. The remaining 8% consisted of cases in which cause of death was established by neuropathology or those in which no anatomic cause of death was established.
While microbiology did not alter cause of death, it was contributory in 5.5% of cases but was, however, under-utilised in cases of presumed sepsis.
Conclusions: Histology was the most common reason for change of cause of death, justifying its routine use. Microbiology was under-utilised, especially in deaths presumed to be due to both hospital-acquired and community-acquired sepsis, in the appropriate clinical setting. Further prospective analysis is required to fully assess its role as an adjunct in the evaluation of cause of death. Toxicology was useful in determination of cause of death in out-of-hospital deaths and neuropathology was useful in confirming cause of death, but rarely contributed if no other anatomical cause was found.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 10, Wednesday Morning