[1989] Photography Is an Underutilized Resource Crucial to Documentation of Cause of Death and Assurance of High Quality Postmortem Examinations

Benjamin Mathis. Miami-Dade County Medical Examiner Department, Miami, FL

Background: Most consider autopsy as the gold standard for both the determination of cause of death and the definitive documentation of antemortem pathology and injury. At the time of autopsy, pathologists have but one opportunity to properly document and preserve the findings. Our institution, a high-volume metropolitan medical examiner office, has a dedicated forensic photographer available throughout all cases. This service is often not available at smaller offices and sites. The purpose of this study is to quantify the proportion of autopsy findings that are photographed from cases with a natural manner of death.
Design: We performed a retrospective review of autopsy records from 104 decedents with a natural-manner death in 2011. The “findings” section of each autopsy report was compared with its associated photographs to determine how many of the findings had been photographed, and whether an anatomic manifestation of the ultimate cause of death had been captured. Additionally, we surveyed how frequently common pathologic findings such as cardiomegaly, coronary artery disease, and pulmonary edema, amongst others, were photographed.
Results: The number of findings in the “findings” section ranged from 2 to 17 (mean=7.3, median=7), with the number photographed ranging from 0 to 10 (mean=2.6, median=2). On average 34% of the autopsy findings were photographed from each case (median=29%). Additionally, anatomic manifestations of the cause of death were photographed in 59% of cases (n=61). For example, among decedents with hypertensive heart disease certified as a cause of death (n=36), 81% (n=29) had cardiomegaly and 89% (n=32) had nephrosclerosis. 42% (n=12) of such cases had photographic documentation of the heart, while 28% (n=9) had of the kidneys.
Conclusions: Our study shows that even at an office with a dedicated photographer in the morgue, natural-manner death cases often do not have accompanying photography. For each case, approximately one-third of the findings were photographed, and 59% of these photographs demonstrated evidence relating to the cause of death. Gross photography is perhaps the most efficient and objective means of preserving the findings observed during an autopsy. New information may come to light in the future, or questions regarding the interpretation of the findings may arise at a later time, necessitating review of gross findings. Therefore, gross photography plays a key role in objectively immortalizing autopsy findings to insure the quality and reproducibility of the postmortem examination.
Category: Quality Assurance

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 248, Tuesday Morning

 

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