[2] What Are We Missing? Repercussions of Declining Autopsy Rates

Matthew D Cain, Charles B Alexander, Hugh M Hood, Stephanie D Reilly. University of Alabama at Birmingham, Birmingham, AL; Corizon, Brentwood, TN

Background: Autopsy is a useful tool in identifying cause of death, usually confirming or clarifying clinical diagnoses. However, in a percentage of cases, autopsy will identify previously unsuspected diagnoses, even when there is a high degree of diagnostic certainty. Information obtained at autopsy allows physicians to hone their clinical skills, recognize uncommon diseases, and potentially modify treatment in future cases. Despite these benefits, autopsy rates in the United States have dropped from 40-60% of hospital deaths to <10%. This decline has been attributed to decreased benefit of autopsy in setting of advanced diagnostic modalities, costs and increase in hospice patients. Decedents with uncertain diagnoses are currently the primary recipients of the hospital based autopsy. This study examined the effect of high versus low autopsy rates on the rate of missed diagnoses over a fifty-seven month period.
Design: In November 2007, Corizon contracted with the state of Alabama to provide health care to state prisoners. Under this contract it was agreed that University of Alabama at Birmingham (UAB) would perform autopsies on inmates that died of natural causes. The autopsy rate for the prison population was substantially higher than the current norm. After obtaining IRB approval and permission from Corizon and the prison commission, we reviewed the mortality logs of adult patients at UAB and the prison system from November 2007 through July 2012 to determine the respective autopsy rates. We then reviewed all prison autopsies performed at UAB and adult UAB autopsies during the study period to compare the rates of major missed diagnoses. A major missed diagnosis was defined as either an unsuspected cause of death or unsuspected significant morbidity, such as active tuberculosis.
Results: UAB autopsied 7.4% of adult hospital deaths, compared to a prison autopsy rate of 46% (p<0.001). Major missed diagnoses were identified in 27% of UAB cases and 19% of prison autopsies (p= 0.023). While the male to female ratio for inmates (11:1) and UAB (1.1:1) differed (p<0.001)), the rate of missed diagnosis between genders was not significantly different (p=0.26).
Conclusions: Our study clearly demonstrates that despite technological advances in medicine the decline in autopsy rates has a statistically significant impact on the rate of major missed diagnoses. Performing more autopsies would yield information regarding missed diagnoses, inaccurate cause of death, and epidemiologic data. Accruing this knowledge could have substantial impact on clinical management.
Category: Autopsy

Wednesday, March 6, 2013 9:30 AM

Poster Session V # 1, Wednesday Morning

 

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