Is the clinical autopsy no longer relevant?
Author: Rosendahl, Anders
Date: 2019-05-24
Location: Hörsal 4V, Alfred Nobels Allè 8, Karolinska institutet, Flemingsberg
Time: 09.00
Department: Inst för laboratoriemedicin / Dept of Laboratory Medicine
View/ Open:
Thesis (809.2Kb)
Abstract
Background: The total number of autopsies has dropped during the last decades to less than a quarter of the number during the 1980-ies. We studied the consequences of a decrease in the autopsy frequency for the accuracy of the death certificates and the cause of death registry.
Aim: The overall aim of the project was to study the background of the low levels of autopsies. One specific aim was to investigate the clinical usefulness of autopsies for determining the cause of death and as a source of information for relatives. (I) Another aim was to describe the changes over time in clinical and forensic post-mortem examinations of males and females at different ages and to study the relevance and accuracy of the cause of death registries from the National Board of Health and Welfare and how this has been affected by the decline in the autopsy rate. (II)
Methods: In study I the process of post-mortem examination was investigated. A total of 53 autopsies was studied using data from medical records, including nurse’s records, autopsy request forms, autopsy reports and death certificates. Study II was a national registry study (1969–2016) of mortality statistics and a local retrospective study (2008–2009) of medical records and death certificates on the cause of death of patients who died at a university hospital.
Results: The autopsy routines were sufficient to fulfill clinical needs in a reasonable time. In six cases, kin requested the examination, while in half of the cases, autopsy was recommended by the responsible physician only. In two-thirds of the cases, the autopsy significantly altered or complemented the clinical picture in a way that was noted in the death certificate. In two-thirds of the cases, it was documented that the next of kin was informed of the result of the autopsy. (I) The total autopsy rate has fallen from 40,000 autopsies to about 10,000 autopsies per year from 1969–2016. Clinical autopsies performed in the healthcare system have dropped from 30,000 to less than 5,000 per year. The frequency of clinical autopsies was age dependent and had low values after the age of 70. We could not confirm sex-dependent differences in the rate of clinical autopsies. We investigated 221 deaths at Karolinska university hospital from 2008–2009. 188 cases were not autopsied and in 26 of these the cause of death was unspecific and irrelevant, while in 33 cases in which an autopsy had been performed, only 2 had an unspecified cause of death. (II)
Conclusion: The data confirm that clinical autopsy is a valuable source of information for the death certificate and for the next of kin. The diagnostic value of autopsy was the same as when autopsy frequencies was above 50%. We conclude that the decrease in number of autopsies requested and performed reduces the value of the cause of death registry and should be increased to improve the understanding of disease and cause of death, as well as to better inform the next of kin.
Aim: The overall aim of the project was to study the background of the low levels of autopsies. One specific aim was to investigate the clinical usefulness of autopsies for determining the cause of death and as a source of information for relatives. (I) Another aim was to describe the changes over time in clinical and forensic post-mortem examinations of males and females at different ages and to study the relevance and accuracy of the cause of death registries from the National Board of Health and Welfare and how this has been affected by the decline in the autopsy rate. (II)
Methods: In study I the process of post-mortem examination was investigated. A total of 53 autopsies was studied using data from medical records, including nurse’s records, autopsy request forms, autopsy reports and death certificates. Study II was a national registry study (1969–2016) of mortality statistics and a local retrospective study (2008–2009) of medical records and death certificates on the cause of death of patients who died at a university hospital.
Results: The autopsy routines were sufficient to fulfill clinical needs in a reasonable time. In six cases, kin requested the examination, while in half of the cases, autopsy was recommended by the responsible physician only. In two-thirds of the cases, the autopsy significantly altered or complemented the clinical picture in a way that was noted in the death certificate. In two-thirds of the cases, it was documented that the next of kin was informed of the result of the autopsy. (I) The total autopsy rate has fallen from 40,000 autopsies to about 10,000 autopsies per year from 1969–2016. Clinical autopsies performed in the healthcare system have dropped from 30,000 to less than 5,000 per year. The frequency of clinical autopsies was age dependent and had low values after the age of 70. We could not confirm sex-dependent differences in the rate of clinical autopsies. We investigated 221 deaths at Karolinska university hospital from 2008–2009. 188 cases were not autopsied and in 26 of these the cause of death was unspecific and irrelevant, while in 33 cases in which an autopsy had been performed, only 2 had an unspecified cause of death. (II)
Conclusion: The data confirm that clinical autopsy is a valuable source of information for the death certificate and for the next of kin. The diagnostic value of autopsy was the same as when autopsy frequencies was above 50%. We conclude that the decrease in number of autopsies requested and performed reduces the value of the cause of death registry and should be increased to improve the understanding of disease and cause of death, as well as to better inform the next of kin.
Abstract
Denna avhandling har som huvudsyfte att undersöka det kliniska värdet av obduktioner. Obduktionsprocessens logistik och ändamålsenlighet har undersökts i en rutinmässig vårdsituation för fastställande av dödsorsak och som informationskälla för närstående. Den sjunkande obduktionsfrekvensen för män och kvinnor har följts över tid och osäkerhet och felkällor i dödsorsaksregistret har beskrivits. Information har inhämtats dels från Socialstyrelsens dödsorsaksregister och dels från journaluppgifter från personer som avlidit på Karolinska universitetssjukhuset under perioden 2008-2009. I denna avhandling har vi visat att obduktion är en viktig informationskälla för att fastställa dödsorsak och informera anhöriga om dödsorsak.
List of papers:
I. Rosendahl A., Mjörnheim B., Takman C., Eriksson L.C. The Clinical Value of Autopsies at a University Hospital in Sweden. Nordic Journal of Nursing Research. 2015;37(3):119-126.
Fulltext (DOI)
II. Rosendahl A., Mjörnheim B., Takman C., Eriksson L.C. Autopsies in Swedish Health Care – a registry study from 1969 to 2016. [Manuscript]
I. Rosendahl A., Mjörnheim B., Takman C., Eriksson L.C. The Clinical Value of Autopsies at a University Hospital in Sweden. Nordic Journal of Nursing Research. 2015;37(3):119-126.
Fulltext (DOI)
II. Rosendahl A., Mjörnheim B., Takman C., Eriksson L.C. Autopsies in Swedish Health Care – a registry study from 1969 to 2016. [Manuscript]
Institution: Karolinska Institutet
Supervisor: Eriksson, Lennart
Co-supervisor: Takman, Christina
Issue date: 2019-05-03
Rights:
Publication year: 2019
ISBN: 978-91-7831-470-6
Statistics
Total Visits
Views | |
---|---|
Is ... | 362 |
Is ...(legacy) | 93 |
Total Visits Per Month
October 2023 | November 2023 | December 2023 | January 2024 | February 2024 | March 2024 | April 2024 | |
---|---|---|---|---|---|---|---|
Is ... | 3 | 6 | 2 | 7 | 6 | 6 | 0 |
File Visits
Views | |
---|---|
Thesis_Anders Rosendahl.pdf | 1385 |
Thesis_Anders Rosendahl.pdf(legacy) | 44 |
Top country views
Views | |
---|---|
United States | 129 |
Sweden | 112 |
China | 69 |
Germany | 46 |
Ireland | 10 |
Canada | 9 |
Finland | 9 |
Russia | 9 |
South Korea | 5 |
Denmark | 4 |
Top cities views
Views | |
---|---|
Ashburn | 70 |
Hangzhou | 23 |
Huddinge | 18 |
Dublin | 9 |
Mountain View | 9 |
Stockholm | 9 |
Menlo Park | 8 |
Umeå | 8 |
Beijing | 6 |
Shanghai | 6 |