Original Article

Consecutive Autopsies on an Internal Medicine Service

Authors: Robert P. Ferguson, MD, Linda Burkhardt, MD, George Hennawi, MD, Loveen Puthumana, MD

Abstract

Objectives: Autopsy rates continue to decline in the United States despite the demonstrated value of this procedure in many different settings. We sought to review clinical pathologic discordance information generated by autopsies on an internal medicine service in the urban United States and to determine whether resident services appear to influence autopsy rates.


Methods: We reviewed consecutive deaths and autopsies on an inpatient internal medicine service during a 30-month period at a 400-bed community hospital in Baltimore, MD.


Results: There were 622 deaths and 65 autopsies (10.3%). Resident teaching status correlated with a higher rate of autopsies performed (P = 0.048). Clinical pathologic discordance was common, with a major discordance rate of 39%. Major discordance was indicated by only one of nine autopsies performed on patients with human immunodeficiency virus.


Conclusions: The autopsy was a valuable educational and quality improvement tool on the urban internal medicine service. Residency influences may be a major factor in continuing this exercise. In our study, although the numbers were small, patients with human immunodeficiency virus had a very low discordance rate.

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References

1. Boers M, Nieuwenhuyzen Kruseman AC, Eulderink F, et al. Value of autopsy in internal medicine: a 1-year prospective study of hospital deaths. Eur J Clin Invest 1988; 18: 314–320.
 
2. Pelletier LL Jr, Klutzow F, Lancaster H. The autopsy: its role in the evaluation of patient care. J Gen Intern Med 1989; 4: 300–303.
 
3. Grundmann E, Menke GG. Autopsy diagnosis versus clinical diagnosis, particularly in malignant disease: comparison of two periods: 1961–70 and 1978–87. IARC Sci Publ 1991; 112: 81–90.
 
4. Tai DY, El-Bilbeisi H, Tewari S, et al. A study of consecutive autopsies in a medical ICU: a comparison of clinical cause of death and autopsy diagnosis. Chest 2001; 119: 530–536.
 
5. Mollo F, Bertoldo E, Grandi G, et al. Reliability of death certifications for different types of cancer: an autopsy survey. Pathol Res Pract 1986; 181: 442–447.
 
6. Blosser SA, Zimmerman HE, Stauffer JL. Do autopsies of critically ill patients reveal important findings that were clinically undetected? Crit Care Med 1998; 26: 1332–1336.
 
7. Mort TC, Yeston NS. The relationship of pre mortem diagnoses and post mortem findings in a surgical intensive care unit. Crit Care Med 1999; 27: 299–303.
 
8. Stevanovic G, Tucakovic G, Dotlic R, et al. Correlation of clinical diagnoses with autopsy findings: a retrospective study of 2,145 consecutive autopsies. Hum Pathol 1986; 17: 1225–1230.
 
9. Bayer-Garner IB, Fink LM, Lamps LW. Pathologists in a teaching institution assess the value of the autopsy. Arch Pathol Lab Med 2002; 126: 442–447.
 
10. Roberts WC. The autopsy: its decline and a suggestion for its revival. N Engl J Med 1978; 299: 332–338.
 
11. Burton EC. The autopsy: a professional responsibility in assuring quality of care. Am J Med Qual 2002; 17: 56–60.
 
12. American Medical Association. Graduate Medical Education Directory. Chicago, American Medical Association, 2002, p 89.
 
13. Friederici HH, Sebastian M. Autopsies in a modern teaching hospital: a review of 2,537 cases. Arch Pathol Lab Med 1984; 108: 518–521.
 
14. Pineda LA, Hathwar VS, Grant BJ. Clinical suspicion of fatal pulmonary embolism. Chest 2001; 120: 791–795.
 
15. Wilkes MS, Fortin AH, Jacobs TA. Physicians’ attitudes toward the autopsy of patients with AIDS. N Y State J Med 1991; 91: 386–389.
 
16. Guerra I, Ortiz E, Portu J, et al. Value of limited necropsy in HIV-positive patients. Pathol Res Pract 2001; 197: 165–168.