This Article  • Full text  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (16)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Quality of Care, Other  • Medical Education  • Diagnosis  • Alert me on articles by topic

Are They Still Useful?

Praveen Kumar, MD; Jerome Taxy, MD; Denise B. Angst, DNSc; Henry H. Mangurten, MD

Arch Pediatr Adolesc Med. 1998;152:558-563.

Background  Autopsy has traditionally been the criterion for determining cause of death and has played a major role in medical education and quality control. With increasing use of bedside technology, however, autopsy rates have steadily declined.

Objective  To identify (1) trends in pediatric autopsy rates during the past decade, (2) concordance between antemortem and postmortem diagnoses, and (3) patient characteristics influencing autopsy rates or diagnostic yield.

Methods  All pediatric deaths between January 1, 1984, and December 31, 1993, were retrospectively reviewed. Data collection included demographics for all patients, and length of stay, diagnostic imaging studies, antemortem diagnoses, and autopsy findings for patients with autopsies. Autopsy diagnoses were compared with antemortem findings and classified according to their concordance.

Results  Of 297 pediatric deaths, autopsies were performed on 107 patients (36%). Autopsy rates did not change significantly during the study period. Autopsies were not associated with patient gender, race, or insurance status, but increased significantly with age. Autopsies were performed in 26% of infants 12 months or younger, 60% of children between 13 to 60 months of age, and 100% of children 61 months or older (²; P<.001). In 34% of cases, new diagnoses were made at autopsy, including 7 cases where new findings, if known before death, would likely have resulted in a change in treatment or improved survival. There was no relationship between new findings at autopsy and age, length of hospital stay, or antemortem imaging studies.

Conclusions  Autopsy can provide additional information in more than one third of pediatric deaths. Pediatric autopsy continues to provide clinically significant data and remains a valuable tool in modern pediatric practice.

From the Department of Pediatrics, Lutheran General Children's Hospital (Drs Kumar, Angst, and Mangurten), and the Department of Pathology, Lutheran General Hospital (Dr Taxy), Park Ridge, Ill. Dr Kumar is currently a staff neonatologist at Northwestern Memorial Hospital, Chicago, Ill.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

What New Information Pediatric Autopsies Can Provide: A Retrospective Evaluation of 100 Consecutive Autopsies Using Family-Centered Criteria
Feinstein et al.
Arch Pediatr Adolesc Med 2007;161:1190-1196.
ABSTRACT | FULL TEXT  

The Autopsy in a Tertiary Teaching Hospital in Brazil
Peres and Ribeiro-Silva
Annals of Clinical & Laboratory Science 2005;35:387-390.
ABSTRACT | FULL TEXT  

Death of a Child in the Emergency Department
Knapp et al.
Pediatrics 2005;115:1432-1437.
ABSTRACT | FULL TEXT  

Trends of accuracy of clinical diagnoses of the basic cause of death in a university hospital
Grade et al.
J. Clin. Pathol. 2004;57:369-373.
ABSTRACT | FULL TEXT  

Changes in Rates of Autopsy-Detected Diagnostic Errors Over Time: A Systematic Review
Shojania et al.
JAMA 2003;289:2849-2856.
ABSTRACT | FULL TEXT  

Autopsy Consent Practice at US Teaching Hospitals: Results of a National Survey
Rosenbaum et al.
Arch Intern Med 2000;160:374-380.
ABSTRACT | FULL TEXT  

Case of the Month: Outcome Analysis and Quality Assessment
Bennett et al.
Arch Intern Med 1999;159:1399-1400.
FULL TEXT  

Autopsies in Children Are Useful
JWatch General 1998;1998:4-4.
FULL TEXT