Pediatric autopsy - Does it yields valuable information?

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Pediatric autopsy - Does it yields valuable information?

Journal Title: Medpulse International Journal of Pediatrics - Year 2018, Vol 6, Issue 1

Abstract

Context: Although autopsy rates have declined significantly in recent decades, studies continue to validate the autopsy as an important source of clinically relevant information, a teaching tool, and a quality assurance measure. A recent review of autopsy series showed a decline in the number of serious errors likely to have affected clinical outcome detected at autopsy during the past 46 years, with a current major error rate of 8.4–24.4%. Objective: Our hypothesis was that the pediatric autopsy would uncover a significant number of major unexpected findings at the high end of the spectrum predicted by a recent review. This study assesses the unexpected findings at two military hospitals whose autopsy service handles in-house (tertiary care) cases for a vertically integrated health-care system. Design: Data were analyzed from an autopsy effectiveness report completed for all autopsies performed for 2003–2005. The data from this series include concordance of premortem and postmortem diagnoses, with the autopsy considered the criterion standard. The autopsy effectiveness report also provided logistic information such as problems with consents, medical records, and specimen identification. Setting: Pediatric autopsies were performed by members of the pediatrics and pathology division in a tertiary care hospital with a Level III neonatal intensive care and pediatric intensive care. The inpatient facilities consist of 432 total licensed inpatient beds including 46 licensed pediatric intensive care beds and 08 licensed neonatal intensive care unit beds. This hospital is part of a large health maintenance organization serving the surrounding entire northern command of Indian Army with all major subspecialty groups represented. Patients: A sample of all in-house and referral autopsies for 2003–2006 was examined. Main Outcome Measure: The percentage of cases with a major or minor diagnostic discrepancy or unexpected pathologic finding using the autopsy as the criterion standard. Results: A total of 1035 (493-2003, 425-2004, 117 up to April 30, 2005) deliveries took place between January 31, 2003, and April 30, 2005, of which 27 were reported as perinatal deaths (2003-09 and 03, 2004-08 and 01, March 31, 2005-03 and 03); 07 being stillborn and 20 being neonatal deaths. A total of 13 autopsies were performed; 09 were in the neonatal group and 04 were among the stillborn. The perinatal mortality rate for the hospital, not including medicolegal cases was 02%. Autopsies were done in 1% of all birth and 48% of perinatal mortality. The hospital autopsy rate for 2004 at 3.6%, the rate for 2003 declined to 1.4%, and the rate for the first half of 2005 was 2.16%. Of 13 autopsies, 01 (8%) revealed a major diagnostic discrepancy or unexpected pathologic finding, 07 (58%) had a minor unexpected finding or additional diagnosis, 8 (67%) clarified the differential diagnosis, 9 (75%) confirmed or verified a major diagnosis, and 03 (34%) provided information regarding treatment effects. In addition, 02 (20%) had problems with consent, all of which were resolved before initiation of the autopsy. Conclusions: These data confirm the value of the pediatric autopsy in a tertiary care hospital with a Level III neonatal intensive care. It is an important medical and quality assurance procedure for assessing the accuracy of diagnoses, clarifying differential diagnoses, yielding unexpected findings, and providing feedback regarding therapeutic outcomes.

Authors and Affiliations

M Pradeep Reddy, D Sridhar, Nitin Sharma, M S Bindra, Anita Jassar Sen

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