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Open Access 01-01-2016 | Annual Review Issue

The medical autopsy as quality assurance tool in clinical medicine: dreams and realities

Authors: Jan G. van den Tweel, Christian Wittekind

Published in: Virchows Archiv | Issue 1/2016

Abstract

The purpose of medical autopsy has changed to issues of quality assurance today. In addition, autopsies are considered valuable in medical education, e.g., delivering cases for problem-based learning for students. Many studies underscore the need for autopsies also in the era of technical progress emphasizing the continuing discrepancies between antemortem and post mortem diagnoses. Despite these important tasks, we face a decline of autopsy for several reasons with complex interactions. The role of all persons involved in this decline is evaluated and suggestions for changes are proposed. Last but not least, the future of the autopsy is in the hands of pathology itself.

Benivieni A (1507) De abditis nonnullis ac mirandis morborum et sanationum causis, Filippo Giunti, Florence

Bonet T (1679) Sepulchretum sive anatomia practica ex cadaveribis morbo denatis. Leonardus Chouet, Geneva

Boerhaave H (1751) Opera Omnia complectentia. Atrocis, nec descripti prius, morbihistoria: 387-404, Venice, Laurentius Basilius

Morgagni GB (1761) De sedibus et causis morborum per anatomen indagatis (Venetiae)

Sedivy R (2004) Rokitansky and the Vienna Medical School–from the philosophy of nature to natural science. Wien Med Wochenschr. 154(19-20):443–453CrossRefPubMed

Virchow R (1884) Die Sektions –Technik im Leichenhause des Charité-Krankenhauses. Berlin, 3rd edition, August Hirschwalt

Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weisberg M (1983) The value of the autopsy in three medical eras. N Engl J Med 308:1000–1005CrossRefPubMed

Shojania KG,, Burton EC, McDonald KM, Goldman M (2003)Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA 289:2849–2856CrossRefPubMed

Wittschieber D, Klauschen F, Kimmritz AC, von Winterfeld M, Kamphues C, Scholman HJ, Erbersdobler A, Pfeiffer H, Denkert C, Dietel M, Weichert W, Budczies J, Stenzinger A (2012) Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin. PLoS ONE 2012:7(5)

10.

Moorchung N, Singh V, Mishra A, Patrikar S, Kakkar S, Dutta V (2013) Is necropsy obsolete—an audit of the clinical autopsy over six decades: a study from Indian sub continent. Indian J Pathol Microbiol 56:372–377CrossRefPubMed

11.

Kuijpers CC, Fronczek J, van de Goot FR, Niessen HW, van Diest PJ, Jiwa M (2014) The value of autopsies in the era of high-tech medicine: discrepant findings persist. J Clin Pathol 67:512–519CrossRefPubMed

12.

Sblano S, Arpaio A, Zotti F, Marzullo A, Bonsignore A, Dell’Erba A (2014) Discrepancies between clinical and autoptic diagnoses in Italy: evaluation of 879 consecutive cases at the "Policlinico of Bari" teaching hospital in the period 1990-2009. Ann Ist Super Sanita 50:44–48PubMed

13.

Schwanda-Burger S, Moch H, Muntwyler J, Salomon F (2012) Diagnostic errors in the new millennium: a follow-up autopsy study. Mod Pathol 25:777–78313CrossRefPubMed

14.

Winters B, Custer J, Galvagno SM, Colontuoni E, Capoor SG, Lee HW, Goode V, Robinson K, Nakhasi A, Pronovost P, Newman-Toker D (2012) Diagnostic errors in the intensive care unit: a systemic review of autopsy studies. BMJ Qual Saf.21:894–902

15.

Fares AF, Cury PM, Lobo SM (2011) Clinical-pathological discrepancies in critically ill patients with difficult premortem diagnoses. Rev Bras Ter Intensiva 23:442–447CrossRefPubMed

16.

Khawaja O, Khalil M, Zmeili O, Soubani AO (2013) Major discrepancies between clinical and postmortem diagnoses in critically ill cancer patients: is autopsy still useful? Avicenna J Med 3:63–67PubMedCentralCrossRefPubMed

17.

Blanco C, Steigman C, Probst N, Stroud M, Bhutta AT, Dyamenahalli U, Imamura M, Prodhan P (2014) Discrepancies between autopsy and clinical findings among patients requiring extracorporeal membrane oxygenator support. ASAIO J 60:207–210CrossRefPubMed

18.

Roosen J, Frans E, Wilmer A, et al. (2000) Comparison of premortem clinical diagnoses in critically ill patients and subsequent autopsy findings. Mayo Clin Proc 75:562–567CrossRefPubMed

19.

Pastores SM, Dulu A, Voigt L, et al. (2007) Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients. Crit Care 11:R48PubMedCentralCrossRefPubMed

20.

Tavora F, Crowder CD, Sun CC, Burke AP (2008) Discrepancies between clinical and autopsy diagnoses. A comparison of university, community, and private autopsy practices. Am J Clin Pathol 129:102–109CrossRefPubMed

21.

Zampieri F, Rizzo S, Thiene G, Basso C (2015) The clinico-pathological conference, based upon Giovanni Battista’s legacy, remains of fundamental importance even in the era of the vanishing autopsy. Virchows Arch. May 20. [Epub ahead of print]

22.

Hill RB, Anderson RE (1991) The autopsy crisis reexamined: the case for a national autopsy policy. The Milbank Quarterly 69:51–78CrossRefPubMed

23.

Landefeld CS, Goldman L (1989) The autopsy in clinical medicine (editorial). Mayo Clin Proc 64:1185–1189CrossRefPubMed

24.

Anderson RE, Hill RB, Key CR (1989) The sensitivity and specificity of clinical diagnostics during five decades. Towards an understanding of necessary fallibility. JAMA 261:1610–1617CrossRefPubMed

25.

Saracci R (1988) Problems with used of autopsy results as a yardstick in medicala audit and epidemiology. Qual Assur Health Care 5:339–344CrossRef

26.

Hill RB (1993) The current status of autopsies in medical care in the USA. Qual Assur Health Care 5:309–313CrossRefPubMed

27.

Setlow VP (1996) The need for a national autopsy policy. MJ Arch Pathol Lab Med 120:773–777

28.

Start RD, Cotton DWK (1993) The meta-autopsy. Changing techniques and attitudes towards the autopsy. Qual Assur Health Care 5:326–332

29.

Hull MJ, Nazarian RM, Wheeler AE, et al. (2007) Resident physicians opinions on autopsy importance and procurement. Human Pathol 38:342–250CrossRef

30.

Fernando LBM (2008) Place of autopsy in quality assurance of curative service. Galle Medical J 13:51–54

31.

Horowitz RE, Naritoku WY (2007) The autopsy as a performance measure and teaching tool. Human Pathol 38:688–695CrossRef

32.

Kahl A (2010) Public perceptions of hospital autopsies: results of a representative survey. Pathologe 32:345–348(in German)CrossRef

33.

Thayyil S, Sebire NJ, Chitty LS, et al (2013) Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 382:223–233CrossRefPubMed

34.

Aghayev E, Thali MJ, Sonnenschein M, Jackowski C, Dirnhofer R, Vock P (2007) Post-mortem tissue sampling using computed tomography guidance. Forensic Sci Int 166(2–3):199–203CrossRefPubMed

35.

Westphal SE, Apitzsch J, Penzkofer T, Mahnken AH, Knüchel R (2012) Virtual CT autopsy in clinical pathology: feasibility in clinical autopsies. Virchows Arch 461:211–219CrossRefPubMed

36.

Weustink AC, Hunink MG, van Dijke CF, et al. (2009) Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 250:897–904CrossRefPubMed

37.

Van der Linden A, Blokker BM, Kap M, Weustink AC, Robertus JL, Riegman PH, Oosterhuis WJ. (2014) Post-mortem tissue biopsies obtained at minimally invasive autopsy: an RNA-quality analysis. PLoS One. 2014 Dec 22;9 (12):e115675

38.

Friemann J (2014) Indikationsliste zur Durchfürung klinischer Obduktionen. Pathologe 4:402–403

39.

Van den Tweel JG (2008) Autopsy pathology should become a recognized subspecialty. Virchows Arch 452:585–587PubMedCentralCrossRefPubMed

40.

Arena V, Capelli A (2009) Autopsy pathology: a subspecialty that must be recognized. Hum Pathol 40:903–904CrossRefPubMed

Title: The medical autopsy as quality assurance tool in clinical medicine: dreams and realities
Authors: Jan G. van den Tweel
Christian Wittekind
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: Virchows Archiv / Issue 1/2016
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-015-1833-5

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The medical autopsy as quality assurance tool in clinical medicine: dreams and realities

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