Paediatric and perinatal postmortem imaging: mortui vivos docent

Excerpt

The classic autopsy, although widely recognised as the gold standard in postmortem diagnosis, has shown a steady worldwide decline in the past decades [1]. A large literature review of adults showed that autopsies could reveal a major error rate from 8.4% to 24.4% and a class I error rate from 4.1% to 6.7% [2]. At the other end of the age spectrum, an Irish study in a neonatal intensive care unit showed that unsuspected or unconfirmed clinical conditions were found in 52% (85/164) of cases, and that in 45 cases information of interest to inheritable conditions was found [3]. While there have been other studies with similar findings, the decline in autopsy rates is difficult to prevent. Parental reluctance to accept an invasive autopsy, rather than clinician reluctance to offer one, is the most likely cause for this, and has been attributed to a variety of causes, including religious beliefs, the fear of unethical practices, the fact that the next of kin believe the deceased should be allowed to rest in peace and an emphasis on individual choices made in our society (where the greater good of gaining knowledge may be perceived to be of lesser importance). Finally, economics plays a certain role in this problem, as the conventional autopsy can be both time-consuming and expensive. …