In 1994, the last year for which data exists, the autopsy rate for all nonforensic deaths decreased to less than 6%.

Studies show decrease rates of major errors over time.

Discordance between clinical and postmortem diagnosis is approximately 20%.

In 44% of discordant cases, knowledge of the correct diagnosis would have altered therapy.

Most frequent missed diagnoses are infections.

Performed in less than 10% of all U.S. deaths.

Results in class I errors that could have resulted in a change in management that may prolong survival of approximately 10% of cases.

Results in identification of class II errors that would affect survival but would be clinically important to have recognized in 12% of cases.

Death certificates have a sensitivity less than 40% compared with autopsy results for identifying deaths related to pulmonary embolus (Dismuke SE, VanderZwaag R).

An autopsy is the examination of the body of a dead person.

Also known as necropsy or postmortem examination.

An autopsy may be restricted to a specific organ or region of the body.

Performed to determine the cause of death, for legal purposes, and for education and research.

Performed primarily to determine the cause of death, to identify or characterize the extent of disease states that the person may have had, or to determine whether a particular medical or surgical treatment has been effective.

The body is opened in a manner that does not interfere with an open casket service.

The rate has dropped from 50% to less than 10% over the past fifty years.

Performed by pathologists, doctors who have received specialty training in the diagnosis of diseases by the examination of body fluids and tissues.

In academic institutions, the procedure may be requested for teaching and research purposes.

Forensic autopsies are performed to determine if death was an accident, homicide, suicide, or a natural event.

A medical examiner can order an autopsy without the consent of the next-of-kin.

Allows determination the direct cause of death of each patient independent of his/her age, gender and gender specific characteristics.

Deaths are investigated include: all suspicious deaths, and, may include deaths of persons not being treated by a physician for a known medical condition, deaths of those who have been under medical care for less than 24 hours, or deaths that occurred during operations or other medical procedures.

In other cases, consent must be obtained from the next-of-kin before an autopsy is performed.

The next-of-kin also has the right to limit the scope of the autopsy.

The extent of an autopsy can vary from the examination of a single organ, to a very extensive examination.

Examination of the chest, abdomen, and brain is considered as the standard scope of the autopsy.

The autopsy begins with a complete external examination.

The weight and height of the body are recorded, and identifying marks such as scars and tattoos also are recorded.

Internal examination begins with the creation of a Y or U- shaped incision from both shoulders joining over the sternum and continuing down to the pubic bone.

Tissues are separated to expose the rib cage and abdominal cavity.

The front of the rib cage is removed to expose the neck and chest organs, allowing the trachea, thyroid gland, parathyroid glands, esophagus, heart, thoracic aorta and lungs to be removed.

Following removal of the neck and chest organs, the abdominal organs are dissected free, and include the intestines, liver, gallbladder and bile duct system, pancreas, spleen, adrenal glands, kidneys, ureters, urinary bladder, abdominal aorta, and reproductive organs.

The brain is removed by an incision in the back of the skull from one ear to the other.

The top of the skull is removed using a vibrating saw, and the entire brain is removed out of the cranial vault.

The spinal cord may be taken by removing the anterior or posterior portion of the spinal column.

The organs are first examined to note any changes visible with the naked eye.

Changes readily recognizable in the organs include atherosclerosis, cirrhosis of the liver, and coronary artery disease in the heart.

Samples are taken from all organs to be made into slide preparations for examination under a microscope.

The incisions made are sewn closed, and the organs may be returned to the body or may be retained for teaching, research, and diagnostic purposes.

Does not interfere with an open casket funeral service, as none of the incisions are apparent after embalming and dressing of the body.

Pictures of findings may be taken, and special studies may include cultures, chemical analysis for the drug levels or metabolic abnormalities, or genetic studies.

Tissue may be frozen for future diagnostic or research purposes.

Organs may be preserved and stored in formalin for later examination.

A report that describes the procedure and microscopic findings, gives a list of medical diagnoses, and a summary of the case is prepared, and emphasizes the relationship or correlation between clinical findings and pathologic findings.

The autopsy rate is declining partially due to change in the basic doctor-patient relationship may make it increasingly difficult to obtain consent for an autopsy.

The visual examination of the body and the removal of tissues and organs for microscopic examination can be completed in a few hours.

There are no visible external changes that would preclude an open-casket funeral service.

In the majority of cases there is no charge to the family and frequently, no compensation for its performance.

Some institutions charge and private autopsies at the request of family members that are performed outside of the hospital may cost several thousand dollars.

Autopsy studies have consistently shown that in 20% to 40% of autopsied patients had treatable conditions detected at autopsy that were not diagnosed clinically.

Studies indicate 25-60% of death certificates are inadequate compared to autopsy findings.

Therefore autopsy remains the gold standard in evaluating the quality of medical care.

An autopsy does not guarantee that the cause of death will be identified.

The autopsy can uncover genetic or environmental causes of disease that could affect other family members.

Could confirm the accuracy of the clinical diagnoses and the appropriateness of medical care.

Findings can be utilized to educate physicians, nurses, residents, and students, thereby contributing to an improved quality of care.

Aids in the evaluation of new diagnostic tests, therapeutic interventions and the investigation of environmental and occupational diseases.

Data derived from autopsies are useful in establishing valid mortality statistics.

Presently, there is no direct funding to hospitals or doctors for autopsies.

Medicare funding to hospitals theoretically includes payments for autopsies, but these funds are not specifically earmarked for autopsies and may not reach the pathology department or pathologist.

Managed care organizations consider the autopsy to be built into their hospital contracts.

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