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Neonatology 2019Autopsy rates in neonatal intensive care unit (NICU) patients who died are declining worldwide. Postmortem magnetic resonance imaging (MRI) is suggested as adjunct to or...
BACKGROUND
Autopsy rates in neonatal intensive care unit (NICU) patients who died are declining worldwide. Postmortem magnetic resonance imaging (MRI) is suggested as adjunct to or substitute for autopsy.
OBJECTIVE
The aim of this paper was to determine the additional diagnostic value of autopsy in NICU patients and whether autopsy findings were potentially detectable using postmortem MRI.
METHODS
From 2008 to 2015, 298 infants died during admission to our NICU. Permission for unrestricted, nonforensic autopsy was obtained in 100 (33.6%) of these 298 infants. Retrospectively, autopsy reports and medical records of NICU patients were compared. Additional autopsy findings were graded according to the Goldman system, grading the clinical relevance of additional findings. In addition, the potential detectability of these additional findings on postmortem MRI was assessed.
RESULTS
Additional findings obtained by autopsy were found in 48% of the cases, divided into major (Goldman I/II, 24%) and minor (Goldman III/IV, 24%) additional findings. Major additional findings were significantly more often found in patients with a lower gestational age, and minor additional findings in patients with a higher postnatal age at death. Of all patients with additional findings determined by autopsy, 56.3% would most likely not have been detected using postmortem MRI.
CONCLUSIONS
Our results emphasize the still very important role of autopsy in the NICU setting and show that conventional autopsy could probably not be completely substituted by postmortem MRI.
Topics: Autopsy; Cause of Death; Diagnostic Errors; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Magnetic Resonance Imaging; Male; Netherlands; Retrospective Studies
PubMed: 30352441
DOI: 10.1159/000493003 -
Medicina 2016
Topics: Autopsy; Cause of Death; History, 15th Century; History, 16th Century; History, 17th Century; History, Medieval; Hospitals; Humans; Italy
PubMed: 27295710
DOI: No ID Found -
Archives of Pathology & Laboratory... Jan 2009Despite the crucial role that autopsy plays in the development of the science and practice of medicine, autopsy rates have been declining throughout the world in recent...
CONTEXT
Despite the crucial role that autopsy plays in the development of the science and practice of medicine, autopsy rates have been declining throughout the world in recent decades.
OBJECTIVE
To identify factors influencing the acceptance of autopsies in Nigeria.
DESIGN
Cross-sectional survey of the knowledge, attitude, and perceptions of doctors and relatives of deceased patients on factors influencing acceptance of autopsy at the University College Hospital, Ibadan, Nigeria.
RESULTS
Only 38% of relatives had satisfactory knowledge about autopsy and about 50% of doctors knew that physicians' desire for autopsy should not override patients' consent. Doctors identified difficulty in obtaining consent from relatives of deceased patients, administrative problems in requesting autopsy, and delay in obtaining autopsy report as major reasons responsible for the decline in autopsy requests, whereas relatives of the deceased cited fear of mutilation, concerns about delaying the funeral, and objection by the patient before death as reasons for refusal to grant permission for an autopsy. Sociodemographic factors such as age, occupation, religion, ethnicity, and level of education significantly influenced willingness to give consent for autopsy.
CONCLUSIONS
There is need for concerted effort on the part of clinicians, pathologists, the public, and the government to resuscitate and sustain the practice of autopsy in Nigeria.
Topics: Adult; Attitude to Death; Autopsy; Cross-Sectional Studies; Ethnicity; Family; Female; Health Knowledge, Attitudes, Practice; Hospitals, University; Humans; Male; Nigeria; Physicians; Surveys and Questionnaires
PubMed: 19123741
DOI: 10.5858/133.1.78 -
Virchows Archiv : An International... Aug 2022The use of autopsies in medicine has been declining. The COVID-19 pandemic has documented and rejuvenated the importance of autopsies as a tool of modern medicine. In... (Review)
Review
The use of autopsies in medicine has been declining. The COVID-19 pandemic has documented and rejuvenated the importance of autopsies as a tool of modern medicine. In this review, we discuss the various autopsy techniques, the applicability of modern analytical methods to understand the pathophysiology of COVID-19, the major pathological organ findings, limitations or current studies, and open questions. This article summarizes published literature and the consented experience of the nationwide network of clinical, neuro-, and forensic pathologists from 27 German autopsy centers with more than 1200 COVID-19 autopsies. The autopsy tissues revealed that SARS-CoV-2 can be found in virtually all human organs and tissues, and the majority of cells. Autopsies have revealed the organ and tissue tropism of SARS-CoV-2, and the morphological features of COVID-19. This is characterized by diffuse alveolar damage, combined with angiocentric disease, which in turn is characterized by endothelial dysfunction, vascular inflammation, (micro-) thrombosis, vasoconstriction, and intussusceptive angiogenesis. These findings explained the increased pulmonary resistance in COVID-19 and supported the recommendations for antithrombotic treatment in COVID-19. In contrast, in extra-respiratory organs, pathological changes are often nonspecific and unclear to which extent these changes are due to direct infection vs. indirect/secondary mechanisms of organ injury, or a combination thereof. Ongoing research using autopsies aims at answering questions on disease mechanisms, e.g., focusing on variants of concern, and future challenges, such as post-COVID conditions. Autopsies are an invaluable tool in medicine and national and international interdisciplinary collaborative autopsy-based research initiatives are essential.
Topics: Autopsy; COVID-19; Humans; Lung; Pandemics; SARS-CoV-2
PubMed: 35364700
DOI: 10.1007/s00428-022-03319-2 -
Global Health Action Dec 2020Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low- and middle-income countries (LMICs). There have... (Review)
Review
BACKGROUND
Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low- and middle-income countries (LMICs). There have been growing investments in less-invasive postmortem examination methodologies, including needle-based autopsy, known as minimally invasive autopsy or minimally invasive tissue sampling (MITS). MITS has been shown to be a feasible and informative alternative to CDA for cause of death investigation and mortality surveillance purposes.
OBJECTIVE
The aim of this narrative review is to describe historical use and evolution of needle-based postmortem procedures as a tool to ascertain the cause of death, especially in LMICs.
METHODS
Key word searches were conducted in PubMed and EBSCO in 2018 and 2019. Abstracts were reviewed against inclusion and exclusion criteria. Full publications were reviewed for those abstracts meeting inclusion criteria and a start set was established. A snowball search methodology was used and references for all publications meeting inclusion criteria were manually reviewed until saturation was reached.
RESULTS
A total of 1,177 publications were initially screened. Following an iterative review of references, 79 publications were included in this review. Twenty-nine studies, published between 1955 and 2019, included MITS as part of postmortem examination. Of the publications included, 76% (60/79) have publication dates after 2010. More than 60% of all publications included addressed MITS in LMICs, and a total of nine publications compared MITS with CDA.
CONCLUSIONS
Although there is evidence of less-invasive postmortem sampling starting in the 1800s, more structured needle-based postmortem examination publications started to appear in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 the number of publications began to increase, and a growing number of studies were conducted in LMICs. Initial studies in LMICs were disease-specific but since 2015 have evolved to include more expansive postmortem examination.
Topics: Autopsy; Cause of Death; Humans; Income; Poverty
PubMed: 32713325
DOI: 10.1080/16549716.2020.1792682 -
European Journal of Pediatrics Jun 2018Clinical post-mortem radiology is a relatively new field of expertise and not common practice in most hospitals yet. With the declining numbers of autopsies and... (Review)
Review
UNLABELLED
Clinical post-mortem radiology is a relatively new field of expertise and not common practice in most hospitals yet. With the declining numbers of autopsies and increasing demand for quality control of clinical care, post-mortem radiology can offer a solution, or at least be complementary. A working group consisting of radiologists, pathologists and other clinical medical specialists reviewed and evaluated the literature on the diagnostic value of post-mortem conventional radiography (CR), ultrasonography, computed tomography (PMCT), magnetic resonance imaging (PMMRI), and minimally invasive autopsy (MIA). Evidence tables were built and subsequently a Dutch national evidence-based guideline for post-mortem radiology was developed. We present this evaluation of the radiological modalities in a clinical post-mortem setting, including MIA, as well as the recently published Dutch guidelines for post-mortem radiology in foetuses, neonates, and children. In general, for post-mortem radiology modalities, PMMRI is the modality of choice in foetuses, neonates, and infants, whereas PMCT is advised in older children. There is a limited role for post-mortem CR and ultrasonography. In most cases, conventional autopsy will remain the diagnostic method of choice.
CONCLUSION
Based on a literature review and clinical expertise, an evidence-based guideline was developed for post-mortem radiology of foetal, neonatal, and paediatric patients. What is Known: • Post-mortem investigations serve as a quality check for the provided health care and are important for reliable epidemiological registration. • Post-mortem radiology, sometimes combined with minimally invasive techniques, is considered as an adjunct or alternative to autopsy. What is New: • We present the Dutch guidelines for post-mortem radiology in foetuses, neonates and children. • Autopsy remains the reference standard, however minimal invasive autopsy with a skeletal survey, post-mortem computed tomography, or post-mortem magnetic resonance imaging can be complementary thereof.
Topics: Adolescent; Autopsy; Cause of Death; Child; Child, Preschool; Fetal Death; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Netherlands; Radiography; Tomography, X-Ray Computed; Ultrasonography
PubMed: 29675642
DOI: 10.1007/s00431-018-3135-9 -
International Journal of Environmental... Sep 2022Autopsy examination, the gold standard for defining causes of death, is often difficult to apply in certain health care settings, especially in developing countries. The... (Review)
Review
Autopsy examination, the gold standard for defining causes of death, is often difficult to apply in certain health care settings, especially in developing countries. The COVID-19 pandemic and its associated difficulties in terms of implementing autopsy examinations have made the need for alternative means of determining causes of death even more evident. One of the most interesting alternatives to the conventional autopsy is the verbal autopsy, a tool that originated in Africa and Asia in the 1950s and consists of a structured interview with the deceased's family members concerning the symptoms manifested by the person and the circumstances of death. In the early 1990s, the first doubts emerged about the validity of verbal autopsies, especially about the real reliability of the cause of death identified through this tool. The objective of the review was to identify studies that had assayed the validity of verbal autopsies through a rigorous comparison of the results that emerged from it with the results of conventional autopsies. When starting from an initial pool of 256 articles, only 2 articles were selected for final review. These are the only two original research articles in which a verbal autopsy validation process was performed by employing the full diagnostic autopsy as the gold standard. The two papers reached opposite conclusions, one suggesting adequate validity of verbal autopsy in defining the cause of death and the other casting serious doubts on the real applicability of this tool. Verbal autopsy undoubtedly has extraordinary potential, especially in the area of health and demographic surveillance, even considering the implementation that could result from the use of artificial intelligence and deep learning. However, at present, there appears to be a lack of solid data to support the robust reliability of this tool in defining causes of death.
Topics: Artificial Intelligence; Autopsy; COVID-19; Cause of Death; Delivery of Health Care; Humans; Pandemics; Reproducibility of Results
PubMed: 36142022
DOI: 10.3390/ijerph191811749 -
Cancer Cytopathology Aug 2015
Review
Topics: Autopsy; Cytodiagnosis; Forecasting; Forensic Pathology; Humans; Neoplasms; Quality Control
PubMed: 26033829
DOI: 10.1002/cncy.21562 -
Journal of Clinical Microbiology Apr 2014Since the inception of evidence-based scientific concepts in medicine in the 19th century, the utility of postmortem microbiologic examinations has been a topic of... (Review)
Review
Since the inception of evidence-based scientific concepts in medicine in the 19th century, the utility of postmortem microbiologic examinations has been a topic of controversy. For every study describing a lack of correlation between antemortem clinical and laboratory findings and postmortem culture results, there is equal evidence from other studies that indicates at least some limited utility in select cases. While the contributions of autopsies and postmortem microbiologic examinations in the discovery of novel infectious microorganisms are generally appreciated by the medical and scientific societies, the problems of implementing routine procedures in daily autopsy practice clearly relate to the lack of consensus on their broader utility as well as to a lack of regulatory guidelines. This review provides an overview of the literature-based evidence regarding the utility of postmortem microbiologic examinations together with some practical aspects and guidelines for those confronted with the issue of whether to allow or discourage the use of bacteriologic cultures obtained during autopsies.
Topics: Autopsy; Communicable Diseases; Diagnosis; Humans; Microbiological Techniques
PubMed: 24403308
DOI: 10.1128/JCM.03102-13 -
Der Pathologe Dec 2021Autopsies are an important tool for understanding novel diseases, including COVID-19. (Review)
Review
BACKGROUND
Autopsies are an important tool for understanding novel diseases, including COVID-19.
MATERIALS AND METHODS
The German Registry of COVID-19 Autopsies (DeRegCOVID) was established and launched in April 2020. DeRegCOVID acts as the electronic backbone of the German Network for Autopsies in Pandemics (DEFEAT PANDEMIcs), which started in September 2020.
RESULTS
The results of DeRegCOVID and DEFEAT PANDEMIcs are characterized by an unprecedented collaboration of more than 35 university and non-university autopsy centers linking pathological, neuropathological, and forensic medicine institutes. DeRegCOVID has evolved, adapted to new challenges, and currently contains the largest international autopsy dataset. After only a short period of operation, more than 80 publications have been produced, which have contributed to the understanding of the pathogenesis of COVID-19, e.g., through the discovery of thromboembolic events, multiorgan tropism, and NeuroCovid-19. The autopsy centers have carried out extensive educational work and, beyond the scientific gain in knowledge, have explained to politicians and the general public the essential role of autopsies in pandemic management. To further develop autopsy-driven research, a continuation of DEFEAT PANDEMIcs was conceived, the National Autopsy Network (NATON).
CONCLUSIONS
The registry and network, in which all interested centers can participate, have demonstrated the value of networked medical research and the high value of autopsy for medicine.
Topics: Autopsy; COVID-19; Forensic Medicine; Humans; Pandemics; SARS-CoV-2
PubMed: 34714353
DOI: 10.1007/s00292-021-01004-w