EMBARGOED UNTIL 1 JULY 2002
Autopsies on the decline after Alder Hey
We could be losing valuable data on deaths in hospitals because of a decline in the numbers of autopsies performed in England and Wales, warn pathologists in the July Journal of the Royal Society of Medicine. Dr Norman Carr, Dr Margaret Burke and fellow Pathology Advisors to the National Confidential Enquiry into Perioperative Deaths (NCEPOD) point out the problems this could cause to bereaved families as well as medical science. They also voice concerns about the coroners' rules which contribute to the number of 'unsatisfactory' autopsy reports, and current lack of communication between clinicians, pathologists and coroners.
Why autopsies are "a crucial part" of investigating
cause of death
Despite recent improvements in diagnostic techniques, the autopsy
is just as vital as it has always been in helping to understand
the causes of death, the authors point out. In nearly a quarter
of cases, NCEPOD's 1999/2000 report - Changing
the way we operate - found major differences between doctors' diagnoses
before the autopsy and the post-mortem findings. This extra information
is not only welcomed by clinicians; studies show that a majority
of bereaved families found autopsy results "beneficial" to them.
Falling numbers may reflect media backlash
In 1988/1989, 41% of patients who had died after an operation were
given an autopsy to find out vital medical information. In 1999/2000,
shortly after the Alder Hey scandal broke in the national press,
the equivalent figure was only 31%. The authors warn that this
situation may get worse as concerned families increasingly refuse
doctors permission to keep body tissues for further examination.
Why are so many autopsy reports "unsatisfactory"?
As many as 30% of autopsies are unsatisfactory, with missing histology
reports "significantly detracting from the value of the autopsy" in
28% of cases. One reason suggested by the authors for this is that
the majority of post-mortems are governed by Coroners' Rules, which
limit investigations of body tissues and make a full histology
report impossible. The full benefits of autopsy may also be missed
because of poor communication, argue the authors. Pathologists
should have hospital notes and details of the events before the
patient's death, and clinicians need autopsy reports returned quickly
so they can explain the findings fully to patients' next-of-kin.
Currently, 30% of clinicians don't see a copy of the report at
all, in some cases because the coroner has prevented it.
The forthcoming NCEPOD report to be published in November 2002
intends to take this issue further.
[ends]
The autopsy: lessons from the National Confidential
Enquiry into Perioperative Deaths [PDF 29k]
