Objective-The role of autopsy in evaluating missed injury after traumatic death is well established and discussed in the literature. The frequency of incidental findings in trauma patients has not been reported. We believe that incidental findings are under recognized and reported by trauma surgeons.Design-Prospective, descriptive, cohort study.Setting-Level 1 trauma center in a rural state.Patients-Four hundred ninety-six deaths over a 4-year period were identified from the trauma registry. Two hundred four complete autopsies were available for review.Interventions-One thousand eighteen traumatic diagnoses were identified from two hundred four autopsies and corresponding medical records by trauma surgeons blinded to patient identity. The surgeons recorded missed diagnoses, incidental diagnoses identified at autopsy, and diagnoses known at the time of death confirmed by autopsy.Measurements and Main Results-The surgeons had a kappa score of 0.82-0.84. Forty-two patients (21% of patients) had 68 severe missed injuries; sixty-seven patients (33% of patients) had 94 minor missed injuries. Twenty-eight patients (14%) had significant incidental findings including premature atherosclerosis, multiple endocrine neoplasia, tuberculosis, and others.Conclusions-The autopsy after traumatic death is more than a mechanism of quality control and teaching. A high proportion of patients will have incidental findings important to family members and have of public health importance. Systems need to be developed to review autopsy results with attention to identifying and communicating incidental findings. Given the incidence of significant missed injuries and incidental findings, the autopsy continues to have an important role in health care.

Composite pheochromocytoma-ganglioneuromas are rare adrenal tumors. They may be functional and while mostly sporadic, they may be associated with several genetic syndromes. Herein, we present the youngest reported patient with this tumor, which was incidentally discovered by CT scan performed prior to emergent appendectomy. The tumor was functional and she underwent a successful laparoscopic adrenalectomy with resolution of her biochemical abnormalities. Surgeons should be aware of this rare entity due to its uncertain long-term prognosis.

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