Consent of the recently bereaved to post-mortem targeted angiography research: 207 adult cases

Saunders, Sarah; Amoroso, Jasmin; Morgan, Bruno; Rutty, Guy N.

doi:10.1136/jclinpath-2012-201250

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…Participants were recruited when consent was gained for study participation from the relatives of the deceased. 26 In one case contrast agent injection and chest compressions were performed in ED shortly after the cessation of advanced life support and pronouncement of life extinct, to provide a physical state as close as possible to that during standard CPR. This was necessarily without relatives' consent, as approved by the ethics committee, but informed consent was acquired prior to any further research procedures and subsequent PMCT imaging.…”

Section: Recruitmentmentioning

confidence: 99%

Could post-mortem computed tomography angiography inform cardiopulmonary resuscitation research?

et al. 2017

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Section: Recruitmentmentioning

confidence: 99%

Could post-mortem computed tomography angiography inform cardiopulmonary resuscitation research?

et al. 2017

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“…The minimally invasive methods include post-mortem angiography and/or tissue biopsies, suitable for histology and/ or molecular diagnostics [ 29 ]. Higher autopsy rates may be achieved with these alternatives [ 30 ] although our study suggests a minor effect in view of the on average low percentage of next-of-kin refusing autopsy because of ‘ fear of mutilation of the deceased’s body ’. However in certain ethnical or religious subgroups non-invasive or minimally invasive procedures might significantly increase the acceptance of post-mortem investigation.…”

Section: Discussionmentioning

confidence: 95%

Autopsy of Adult Patients Deceased in an Academic Hospital: Considerations of Doctors and Next-of-Kin in the Consent Process

Blokker¹,

Weustink²,

Hunink

et al. 2016

PLoS ONE

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IntroductionHospital autopsies, vanishing worldwide, need to be requested by clinicians and consented to by next-of-kin. The aim of this prospective observational study was to examine how often and why clinicians do not request an autopsy, and for what reasons next-of-kin allow, or refuse it.MethodsClinicians at the Erasmus University Medical Centre were asked to complete a questionnaire when an adult patient had died. Questionnaires on 1000 consecutive naturally deceased adults were collected. If possible, missing data in the questionnaires were retrieved from the electronic patient record.ResultsData from 958 (96%) questionnaires was available for analysis. In 167/958 (17·4%) cases clinicians did not request an autopsy, and in 641/791 (81·0%) cases next-of-kin did not give consent. The most important reason for both clinicians (51·5%) and next-of-kin (51·0%) to not request or consent to an autopsy was an assumed known cause of death. Their second reason was that the deceased had gone through a long illness (9·6% and 29·5%). The third reason for next-of-kin was mutilation of the deceased’s body by the autopsy procedure (16·1%). Autopsy rates were highest among patients aged 30–39 years, Europeans, suddenly and/or unexpectedly deceased patients, and tissue and/or organ donors. The intensive care and emergency units achieved the highest autopsy rates, and surgical wards the lowest.ConclusionThe main reason for not requesting or allowing an autopsy is the assumption that the cause of death is known. This is a dangerous premise, because it is a self-fulfilling prophecy. Clinicians should be aware, and communicate with the next of kin, that autopsies not infrequently disclose unexpected findings, which might have changed patient management.Mutilation of the deceased’s body seems a minor consideration of next-of-kin, though how it really affects autopsy rates, should be studied by offering minimally or non-invasive autopsy methods.

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“…No exclusions occurred as a result of weight or infectious disease. Details of the few cases for which consent was not obtained before selection have been published separately 19 . Cases were aged 18–96 years; 158 (66%) were men and 83 (34%) women (table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Cases were recruited only if oral consent by telephone was gained for study participation from the relatives of the deceased. 19 Time of death was recorded if known. If a case met any of the exclusion criteria, or if consent could not be obtained, then either the next suitable referral was chosen or no case was recruited on that particular study day.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study

et al. 2017

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SummaryBackgroundEngland and Wales have one of the highest frequencies of autopsy in the world. Implementation of post-mortem CT (PMCT), enhanced with targeted coronary angiography (PMCTA), in adults to avoid invasive autopsy would have cultural, religious, and potential economic benefits. We aimed to assess the diagnostic accuracy of PMCTA as a first-line technique in post-mortem investigations.MethodsIn this single-centre (Leicester, UK), prospective, controlled study, we selected cases of natural and non-suspicious unnatural death referred to Her Majesty's (HM) Coroners. We excluded cases younger than 18 years, known to have had a transmittable disease, or who weighed more than 125 kg. Each case was assessed by PMCTA, followed by autopsy. Pathologists were masked to the PMCTA findings, unless a potential risk was shown. The primary endpoint was the accuracy of the cause of death diagnosis from PMCTA against a gold standard of autopsy findings, modified by PMCTA findings only if additional substantially incontrovertible findings were identified.FindingsBetween Jan 20, 2010, and Sept 13, 2012, we selected 241 cases, for which PMCTA was successful in 204 (85%). Seven cases were excluded from the analysis because of procedural unmasking or no autopsy data, as were 24 cases with a clear diagnosis of traumatic death before investigation; 210 cases were included. In 40 (19%) cases, predictable toxicology or histology testing accessible by PMCT informed the result. PMCTA provided a cause of death in 193 (92%) cases. A major discrepancy with the gold standard was noted in 12 (6%) cases identified by PMCTA, and in nine (5%) cases identified by autopsy (because of specific findings on PMCTA). The frequency of autopsy and PMCTA discrepancies were not significantly different (p=0·65 for major discrepancies and p=0·21 for minor discrepancies). Cause of death given by PMCTA did not overlook clinically significant trauma, occupational lung disease, or reportable disease, and did not significantly affect the overall population data for cause of death (p≥0·31). PMCTA was better at identifying trauma and haemorrhage (p=0·008), whereas autopsy was better at identifying pulmonary thromboembolism (p=0·004).InterpretationFor most sudden natural adult deaths investigated by HM Coroners, PMCTA could be used to avoid invasive autopsy. The gold standard of post-mortem investigations should include both PMCT and invasive autopsy.FundingNational Institute for Health Research.

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Consent of the recently bereaved to post-mortem targeted angiography research: 207 adult cases

Abstract: This study shows that prospective consenting for HM coroners' cases to be used for autopsy research is feasible in adults, and can be done ethically, and in the limited time available, by obtaining the consent of the next of kin by telephone before autopsy.

Cited by 10 publications

References 15 publications

Could post-mortem computed tomography angiography inform cardiopulmonary resuscitation research?

Could post-mortem computed tomography angiography inform cardiopulmonary resuscitation research?

Autopsy of Adult Patients Deceased in an Academic Hospital: Considerations of Doctors and Next-of-Kin in the Consent Process

Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study

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