Do we still need the autopsy? Clinical diagnosis versus autopsy diagnosis

Abstract

The autopsy is one of the main tools for the evolution of medicine. Nevertheless, the autopsy rate declined worldwide in the last decades due to several reasons: progress in diagnosis of diseases, fear of legal consequences if a wrong diagnosis is proved, refusal of the deceased's family, reluctance of forensic pathologists and pathologists because of infectious risk and time consumption. However, despite the huge progress of medical science, discrepancies between the death diagnosis established by the clinician and the diagnosis established by the pathologist after performing the autopsy still exist and have remained relatively constant over the last 50 years. Our study aimed to identify the concordance rate between the cause of death established in the hospital and the cause of death established after performing the forensic autopsy and to determine the factors that could influence the concordance rate. The study group included 100 patients who died in hospital and underwent autopsy. We found a concordance rate of 45% which could be influenced by certain factors, such as: duration of hospitalization, interclinic consultation, mechanism of death, postmortem microscopic examination and the biochemical analysis performed during hospitalization. Our results support the fact that autopsy remains an essential tool for assessing the quality of care, for improving medical education process and for highlighting those diseases that represent "diagnostic challenges".

Multiple Fatal Intoxications Caused by Improper Consumption of an Alcoholic Para-Pharmaceutical Product

“…The deceased victims underwent medico-legal autopsy at the Medico-Legal Service of Bihor County. The macroscopic examination revealed unspecific features which are frequently encountered in intoxications [11,12].…”

Heart infarct as the major cause of death of hematological patients as identified by autopsy

“…It is apparently more frequently than in other studies of patients without neoplasia but less frequently than in the studies of oncological patients. 1,5,7,11,23,24 A higher rate of class I discrepancies reported by Xavier et al in hematological patients (31.3%) may be due to the treatment in an unspecialized unit. 14 All the data might confirm that a highly complex course of malignant disorders might result from the elevated rates of discrepancies.…”

Challenges to Forensic Medicine in the Postmodern Era the Impact of the New Technologies

“…Virtopsy represents a genuine help in establishing the cause and manner of death, without affecting the body integrity (Badam et al, 2017, National Research Council, 2009). This "virtual preservation" of the body induces a decrease in the number of autopsies, an important issue when religious issues come forth (National Research Council, 2009;Ioan et al, 2012). It allows an effective assessment of some important items in a short period of time, involving more experts in specific subspecialties in order to obtain an optimal analysis, with the possibility to replay the scans (Badam et al, 2017;Bollinger, Thali, 2015).…”

“…For the victims who were subject of various types of injuries, virtopsy helps to establish the trajectory of the projectile, to detect bone fragments-which in case of comminutive fracture of the skull would necessitate the reconstruction piece by piece (Bollinger, Thali, 2015) or projectile fragments, as well as to identify the fracture pattern or ocult fractures, objectives which are difficult to accomplish by the traditional autopsy. On the other hand, in case of fragmentation or retention of the bullets, traditional autopsy is irreplaceable for their recovery (National Research Council, 2009;Ioan et al, 2012), given the known importance of the projectile examination for the identification of the offender. Virtopsy is also more useful than traditional autopsy for the assessment of brain injuries when the putrefaction process began, as it preserves its anatomical features (Bollinger, Thali, 2015).…”