The clinical value of autopsies at a university hospital in Sweden

Rosendahl, Anders; Mjörnheim, Berit; Takman, Christina; Eriksson, Lennart C.

doi:10.1177/2057158516664211

Cited by 3 publications

(12 citation statements)

References 47 publications

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“…To this error should be added uncertainty in diagnosis, particularly regarding cases that were not autopsied. 2,3,8…”

Section: Resultsmentioning

confidence: 99%

“…In addition, it also affects the quality of the information given to next of kin, a situation that will probably cause an increase in the number of autopsies requested by the relatives of the deceased. 8…”

Section: Discussionmentioning

confidence: 99%

“…6,7 In our own studies from 2017, we were able to conclude that clinically significant diagnoses were missing in more than 60% of cases when autopsies were not performed. 8…”

Section: Discussionmentioning

confidence: 99%

“…6,7 This increased knowledge was essential for determining and registering the cause of death in more than a quarter of the cases that were examined. 6,8…”

Section: Introductionmentioning

confidence: 99%

“…6,7 This increased knowledge was essential for determining and registering the cause of death in more than a quarter of the cases that were examined. 6,8 The consequences of the decline in the autopsy rate and doubt in the quality of the cause of death register are complex and hard to estimate, but involve kinsfolk, the healthcare system and society. It is obviously a risk that the statistics on causes of death are based mainly on clinical diagnoses that are not confirmed by autopsy.…”

Section: Introductionmentioning

confidence: 99%

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Autopsies and quality of cause of death diagnoses

2021

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Objective: The consequences of a low autopsy rate are not considered in determining the cause of death. Method: We have analyzed the Cause of Death Register of the Swedish National Board of Health and Welfare since it started 1969 to and including 2016 to visualize the decline in the frequency of clinical autopsies over time and evaluated the effect on the quality of the cause of death diagnoses. Results: Over the five decades studied, the frequency of clinical autopsies declined from almost 40% to less than 5%. The rate of decline was not even. Political decisions and changes of healthcare organization in Sweden affected the slope of decline of autopsies superimposed on a linear decline over time reflecting changes in clinical routines. A request of clinical autopsies was highly dependent on the level of care at the time of death, with the lowest number of requests for persons who died in nursing homes. The age at the time of death was a major factor affecting the number of autopsies, resulting in an autopsy rate of less than 1% in the ages where most persons die. Although men were autopsied more often than women, a gender-specific difference was not seen after correction for the age of death. We also found a higher rate of unspecific and irrelevant diagnosis in the cases not autopsied and we know from earlier studies by us and other authors that the cause of death diagnoses were missed in between 30% and 50% of the cases not autopsied. Conclusion: The decline in the clinical autopsy rate reduced the value of the death certificate register. An increase in the number of autopsies performed will improve the understanding of disease and cause of death, as well as to better inform next of kin.

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“…To this error should be added uncertainty in diagnosis, particularly regarding cases that were not autopsied. 2,3,8…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…6,7 In our own studies from 2017, we were able to conclude that clinically significant diagnoses were missing in more than 60% of cases when autopsies were not performed. 8…”

Section: Discussionmentioning

confidence: 99%

“…6,7 This increased knowledge was essential for determining and registering the cause of death in more than a quarter of the cases that were examined. 6,8…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Autopsies and quality of cause of death diagnoses

2021

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Postmortem metabolomics as a high-throughput cause-of-death screening tool for human death investigations

Ward,

Kling,

Engvall

et al. 2024

iScience

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Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

et al. 2022

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To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category. Patients and MethodsUsing data from the Prostate Cancer data Base Sweden, we identified a study frame of 5543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of healthcare records for a stratified sample of 495/5543. We extracted data on prostate-specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system. ResultsBoth no evidence and moderate evidence for PCa progression was more common in men aged >85 years at death than those aged <85 years (29% vs 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low-risk, 14% for intermediate-risk, 8% for high-risk, and 0% for metastatic PCa. In contrast, in men aged >85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low-risk, 29% for intermediate-risk, 29% for high-risk, and 21% for metastatic PCa. Of the 5543 men who died from PCa, 13% (95% confidence interval 5-19%) were estimated to have either no evidence or moderate evidence of PCa progression. ConclusionsWeak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low-risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localised disease at diagnosis.

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The clinical value of autopsies at a university hospital in Sweden

Cited by 3 publications

References 47 publications

Autopsies and quality of cause of death diagnoses

Autopsies and quality of cause of death diagnoses

Postmortem metabolomics as a high-throughput cause-of-death screening tool for human death investigations

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

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