Ann Thorac Surg 1997;64:383
© 1997 The Society of Thoracic Surgeons
Discussion
Discussion
See also page 380.
DR EDDY H. CARRILLO (Louisville, KY): Your postmortem rate of 25%, although it is low, somehow reflects what is going on across the United States. It has been our experience in the trauma population that up until 5 years ago we had a postmortem examination rate of almost close to 80%. However, the number has dwindled significantly in the last 5 years for the reasons you explained and also because of the laws that have changed in some states, where the coroner can determine the need for a postmortem examination just based on the mechanism of injury alone and also because of the increased reluctance of family members to allow postmortem examinations.
I wonder if you have had any experience with diagnostic postmortem laparoscopy or thoracoscopy. There are some preliminary reports in the surgical literature, especially the trauma literature, suggesting that the accuracy and the sensitivity are as high as in a conventional postmortem examination.
DR ZEHR: No, we have not had experience using laparoscopy or thoracoscopy for postmortem determination of the cause of death. Most of the data providing a definitive diagnosis were derived from histologic samples and not gross examination. Examples include myocardial infarctions, strokes, showering of cholesterol emboli, and adult respiratory distress syndrome. Far fewer answers were determined by gross examination, in cases such as pulmonary emboli and several technical errors. These diagnoses would not be obvious by laparoscopic or thoracoscopic techniques either.
DR LAURENS R. PICKARD (Houston, TX): This is a very nice paper. Many diagnostic procedures see improved accuracy with more clinical information being given to those performing and interpreting the procedure or "test." I think this might apply to autopsy. Also I think that if the surgeon or other staff member is present at the time the autopsy is done, the results can be much more accurate. It is interesting to see that a significant percentage of definitive diagnoses are still not established at the time of the autopsy. Therefore, I wanted to ask if you have a policy or if there is a significant effort made by the surgeon, house staff, and other interested parties associated with the case to be present at the time of the autopsy.
DR MARION R. LAWLER, JR (Harlingen, TX): That is a very good point, Dr Pickard. We had a case where the pathologist could not make the diagnosis of anything. There was a very minimal amount of pericardial fluid present and he wanted to sign it out as a tamponade, which it certainly was not. With the surgical team present, we could explain to the pathologist the pathophysiology of that problem.
DR ZEHR: Doctors Pickard and Lawler, I appreciate your comments emphasizing the importance of surgical input at the time of autopsy. We do not have a formal protocol of the surgeon being present at the time of autopsy. However, in confusing cases the surgeon or senior resident involved in the case requests to be present at the autopsy. The purpose of our study was to determine whether the autopsy was a valuable exercise or not. We were surprised that many of the cases that we thought were clear-cut turned out to be not quite so clear at autopsy. This paper clearly points out the value of the autopsy in providing clinical feedback.
Related Article
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The Autopsy: Still Important in Cardiac Surgery
- Kenton J. Zehr, John R. Liddicoat, Jorge D. Salazar, A. Marc Gillinov, Ralph H. Hruban, Grover M. Hutchins, and Duke E. Cameron
Ann. Thorac. Surg. 1997 64: 380-383.
[Abstract]
[Full Text]
