To Image or to Autopsy?

Editorials17 January 2012To Image or to Autopsy?Elizabeth C. Burton, MD and Mahmud Mossa-Basha, MDElizabeth C. Burton, MDFrom Johns Hopkins University, Baltimore, MD 21287. and Mahmud Mossa-Basha, MDFrom Johns Hopkins University, Baltimore, MD 21287.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-2-201201170-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In the United States, autopsy rates have fallen precipitously since the 1970s to 4.3% for natural deaths occurring both inside and outside of the hospital (1). This decrease is mirrored worldwide. Reasons for the decline have long been debated and include diagnostic overconfidence, physician reluctance to pursue consent for autopsy, family reluctance to grant permission for autopsy, lack of regulatory rate requirements, and budgetary constraints. Despite this underutilization, autopsy remains the gold standard for determining the cause of death. It offers benefit for education, research, and quality improvement, particularly as applied to diagnostic accuracy and the potential to improve patient ...References1. Hoyert DL. The changing profile of autopsied deaths in the United States, 1972-2007. NCHS Data Brief, no 67. Hyattsville, MD: National Center for Health Statistics; 2011. Google Scholar2. Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA. 2003;289:2849-56. [PMID: 12783916] CrossrefMedlineGoogle Scholar3. Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ. VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics. 2006;26:1305-33. [PMID: 16973767] CrossrefMedlineGoogle Scholar4. Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, et al. 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Wichmann D, Obbelode F, Vogel H, Hoepker WW, Nierhaus A, Braune S, et al. Virtual autopsy as an alternative to traditional medical autopsy in the intensive care unit. A prospective cohort study. Ann Intern Med. 2012;156:123-30. LinkGoogle Scholar13. Kochanek KD, Xu JQ, Murphy SL, Minino AM, Kung HC. Deaths: preliminary data for 2009. National Vital Statistics Reports; vol 59, no 4. Hyattsville, MD: National Center for Health Statistics; 2011. Google Scholar14. Shojania KG, Burton EC, McDonald K, Goldman L. The Autopsy as an Outcome and Performance Measure. Evidence Report/Technology Assessment no. 58 (Prepared by the University of California at San Francisco-Stanford Evidence-based Practice Center under contract no. 290-97-0013). AHRQ Publication no. 03-E002. Rockville, MD: Agency for Healthcare Research and Quality; 2002. Google Scholar15. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370-6. [PMID: 1987460] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Elizabeth C. Burton, MD; Mahmud Mossa-Basha, MDAffiliations: From Johns Hopkins University, Baltimore, MD 21287.Acknowledgment: The authors thank Katie Flickinger, MS, for providing insightful comments and helpful feedback on the draft of this article.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2725.Corresponding Author: Elizabeth C. Burton, MD, Johns Hopkins University School of Medicine, Pathology Building, Room B106, 600 North Wolfe Street, Baltimore, MD 21287; e-mail, eburton3@jhmi.edu.Current Author Addresses: Dr. Burton: Johns Hopkins University School of Medicine, Pathology Building, Room B106, 600 North Wolfe Street, Baltimore, MD 21287.Dr. Mossa-Basha: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287. 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A literature reviewAutopsyPost-mortem diagnosis: evolving a team approachBildgebung zur Klärung des BehandlungsfehlervorwurfsMessages from the morgue to rheumatology: from Chagas disease to giant cell arteritis 17 January 2012Volume 156, Issue 2 Page: 158-159 Keywords Autopsy Computed axial tomography Diagnostic radiology Forensics Imaging techniques Magnetic resonance imaging Patients Pulmonary embolism Radiologists Systematic reviews ePublished: 17 January 2012 Issue Published: 17 January 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...