Autopsies in children: are they still useful?

Background: Autopsy has traditionally been the criterion for determining cause of death and has played a major role in medical education and quality control. With increasing use of bedside technology, however, autopsy rates have steadily declined. Objective: To identify (1) trends in pediatric autopsy rates during the past decade, (2) concordance between antemortem and postmortem diagnoses, and (3) patient characteristics influencing autopsy rates or diagnostic yield. Methods: All pediatric deaths between January 1, 1984, and December 31, 1993, were retrospectively reviewed. Data collection included demographics for an patients, and length of stay, diagnostic imaging studies, antemortem diagnoses, and autopsy findings for patients with autopsies. Autopsy diagnoses were compared with antemortem findings and classified according to their concordance. Results: Of 297 pediatric deaths, autopsies were performed on 107 patients (36%). Autopsy rates did not change significantly during the study period. Autopsies were not associated with patient gender, race, or insurance status, but increased significantly with age. Autopsies were performed in 26% of infants 12 months or younger, 60% of children between 13 to 60 months of age, and 100% of children 61 months or older ([chi square]; P [is less than] .001). In 34% of cases, new diagnoses were made at autopsy, including 7 cases where new findings, if known before death, would likely have resulted in a change in treatment or improved survival. There was no relationship between new findings at autopsy and age, length of hospital stay, or antemortem imaging studies. Conclusion: Autopsy can provide additional information in more than one third of pediatric deaths. Pediatric autopsy continues to provide clinically significant data and remains a valuable tool in modern pediatric practice. Arch Pediatr Adolesc Med. 1998;152:558-563
Autopsies can provide additional information on the cause of death in children. Researchers analyzed 297 pediatric deaths at one hospital between 1984 and 1993. An autopsy was done in 36% of the cases over the 10-year period. This autopsy rate remained relatively stable throughout the period. in 34% of the cases, the autopsy provided new information that led to a change in the diagnosis. In seven cases, this information might have led to a change in treatment while the child was alive. Infants were less likely to have an autopsy than older children.