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Autopsies and quality of cause of death diagnoses

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 cl...

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Autores principales: Rosendahl, Anders, Mjörnheim, Berit, Eriksson, Lennart C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351029/
https://www.ncbi.nlm.nih.gov/pubmed/34394931
http://dx.doi.org/10.1177/20503121211037169
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author Rosendahl, Anders
Mjörnheim, Berit
Eriksson, Lennart C
author_facet Rosendahl, Anders
Mjörnheim, Berit
Eriksson, Lennart C
author_sort Rosendahl, Anders
collection PubMed
description 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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spelling pubmed-83510292021-08-13 Autopsies and quality of cause of death diagnoses Rosendahl, Anders Mjörnheim, Berit Eriksson, Lennart C SAGE Open Med Original Research Article 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. SAGE Publications 2021-08-04 /pmc/articles/PMC8351029/ /pubmed/34394931 http://dx.doi.org/10.1177/20503121211037169 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Article
Rosendahl, Anders
Mjörnheim, Berit
Eriksson, Lennart C
Autopsies and quality of cause of death diagnoses
title Autopsies and quality of cause of death diagnoses
title_full Autopsies and quality of cause of death diagnoses
title_fullStr Autopsies and quality of cause of death diagnoses
title_full_unstemmed Autopsies and quality of cause of death diagnoses
title_short Autopsies and quality of cause of death diagnoses
title_sort autopsies and quality of cause of death diagnoses
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351029/
https://www.ncbi.nlm.nih.gov/pubmed/34394931
http://dx.doi.org/10.1177/20503121211037169
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