title: Consecutive autopsies on an internal medicine service.
abstract: OBJECTIVE
  Autopsy rates continue to decline in the United States despite the demonstrated value of this procedure in many different settings. We sought to review clinical pathologic discordance information generated by autopsies on an internal medicine service in the urban United States and to determine whether resident services appear to influence autopsy rates.
  
  
  METHODS
  We reviewed consecutive deaths and autopsies on an inpatient internal medicine service during a 30-month period at a 400-bed community hospital in Baltimore, MD.
  
  
  RESULTS
  There were 622 deaths and 65 autopsies (10.3%). Resident teaching status correlated with a higher rate of autopsies performed (P = 0.048). Clinical pathologic discordance was common, with a major discordance rate of 39%. Major discordance was indicated by only one of nine autopsies performed on patients with human immunodeficiency virus.
  
  
  CONCLUSIONS
  The autopsy was a valuable educational and quality improvement tool on the urban internal medicine service. Residency influences may be a major factor in continuing this exercise. In our study, although the numbers were small, patients with human immunodeficiency virus had a very low discordance rate.
authors.affiliation: Department of Medicine, Union Memorial Hospital, 201 E. University Parkway, Suite 405, Baltimore, MD 21218, USA. Robert.Ferguson@MedStar.net
authors.forename: Robert P
authors.initials: RP
authors.lastname: Ferguson
authors.forename: Linda
authors.initials: L
authors.lastname: Burkhardt
authors.forename: George
authors.initials: G
authors.lastname: Hennawi
authors.forename: Loveen
authors.initials: L
authors.lastname: Puthumana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000706:statistics & numerical data*; D015142:Baltimore / Q000453:epidemiology; D002423:Cause of Death; D003951:Diagnostic Errors; D005260:Female; D006748:Hospital Departments; D017052:Hospital Mortality; D006760:Hospitalization; D006786:Hospitals, Urban; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged