Perceived value of trauma autopsy among trauma medical directors and coroners.
BACKGROUND
Although autopsy is acknowledged as essential for improving quality of medical care of trauma patients and accuracy of injury surveillance systems, the autopsy rate has remained well below 100% for certain categories of trauma. We obtained recent documentation of the frequency of autopsy among trauma-related deaths in Ohio, and surveyed coroners and trauma program medical directors (TMDs) about the perceived benefits and challenges of performing autopsy.


METHODS
Copies of death certificates were obtained for the years 1996-2001. Death and autopsy rates were calculated and examined for trends over time. Surveys covering the topics of mechanisms of injury prompting autopsy, uses and users of autopsy data, and barriers to performing autopsy were sent to Ohio's coroners, coroners from nearby states, and Ohio TMDs. The chi(2)-test for trend analysed autopsy rates over time, while responses among groups were compared using the chi(2)-test.


RESULTS
The autopsy rate for injury related deaths increased from 50% in 1996 to 66.5% in 2001 (p=.0018). During the study period the volume of autopsies rose by 18%, from 2990 to 3546. There was no review by the coroner in almost 10% of trauma deaths. TMDs more often indicated that autopsies advance medical knowledge than did Ohio and non-Ohio coroners (62.9% versus 33.4% and 47.6%, respectively, p=.016). TMDs more frequently reported themselves as users of autopsy information than did Ohio and non-Ohio coroners (91.4% versus 14.6% and 20%, respectively, p<.0001). All groups reported inadequate funds and personnel as the two most common barriers to performing autopsies, although TMDs were more likely to identify these as barriers than coroners (p<.0001). Almost 27% of Ohio coroners agreed with the statement, "I do not feel that trauma-related autopsies are necessary".


CONCLUSIONS
Significant barriers exist to improving autopsy rates among trauma patients who die. These include not only more well-recognised impediments such as inadequate funds and personnel, but less commonly reported issues concerning differing points of view on the role of trauma-related autopsy among coroners and TMDs. To improve trauma-related autopsy rates, each of these issues requires attention and cooperation among all parties.
Santanello
Steven
S
Trauma Services, Grant Medical Center, 111 South Grant Avenue, Columbus, OH 43215, USA.
Dean
Dorothy
D
Hayes
John R
JR
Bonta
Marco
M
Groner
Jonathan
J
Martin
Larry
L
Sinard
James
J
Shaffer
Lynn E T
LE
Bechtel
Nancie
N
D001291:Attitude of Health Personnel; D001344:Autopsy / Q000706:statistics & numerical data*; D002423:Cause of Death / Q000639:trends*; D003334:Coroners and Medical Examiners / Q000523:psychology; D003644:Death Certificates; D006801:Humans; D009820:Ohio; D008486:Physician Executives / Q000523:psychology; D014947:Wounds and Injuries / Q000473:pathology*