Autopsy after traumatic death--a shifting paradigm.
OBJECTIVE
The role of autopsy in evaluating missed injury after traumatic death is well established and discussed in the literature. The frequency of incidental findings in trauma patients has not been reported. We believe that incidental findings are under recognized and reported by trauma surgeons.


METHODS
This prospective, descriptive, cohort study was conducted at a Level 1 trauma center in a rural state. Four hundred ninety-six deaths over a 4-y period were identified from the trauma registry. Two hundred four complete autopsies were available for review. One thousand eighteen traumatic diagnoses were identified from 204 autopsies and corresponding medical records by trauma surgeons blinded to patient identity. The surgeons recorded missed diagnoses, incidental diagnoses identified at autopsy, and diagnoses known at the time of death confirmed by autopsy.


RESULTS
The surgeons had a κ-score of 0.82-0.84. Forty-two patients (21% of patients) had 68 severe missed injuries; 67 patients (33% of patients) had 94 minor missed injuries. Twenty-eight patients (14%) had significant incidental findings including premature atherosclerosis, multiple endocrine neoplasia, tuberculosis, and others.


CONCLUSIONS
The autopsy after traumatic death is more than a mechanism of quality control and teaching. A high proportion of patients will have incidental findings important to family members, and have public health importance. Systems need to be developed to review autopsy results with attention to identifying and communicating incidental findings. Given the incidence of significant missed injuries and incidental findings, the autopsy continues to have an important role in health care.
Light
Timothy D
TD
Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA. timothy-light@uiowa.edu
Royer
Nora A
NA
Zabell
Joseph
J
Le
Mark B
MB
Thomsen
Timothy A
TA
Kealey
Gerald P
GP
Alpen
Michel A
MA
Nashelsky
Marcus B
MB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D033162:Incidental Findings; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011786:Quality Control; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000639:trends*; D014947:Wounds and Injuries / Q000401:mortality*