An evaluation of overnight fixation to facilitate neuropathological examination in Coroner's autopsies: our experience of over 200 cases.
OBJECTIVE
Following recent changes in Coroner's Rules, there has been a desire to examine brains at the time of autopsy, rather than after a prolonged period of immersion fixation. Examination of the fresh brain at postmortem can yield unsatisfactory results where detailed histological examination is required. We aim to provide a compromise, where detailed examination of the brain is possible, without the requirement for prolonged fixation, interference with funeral arrangements and delay in the Coronial process.


METHODS
A retrospective audit of over 200 neuropathology cases requested by HM Coroner for the East Riding of Yorkshire between 2007 and 2010 was performed. The cases consisted of full neuropathology autopsies (n=212) and brains referred by general pathology colleagues (n=26).


RESULTS
Of the 238 brains examined, approximately half (n=109) of the brains were sectioned fresh in the mortuary. The remaining brains (n=129) were immersion fixed overnight in 20% formalin prior to cutting and sampling for histology (n=127). The median time for reporting was 31 days (range 1-167; n=101) for brains requiring histology. This equates to a median turnaround time of 1 month for a neuropathological autopsy requiring detailed histology. In all cases, the report was prepared and available to HM Coroner in advance of the Inquest.


CONCLUSIONS
This method provides reliable histological diagnoses in neuropathological autopsies and does not interfere with funeral arrangements for bereaved families following deaths falling under Coronial jurisdiction. In all cases, the body could be released to relatives, at Coroner's discretion, within two working days of the autopsy.
Department of Cellular Pathology, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK. ian.scott@nuh.nhs.uk
Ian Stuart
IS
Scott
Alastair Wray
AW
MacDonald
D001344:Autopsy / Q000379:methods*; D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality; D002423:Cause of Death; D003334:Coroners and Medical Examiners; D049429:Forensic Pathology / Q000331:legislation & jurisprudence / Q000379:methods*; D006801:Humans; D008485:Medical Audit; D011180:Postmortem Changes; D012189:Retrospective Studies; D013048:Specimen Handling / Q000379:methods*; D016707:Tissue Fixation / Q000379:methods*