VALUE AND IMPACT OF NECROPSY IN PEDIATRIC CARDIOLOGY

Objective-To assess the current value of necropsy in paediatric cardio logy and cardiothoracic surgery and determine its potential impact on clinical practice. Design and setting-Descriptive study of all paediat ric cardiac deaths occurring over four years in a tertiary referral ce ntre. Data were obtained from reviewing the hospital files, available necropsy records and specimens, and audit reports. Patients-Paediatric patients with congenital or acquired heart disease, who died of a car diac cause between January 1992 and July 1995. Inclusion criteria were that the diagnosis of heart disease was made before death, and that p atients were managed thereafter medically and/or surgically at the ref erral centre. The value of necropsy was assessed according to its cont ribution in establishing the cause of death (confirmed, clarified, pre cise cause of death uncertain) and the anatomy (simple confirmation or additional information provided). For cases not submitted to necropsy the clinical information relating to the cause of death was assessed and the case assigned as cause of death firm, uncertain, or unknown. R esults-One hundred and six deaths were identified (61 males, age at de ath: one day to 20 years). Seventy occurred early (a month or less) af ter surgery and were graded as postoperative deaths, The rest were con sidered to be either medical or late surgical deaths. Necropsy was per formed in. 59 (55.6%). The precise cause of death was confirmed in 33 (55.9%), clarified in 22 (37.3%), and uncertain in four (7.8%). Additi onal information regarding the anatomy was found in eight (13.6%) case s. In five cases the necropsy detected findings if known before death, would probably have improved outcome. For the patients dying without a necropsy, the cause of death remained uncertain in 10 (21.3%) and un known in seven (14.9%). In 36% of cases, therefore, a firm cause of de ath that might have been provided by a necropsy was missing. Conclusio n-In paediatric cardiology necropsy continues to provide clinically re levant information at a high level. It remains vital for ensuring qual ity of medical care, in instigating improvements in future management, and increasing understanding of congenital heart disease. The procedu re should therefore be sought actively in all cases.