FACTORS PREDICTING CASES WITH UNEXPECTED CLINICAL FINDINGS AT NECROPSY

Aims/background-A major medical role for postmortem examinations is th e detection of clinically unexpected disease processes contributing to death. The aim of the present study was to determine whether simple c linical parameters can predict the presence of important unanticipated findings at necropsy. Methods-Prospective audit of adult necropsies c arried out in a single year to assess the extent of unexpected finding s at necropsy, to compare these cases with non-necropsied deaths to co nfirm they are a similar population and to seek features that predict which cases have unexpected necropsy findings. Results-No correlation was found between age,, duration of in-hospital sex treatment, surgica l intervention, clinical speciality, or necropsy request rates and inc idence of unexpected findings in 187 adult necropsies. Conclusions-No parameters have been identified for patient selection to permit an inc rease in the yield of clinically unexpected findings. Until there is c lear evidence that the current practice of patient selection is anythi ng more than random, an increase in postmortem examination rates, as p roposed by the Joint Working Party of the Royal College of Pathologist s, the Royal College of Physicians of London and the Royal College of Surgeons of England in their report The Autospy and Audit, will increa se the workload without necessarily producing a commensurate gain in k nowledge.