AUTOPSIES IN CHILDREN - ARE THEY STILL USEFUL

Background: Autopsy has traditionally been the criterion for determini ng cause of death and has played a major role in medical education and quality control. With increasing use of bedside technology, however, autopsy rates have steadily declined. Objective: To identify (1) trend s in pediatric autopsy rates during the past decade, (2) concordance b etween antemortem and postmortem diagnoses, and (3) patient characteri stics influencing autopsy rates or diagnostic yield. Methods: All pedi atric deaths between January 1, 1984, and December 31, 1993, were retr ospectively reviewed. Data collection included demographics for all pa tients, and length of stay, diagnostic imaging studies, antemortem dia gnoses, and autopsy findings for patients with autopsies. Autopsy diag noses were compared with antemortem findings and classified according to their concordance. Results: Of 297 pediatric deaths, autopsies were performed on 107 patients (36%). Autopsy rates did not change signifi cantly during the study period. Autopsies were not associated with pat ient gender, race, or insurance status, but increased significantly wi th age. Autopsies were performed in 26% of infants 12 months or younge r, 60% of children between 13 to 60 months of age, and 100% of childre n 61 months or older (chi(2); P < .001). In 34% of cases, new diagnose s were made at autopsy, including 7 cases where new findings, if known before death, would likely have resulted in a change in treatment or improved survival. There was no relationship between new findings at a utopsy and age, length of hospital stay, or antemortem imaging studies . Conclusions: Autopsy can provide additional information in more than one third of pediatric deaths. Pediatric autopsy continues to provide clinically significant data and remains a valuable tool in modem pedi atric practice.