ARE AUTOPSIES OBSOLETE

To determine the current frequency of discovering important diagnoses at autopsy, the diagnoses made in all complete or ''no head'' autopsie s during 1994 at a major tertiary care transplantation referral center were retrospectively compared with the diagnosis made antemortem. Of 176 autopsies, 79 (44.9%) revealed 1 or more undiagnosed causes of dea th. Of the 123 undiagnosed causes of death, 13 were sole immediate cau ses of death, 72 were one of multiple immediate causes, 22 were interv ening causes, and 16 were underlying causes. The causes of death were as follows: infections, 34; infarctions, 11; malignant neoplasms, 8; p ulmonary emboli, 7; gastrointestinal ulcers, 7; hemorrhages, 6; thromb oses, 3; amyloidosis, 1; genetic hemochromatosis, 1; and cardiac tampo nade, 1. Of 35 autopsies of transplant recipients, 16 (46%) disclosed undiagnosed causes of death, compared with 63 (44.7%) of 141 autopsies of patients who had not received transplants. Approximately two third s of the undiagnosed causes of death were judged to be treatable condi tions. This and similar studies suggest that old-fashioned low-technol ogy autopsies can uncover many important diagnoses missed by modern hi gh-technology medicine.