P. Chariot et al., Declining autopsy rate in a French hospital - Physicians' attitudes to theautopsy and use of autopsy material in research publications, ARCH PATH L, 124(5), 2000, pp. 739-745
Citations number
28
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology","Medical Research Diagnosis & Treatment
Context.-Autopsy rates have been declining throughout the world, although p
reservation of the autopsy is considered a fundamental principle of medical
care. In France, the 1994 bioethics law requires physicians to inform rela
tives before performing an autopsy.
Objective.-To analyze the following factors that potentially influence hosp
ital autopsy rates: legal constraints, autopsy reporting times, opinions of
physicians requesting autopsies and pathologists regarding the usefulness
of autopsy in patient care, and use of autopsy material in research publica
tions.
Design.-Record of the annual numbers of deaths and autopsies during a 10-ye
ar period (1988-1997), Record of the delays for transmission of final autop
sy report to the requesting physician. Questionnaire analyzing the possible
factors influencing autopsy rate. Categorization of articles published by
pathologists according to the use of autopsy material.
Setting.-A 1000-bed, university teaching hospital in the Paris, France, are
a.
Participants.-Questionnaire addressed to physicians, head nurses, and mortu
ary staff.
Results.--A total of 1454 autopsies were reviewed. The autopsy rate decline
d from 15.4% in 1988 to 3.7% in 1997. This decline was marked after 1994 an
d tended to be slower for neurologic indications than for other indications
. The final report had not been communicated within 180 days in 620 (42.6%)
of 1454 autopsies. Fifty-five of 105 respondents considered that the bioet
hics law was one cause of the recent decrease of autopsy rate. Considering
the contribution of autopsy to medical research, 94 (81%) of 116 articles d
ealing with central nervous system but only 28 (6%) of 464 articles dealing
with other organs used autopsy-derived material.
Conclusions.-The 1994 bioethics law seems to contribute to the decline of a
utopsy. Inadequate delays for communicating autopsy results are frequent. E
xcept for neuropathologists, autopsy is a minor source of research material
.