Implication des médecins légistes dans l’autopsie médicale : l’expérience toulousaine

Abstract

Despite its progressive decline, clinical autopsy remains a useful diagnostic tool. In the French Toulouse University Hospital, a pathologist in collaboration with a forensic scientist performs theses autopsies since macroscopic time. Our purpose is to present a retrospective study of theses autopsies since the beginning of this collaboration. We reviewed the demands of medical autopsies between January 2006 and June 2010. We have then analyzed different data such as epidemiological data, gross and microscopic findings and the different causes of death. Thirty-eight medical autopsies were performed during this period. The average age of patients was 45.7 years and the sex ratio M/F 1.5. We distinguished two different populations in this sample: hospitalized patients with numerous associated diseases and non-hospitalized patients who died in a context of sudden unexpected death. A diagnosis was established in 73.7% of the observations. Most of them suffered from infections. Discrepancies between clinical and autopsy diagnoses reached 50% of all cases. Histological examination allowed to establish a complete diagnosis in 47.3% of cases. Histological analysis has a major impact on necropsy diagnosis especially in the lungs, heart or brain. Medical autopsy is still the most accurate method of determining the cause of death. Gross and microscopic examinations are fundamental to achieve this aim. Two experts, one pathologist and one forensic scientist, perform these autopsies in Toulouse, in order to improve both experiences and performance in the diagnosis of death.