The quality of medical autopsy reports.

Abstract

Medical autopsies are rarely made subject to quality assurance. We have investigated the quality of autopsy reports in Norway and assessed the impact of errors on the cause of death statistics. Every fifth medical autopsy report for adults (>2years) in 2014 was reviewed. The significance of the autopsy result for the registration of cause of death was studied by comparing the death certificate issued by the clinician with the coding in the Cause of Death Registry after the autopsy. A total of 389autopsy reports from 15 departments of pathology were reviewed. The autopsy request, as well as the death certificate and the codes for the cause of death from the Cause of Death Registry were available for 339and 360cases respectively. Ninety-five requests had specified clinical questions, but were commented on by the pathologist in 33cases. Obesity was rarely reported as a finding, even in cases of pathological deviations from a normal weight. A post-mortem virus examination or toxicology had been performed in 1and 28autopsies respectively. The average turnaround time for autopsies without and with a neuropathological examination was 99and 138 days respectively. Errors in reporting the cause of death or inadequate reporting were evident in 69cases (18%), most frequently for deaths from cardiovascular diseases. The autopsy result led to a change to the cause of death in the Cause of Death Registry in 206out of 360 (57%) cases for which coding data were available. Errors in the formulation of the autopsy result resulted in erroneous coding of the cause of death in 22out of 47 (47%) of cases with errors. The proportion of autopsy reports with errors in the formulation of the cause of death was unexpectedly high and may have consequences for the cause of death statistics. Long turnaround times for autopsies complicate communication with the clinician about the findings.