What’s new beyond Forensics?

Abstract

Light TD, Royer NA, Zabell J, Le MB, Thomsen TA, Kealey GP, Alpen MA, Nashelsky MB. Autopsy after Traumatic Death: A Shifting Paradigm. J Surg Res 2009, online first, doi:10.1016/j.jss.2009.07.009. The authors performed a prospective, descriptive cohort study in order to analyze the frequency of incidental findings, which are under recognized and reported by trauma surgeons, and missed trauma diagnoses. Of 496 trauma deaths identified over a 4-year period, 229 were subjected to autopsy (46%), and 204 complete autopsies were available for review. Diagnoses from the autopsy reports were compared to abstracted medical records to identify injuries known ante mortem and confirmed by autopsy, injuries not known ante mortem and incidental autopsy findings. 74% of deaths were due to blunt force trauma in motor vehicle collisions or falls. Class 3 missed diagnoses (minor, would not have changed outcome if identified) were common (33%). Class 1 (major, would have changed outcome) and 2 (major, would not have changed outcome) missed diagnoses were identified in 21% of all cases and consisted of traumatic brain injury, spine fractures and skull fractures in moribund patients. In 14% of the cases, important incidental findings were reported at autopsy. These included infectious disease, severe premature atherosclerosis, neoplasms and others such as cardiomyopathy. The authors conclude that incidental autopsy findings might have implications for family members and public health, and that autopsies are a valuable tool to validate clinical diagnoses and reveal unknown diagnoses, and they contribute to the education of health professionals. Their results should be followed up as are the results of other procedures and should be communicated to the next of kin.