Autopsy Reports and Performance Improvement

Autopsy reports have traditionally been used as part of the trauma performance improvement (PI) process. They are typically a tool to help determine preventability of death in cases where the etiology is not clear. Deaths that occur immediately prior to arrival or in the ED are typically those in which most questions arise.

The American College of Surgeons Trauma Verification Program includes a question on what percentage of deaths at a trauma center undergo autopsy. Low numbers are usually discussed further, and strategies for improving them are considered. But are autopsies really that helpful?

A total of 434 trauma fatalities in one state over a one year period were reviewed by a multidisciplinary committee and preventability of death was determined. Changes in preventability and diagnosis were noted after autopsy results were available. 

Here are the factoids:

  • The autopsy rate was 83% for prehospital deaths and 37% for in-hospital deaths 
  • Only 69% were complete autopsies; the remainder were limited internal or external only exams
  • Addition of autopsy information changed the preventability determination in 2 prehospital deaths and 1 in-hospital death (1%)
  • In contrast to this number, it changed the cause of death in about 40% of cases, mostly in the prehospital deaths

Bottom line: From a purely performance improvement standpoint, autopsy does not appear to add much to determining preventability of death. It may modify the cause of death, which could be of interest to law enforcement personnel. And it may modify some of the diagnoses recorded in the trauma registry. I would still recommend obtaining the reports for their educational value, especially for those of you who are part of residency training programs.

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Reference: Dead men tell no tales: analysis of the utility of autopsy reports in trauma system performance improvement activities. J Trauma 73(3): 587-590, 2012.

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