![]() Forensic autopsy is performed in cases of suspected suicide, homicide, death by accident, ongoing drug/alcohol misuse, health care mistreatment, and when death is unexpected or when there is prolonged post-mortem delay, i.e., decomposition of the body, or otherwise difficulty identifying the deceased. ![]() ![]() Currently in Sweden, less than 12% of all deceased are assessed post-mortem, half by a clinical and half by a forensic autopsy the proportion has declined from approximately 50% in the 1970’s. The indications for clinical autopsy in Sweden were extended in 1996 to include investigation of the effects of medical or surgical treatments and investigation of the presence of any disease or injury, in addition to the determination of the cause of death and concurrent diseases. Since then, changes have occurred not only related to the frequency of autopsies but also to basic regulations. A previous assessment of agreement rates between clinical diagnosis and autopsy in a university hospital in Sweden is from 1994. Studies have shown discrepancies between clinical diagnoses and post-mortem autopsy diagnoses in at least 25% of patients, even today. Furthermore, economic reasons and advancing medical diagnostics may further depreciate the real or apparent need for autopsies. The likelihood of relatives to oppose a proposed autopsy is in turn dependent on the emphasis of the proposition. ![]() Reasons for the decline include the clinician’s view that the cause of death is already known, that relatives would oppose autopsy, or that autopsy would not provide additional important information. Clinical autopsy referral rates have been in decline for several decades in Europe as well as in the USA. Accurate diagnosis of cause of death and concurrent diseases is important on an individual level for family and relatives but also on a population level for planning of health care and health care research. The clinical autopsy is regarded as the “gold standard” for diagnosis of disease and is an important quality assessment tool in health care. In accordance with previous research, our study confirms a declining rate of autopsy even at tertiary, academic hospitals and points out factors possibly involved in the decline. In a large proportion of cases (> 30%), significant findings of disease were not anticipated before autopsy, as judged from the referral document and additional data obtained in some but not all cases. The autopsies revealed a high prevalence of cardiovascular disease, with myocardial infarction and cerebrovascular lesion found in 40% and 19% of all cases, respectively. The proportion of autopsy referrals from the emergency department increased from 9 to 16%, while the proportion of referrals from regular hospital wards was almost halved. There was a decline in the number of autopsies performed over time, however, mainly in one of the two hospitals. We reviewed the autopsy reports and autopsy referrals of 2410 adult (age > 17) deceased patients referred to two University hospitals in Sweden during two plus two years, a decade apart. We conducted a study to evaluate over time the use and results of clinical autopsies in Sweden. The use of clinical autopsy has been in decline for many years throughout healthcare systems of developed countries despite studies showing substantial discrepancies between autopsy results and pre-mortal clinical diagnoses.
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