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Clinical and Needle Autopsy Correlation Evaluation in a Tertiary Care Teaching Hospital: A Prospective Study of 50 Cases From the Emergency Department

Bansal, Meenakshi Garg MD*; Punia, Rajpal S. MD*; Sachdev, Atul MD, DM

American Journal of Forensic Medicine & Pathology: September 2012 - Volume 33 - Issue 3 - p 194–196
doi: 10.1097/PAF.0b013e31823d295e
Original Articles

Abstract: With gradual fall in autopsy all over the world in recent years, the present study aimed to assess the accuracy of clinical diagnosis and efficacy of needle autopsy from the emergency department. Fifty deceased patients, who died in the emergency department during a period of 1 year, were subjected to needle autopsy of the major viscera, using spring-loaded automated biopsy gun, and the findings were correlated with clinical diagnosis. The deceased patients were in the age range of 12 to 80 years (mean [SD], 50.48 [18.41] years). The tissues yielded from various organs were as follows: lungs, 90%; liver, 82%; kidney, 48%; heart, 28%; spleen, 22%; and pancreas, 18%. Before death, 86 clinical diagnoses were recorded, of which 21 (24%) (eg, metabolic encephalopathy, cardiac arrhythmia, diabetic ketoacidosis) were impossible to verify on needle autopsy. A total of 48 new diagnoses, missed by physicians, were revealed by needle autopsy. The most frequently missed diagnoses were liver fatty change (19 patients) and pneumonitis (11 patients). Other frequently missed diagnoses were chronic hepatitis (3 patients) and cancer (2 patients: 1 lung squamous cell carcinoma and 1 lung adenocarcinoma). Major diagnostic errors (Goldman classes I and II) were noted in 16 (32%) of 50 cases. Needle autopsy can be a better alternative in the absence of conventional autopsy.

From the Departments of *Pathology and †General Medicine, Government Medical College & Hospital, Chandigarh, India.

Manuscript received March 22, 2010; accepted April 27, 2010.

Dr Bansal participated in the procedure, literature search, and preparation of the final manuscript. Drs Punia and Sachdev conceptualized the study and participated in the interpretation and preparation of the manuscript draft.

No funds were received for this study.

The authors report no conflicts of interest.

Reprints: Rajpal S. Punia, MD, Department of Pathology, Government Medical College & Hospital, Sector 32, Chandigarh 160030, India. E-mail: drpunia@gmail.com.

© 2012 Lippincott Williams & Wilkins, Inc.