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PICU Autopsies: Rates, Patient Characteristics, and the Role of the Medical Examiner*

Basu, Sonali MD1; Holubkov, Richard (RH), PhD2; Dean, J. Michael MD2; Meert, Kathleen L. MD3; Berg, Robert A. MD4; Carcillo, Joseph MD5; Newth, Christopher J. L. MD, FRCPC6; Harrison, Rick E. MD7; Pollack, Murray M. MD1; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)

Pediatric Critical Care Medicine: December 2018 - Volume 19 - Issue 12 - p 1137-1145
doi: 10.1097/PCC.0000000000001742
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Objectives: Autopsy rates in North American Children’s hospitals have not been recently evaluated. Our objectives were 1) to determine the autopsy rates from patients cared for in PICUs during a portion of their hospital stay, 2) to identify patient characteristics associated with autopsies, and 3) to understand the relative role of medical examiner cases.

Design: Secondary analysis of data prospectively collected from a sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 2011 and April 2013.

Setting: Eight quaternary care PICUs.

Patients: Patients in the primary study were less than 18 years old, admitted to a PICU and not moribund on PICU admission. Patients included in this analysis were those who died during their hospital stay.

Interventions: None.

Measurements and Main Results: Sociodemographic, clinical, hospital, and PICU data were compared between patients who had autopsies conducted and those who did not and between medical examiner and nonmedical examiner autopsies. Of 10,078 patients, 275 died of which 36% (n = 100) had an autopsy performed. Patients with cancer who died were less likely to receive autopsies (p = 0.005), whereas those who died after trauma or cardiac arrest had autopsies performed more often (p < 0.01). Autopsies were more common in patients with greater physiologic instability at admission (p < 0.001), and those who received more aggressive PICU care. Medical examiner cases comprised nearly half of all autopsies (n = 47; 47%) were conducted in patients presenting with greater physiologic instability (p < 0.001) and more commonly after catastrophic events such as cardiac arrest or trauma (p < 0.001).

Conclusions: In this first multicenter analysis of autopsy rates in children, 36% of deaths had autopsies conducted, of which nearly half were conducted by the medical examiner. Deaths with autopsy are more likely to be previously healthy children that had catastrophic events prior to admission.

1Department of Pediatrics, Children’s National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC.

2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.

3Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

4Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA.

5Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA.

6Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.

7Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA.

*See also p. 1173.

Members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) are: K.L. Meert, S.M. Heidemann, D.L. Wessel, M.M. Pollack, R.S. Burd, J.T. Berger, J.A. Carcillo, M.J. Bell, E.L. Fink, C.J. Newth, R.E. Harrison, R.A. Berg, A.F. Zuppa, T.P. Shanley, F.W. Moler, H.J. Dalton, R. Holubkov, J.M. Dean, P.M. Mourani, T.C. Carpenter, P.S. McQuillen, A. Sapru, M.W. Hall, A.R. Yates, D.A. Notterman, A. Doctor, T.L Jenkins, R.F. Tamburro, and C.E. Nicholson.

The content is solely responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.

Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063106, U10HD063114, and U01HD049934.

Drs. Basu, Holubkov, Dean, Meert, Berg, Carcillo, Harrison, and Pollack received support for article research from the National Institutes of Health (NIH). Drs. Holubkov's, Dean's, Meert's, Berg's, Carcillo's, Harrison's, and Pollack's institutions received funding from the NIH. Dr. Holubkov received funding from Pfizer (Data Safety Monitoring Board [DSMB] membership), Medimmune (DSMB membership), Physicians Committee for Responsible Medicine (biostatistical consulting), St Jude Medical (biostatistical consulting, past), Armaron (DSMB membership, past), and the American Burn Association (DSMB membership, past). Dr. Newth received funding from Philips Research North America.

For information regarding this article, E-mail: sbasu@childrensnational.org

Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies