Division of Trauma, Surgical Critical Care and Burns, Loyola University Medical Center, Maywood, Illinois 60153, USA.
J Trauma Acute Care Surg. 2012 Sep;73(3):587-90; discussion 590-1. doi: 10.1097/TA.0b013e318265ce05.
To analyze the influence and use of autopsy report review on preventability judgments as part of trauma system performance improvement activities.
All cases trauma fatalities occurring across one state within 1 year were reviewed. Preventability judgments were first analyzed by multidisciplinary panel consensus without benefit of autopsy report. Deaths were then reanalyzed after the panel was provided with autopsy findings. Changes in panel determinations of preventability and cause of death were noted.
A total of 434 cases were reviewed, autopsies were performed in 240 (55%) patients. Autopsy rate was 83% for prehospital deaths (PHDs) and 37% for hospital deaths (HDs). A complete examination (CA) was performed in 166 (69%) cases, and 74 (31%) cases were limited internal or external examinations only (NCA). Of autopsies performed on HD, 60% were CA versus 75% in PHD. Autopsy review changed preventability determination in four cases (1%). All changes were from nonpreventable to possibly preventable. For all patients with autopsy, the panel felt that the autopsy should have been of sufficient quality to analyze the cause of death in 83%. The autopsy was felt to actually establish a specific cause of death in 70% of all patients with autopsy, 71% in patients with NCA, and 74% in patients with CA. The autopsy changed the panel's preautopsy review-determination cause of death in 31% of all patients with autopsy (37% in the CA group; 13% in the NCA group). For PHD, autopsy changed the panel-determination cause of death in 44% and in 13% for HD.
Review of autopsy reports adds little to the trauma performance improvement process. It does not significantly change death review panel determinations. It may, perhaps, be most useful in PHD. Ardent initiatives to expend resources on autopsy performance and acquisition of autopsy reports in all patients with trauma is unwarranted.
分析尸检报告审查对创伤系统性能改进活动中可预防性判断的影响和使用。
回顾了一个州在一年内发生的所有创伤死亡案例。首先，在没有尸检报告的情况下，由多学科小组进行共识分析，以确定可预防性判断。然后，在小组提供尸检结果后，重新分析死亡情况。注意小组对可预防性和死因判断的变化。
共审查了 434 例病例，对 240 例（55%）患者进行了尸检。在院前死亡（PHD）中，尸检率为 83%，在医院死亡（HD）中，尸检率为 37%。对 166 例（69%）病例进行了全面检查（CA），对 74 例（31%）病例仅进行了有限的内部或外部检查（NCA）。在进行 HD 尸检的病例中，60%为 CA，而 PHD 中为 75%。尸检审查改变了 4 例（1%）的可预防性判断。所有变化均从不可预防性变为可能可预防性。对于所有接受尸检的患者，小组认为尸检应具有足够的质量来分析死因，这在 83%的病例中是可行的。尸检实际上确定了所有接受尸检患者的特定死因的 70%，NCA 患者为 71%，CA 患者为 74%。尸检改变了小组在尸检前审查确定的死因的 31%，在所有接受尸检的患者中（CA 组为 37%，NCA 组为 13%）。对于 PHD，尸检改变了小组确定的死因的 44%，对于 HD 为 13%。
尸检报告的审查对创伤性能改进过程没有太大帮助。它没有显著改变死亡审查小组的决定。也许在 PHD 中最有用。在所有创伤患者中投入资源进行尸检和获取尸检报告的积极举措是不必要的。
