Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
Cecil G. Sheps Center for Health Services Research, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Biol Blood Marrow Transplant. 2018 Sep;24(9):1861-1865. doi: 10.1016/j.bbmt.2018.05.030. Epub 2018 Jun 9.
Autopsy may confirm clinical diagnoses or identify conditions that were not suspected prior to a patient's death. Previous studies evaluating the utility of autopsy in hematopoietic stem cell transplant (HSCT) recipients yielded conflicting results. We conducted a retrospective cohort study of children (<18 years of age) undergoing allogeneic HSCT at Duke University who died of any cause between January 1, 1995, and December 31, 2016. We evaluated associations between patient characteristics and autopsy performance using chi-square or Fisher exact tests. We reviewed autopsy reports to determine the concordance between preautopsy causes of death and pathological diagnoses identified on autopsy. We classified unexpected diagnoses on autopsy using criteria developed by Goldman et al. We evaluated for temporal changes in the autopsy consent rate and the frequency of unexpected diagnoses on autopsy using Cochran-Armitage tests. During the 22-year study period, 475 patients died and had data available on autopsy performance, and 130 (27%) of these patients underwent autopsy. The autopsy consent rate declined over time (P < .0001), with autopsies being performed for 40% of deaths in 1995 to 1999 and 17% of deaths in 2009 to 2016. White patients were more likely to undergo autopsy than nonwhite patients (P = .03). There were no associations between autopsy performance and patient age, sex, HSCT indication, or HSCT donor. Unexpected diagnoses were identified in 31 (24%) autopsies. The proportion of autopsies with an unexpected diagnosis did not change during the study period (P = .45). However, infectious diagnoses that would have led to a change in management were more frequently identified on autopsies in 1995 to 2003 than in 2004 to 2016 (20% versus 0%; P = .001). The autopsy consent rate for pediatric HSCT recipients at our institution has declined substantially over the past several decades. The utility of autopsy in this patient population remains high despite a reduction in the identification of unexpected infections.
尸检可以确认临床诊断，或确定患者死亡前未怀疑的病症。先前评估尸检在造血干细胞移植 (HSCT) 受者中效用的研究结果相互矛盾。我们对 1995 年 1 月 1 日至 2016 年 12 月 31 日期间在杜克大学接受异基因 HSCT 并因任何原因死亡的<18 岁儿童进行了回顾性队列研究。我们使用卡方或 Fisher 精确检验评估了患者特征与尸检实施之间的关联。我们查阅尸检报告，以确定尸检前死因与尸检病理诊断之间的一致性。我们使用 Goldman 等人制定的标准对尸检中的意外诊断进行分类。我们使用 Cochran-Armitage 检验评估尸检同意率和尸检中意外诊断的频率随时间的变化。在 22 年的研究期间，有 475 名患者死亡且有尸检数据，其中 130 名（27%）患者接受了尸检。尸检同意率随时间下降（P<.0001），1995 年至 1999 年期间 40%的死亡患者接受了尸检，而 2009 年至 2016 年期间则为 17%。白人患者比非白人患者更有可能接受尸检（P=.03）。尸检的实施与患者年龄、性别、HSCT 适应证或 HSCT 供者之间无关联。31 例（24%）尸检中发现了意外诊断。在研究期间，尸检中发现意外诊断的比例没有变化（P=.45）。然而，1995 年至 2003 年与 2004 年至 2016 年相比，尸检中更频繁地发现了可导致治疗方案改变的感染性诊断（20%与 0%；P=.001）。在过去几十年中，我们机构 HSCT 受者的尸检同意率大幅下降。尽管意外感染的识别减少，但尸检在该患者人群中的效用仍然很高。
