Oura Petteri, Mäkinen Hilla, Ruotsalainen Roosa, Ruokomäki Miko, Virtanen Antti, Hakkarainen Antti J
Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FIN-00271, Finland.
Department of Forensic Medicine, Faculty of Medicine, University of Helsinki, P.O. Box 21, Helsinki, FIN- 00014, Finland.
Int J Legal Med. 2025 Mar;139(2):805-815. doi: 10.1007/s00414-024-03399-6. Epub 2025 Jan 13.
In July 2023, an in-house forensic neuropathology consultation pilot was established at the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare. This offered an alternative to the previous practice of full outsourcing to a hospital neuropathology department. This paper aims to introduce the first year experiences of the pilot. The in-house consultant team comprised two forensic pathologists with special training in neuropathology. In-house consultations were offered for medico-legal autopsy cases with traumatic brain injury (TBI) and hypoxic-ischaemic encephalopathy. The in-house histology laboratory participated in the pilot, implementing beta-amyloid precursor protein (β-APP) stain at the end of the pilot year. An electronic database was also developed for data collection and reporting. The characteristics, costs, and duration of the first 25 consultation cases were reviewed. The cases involved mostly male decedents (84.0%) with TBI (84.0%). The median total cost of a pilot case was €624, which was substantially lower compared to the previous outsourced practice (€1013 per case + €38/84 for each microscope slide with special/immunohistochemical stain, respectively). After the implementation of β-APP stain into the in-house laboratory service, the median total cost of a pilot case was reduced further to €94. The median duration of an in-house consultation was 2.3 months. Thanks to a favourable in-house atmosphere, the first year experiences are encouraging. While the costs of the in-house consultation practice appear to be markedly lower than those of an external provider, both alternatives should be available for cases where sufficient expertise cannot be found in-house.
2023年7月，芬兰健康与福利研究所法医学部赫尔辛基办公室设立了内部法医神经病理学咨询试点项目。这为之前将所有工作完全外包给医院神经病理学部门的做法提供了一种替代方案。本文旨在介绍该试点项目的第一年经验。内部顾问团队由两名接受过神经病理学专门培训的法医病理学家组成。为涉及创伤性脑损伤（TBI）和缺氧缺血性脑病的法医学尸检病例提供内部咨询。内部组织学实验室参与了该试点项目，在试点年结束时开展了β-淀粉样前体蛋白（β-APP）染色。还开发了一个电子数据库用于数据收集和报告。对前25个咨询病例的特征、成本和时长进行了审查。这些病例大多涉及男性死者（84.0%），且患有创伤性脑损伤（84.0%）。试点病例的总费用中位数为624欧元，与之前的外包做法相比大幅降低（之前每个病例1013欧元，每张特殊/免疫组织化学染色的显微镜载玻片分别额外收取38/84欧元）。在内部实验室服务中实施β-APP染色后，试点病例的总费用中位数进一步降至94欧元。内部咨询的时长中位数为2.3个月。得益于良好的内部氛围，第一年的经验令人鼓舞。虽然内部咨询做法的成本似乎明显低于外部供应商，但对于在内部找不到足够专业知识的病例，两种方案都应可供选择。
