Eriksson L, Sundström C
Department of Pathology, University Hospital, Uppsala, Sweden.
Qual Assur Health Care. 1993 Dec;5(4):319-23. doi: 10.1093/intqhc/5.4.319.
The autopsy rate has declined in the last 20 years in Sweden and is now approximately 30%. Clinical autopsies constitute about 18% and medico-legal autopsies somewhat more than 10%. There is an obvious geographical variation in clinical autopsy rate, whereas the variation in medico-legal autopsy rate is narrower. The difference in autopsy frequency between males and females seemed to be mainly dependent on the higher number of medico-legal autopsies among males. In order to explore the reasons behind the decline in autopsy rate we accomplished a study of the autopsy rate in 1986 and 1991 in three Swedish hospitals of various types and sizes. The hospitals studied were one university hospital and two community hospitals of different sizes. The autopsy rate varied between 0 and 100% among the different departments within these hospitals and also varied considerably between wards within the same department. The number of clinical autopsies declined between 1986 and 1991 in all three hospitals. The fall was greatest in the university hospital and in the larger of the two community hospitals. However, in these two hospitals departments with active research of clinico-pathological relevance maintained or even increased their autopsy rate during this period. The decline in autopsy rate in general and the difference in rate between hospitals, departments and wards could be explained neither by the Autopsy Act of 1976, or by the reluctance of relatives to give consent to the autopsy of a relative. A change in attitude toward and interest in the autopsy activity of clinicians seemed to be the major explanation for the decline of the autopsy.
在过去20年里，瑞典的尸检率有所下降，目前约为30%。临床尸检约占18%，法医尸检略高于10%。临床尸检率存在明显的地域差异，而法医尸检率的差异则较小。男性和女性在尸检频率上的差异似乎主要取决于男性中法医尸检数量较多。为了探究尸检率下降背后的原因，我们对1986年和1991年瑞典三家不同类型和规模的医院的尸检率进行了研究。所研究的医院包括一家大学医院和两家不同规模的社区医院。这些医院不同科室的尸检率在0%至100%之间，同一科室不同病房之间的尸检率也有很大差异。1986年至1991年期间，所有三家医院的临床尸检数量都有所下降。大学医院和两家社区医院中较大的那家下降幅度最大。然而，在这两家医院中，与临床病理相关且积极开展研究的科室在此期间保持甚至提高了尸检率。尸检率总体下降以及医院、科室和病房之间的尸检率差异，既不能用1976年的《尸检法》来解释，也不能用亲属不愿同意对亲属进行尸检来解释。临床医生对尸检活动的态度和兴趣的转变似乎是尸检率下降的主要原因。
