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BACKGROUND: English-speaking Caribbean (ESC) childhood cancer outcomes are unknown. PROCEDURE: Through the SickKids-Caribbean Initiative (SCI), we established a multicenter childhood cancer database across seven centers in six ESC countries. Data managers entered patient demographics, disease, treatment, and outcome data. Data collection commenced in 2013, with retrospective collection to 2011 and subsequent prospective collection. RESULTS: A total of 367 children were diagnosed between 2011 and 2015 with a median age of 5.7 years (interquartile range 2.9-10.6 years). One hundred thirty (35.4%) patients were diagnosed with leukemia, 30 (8.2%) with lymphoma, and 149 (40.6%) with solid tumors. A relative paucity of children with brain tumors was seen (N = 58, 15.8%). Two-year event-free survival (EFS) for the cohort was 48.5% ± 3.2%; 2-year overall survival (OS) was 55.1% ± 3.1%. Children with acute lymphoblastic leukemia (ALL) and Wilms tumor (WT) experienced better 2-year EFS (62.1% ± 6.4% and 66.7% ± 10.1%), while dismal outcomes were seen in children with acute myeloid leukemia (AML; 22.7 ± 9.6%), rhabdomyosarcoma (21.0% ± 17.0%), and medulloblastoma (21.4% ± 17.8%). Of 108 deaths with known cause, 58 (53.7%) were attributed to disease and 50 (46.3%) to treatment complications. Death within 60 days of diagnosis was relatively common in acute leukemia [13/98 (13.3%) ALL, 8/26 (30.8%) AML]. Despite this, traditional prognosticators adversely impacted outcome in ALL, including higher age, higher white blood cell count, and T-cell lineage. CONCLUSIONS: ESC childhood cancer outcomes are significantly inferior to high-income country outcomes. Based on these data, interventions for improving supportive care and modifying treatment protocols are under way. Continued data collection will allow evaluation of interventions and ensure maximal outcome improvements.

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OBJECTIVE: To evaluate the trends in vulvar cancer between 1978 and 2007 in Kingston and St Andrew, Jamaica, with respect to age-standardized rates and histologic types. METHODS: All cases of vulvar cancer recorded in the Jamaica Cancer Registry from 1978 to 2007 were extracted and analysed for age distribution and histologic type. RESULTS: There were 78 cases (one person of unknown age) of vulvar cancer recorded over the 30-year period. Sixty per cent of the affected patients were between 50 and 80 years old. The most common histologic type of vulvar malignancy was squamous cell carcinoma (82%). There was a decline in age-standardized incidence rates of both vulvar cancers overall and vulvar squamous cell carcinoma over the 30-year period. CONCLUSION: Squamous cell carcinoma is the most common vulvar malignancy in the Jamaican population, and affects primarily older women. Despite high prevalence rates of high-risk human papillomavirus infection, no increase in the age-standardized incidence of vulvar squamous cell carcinoma was identified.

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OBJECTIVE: Several countries have reported increasing incidence of oral cavity and oropharyngeal (OCOP) squamous cell carcinoma (SCC) over recent years, particularly among young men and primarily in tongue and tonsil subsites, attributed to human papillomavirus (HPV) infection. This study examines trends in incidence and age distribution of OCOP SCC in Jamaica over a 30-year period. METHODS: We extracted all cases of OCOP SCC archived in the Jamaica Cancer Registry files over the 30 year-period from 1978 to 2007 and grouped them according to anatomical site (International Classification of Diseases; ICD-9), age and gender. The data were used to calculate age standardized rates (ASRs) and age-specific incidence rates (ASIRs). RESULTS: There were 384 patients (age range 21 to 94 years; male to female ratio 2.6:1) with OCOP SCC; the majority (85.4%) was > 50 years. Age standardized rates of all OCOP SCC combined were higher in males than in females and there was a decrease in both genders over the study period. Tongue and tonsil were the commonest subsites, and males showed decreasing ASR in both. Females showed decreasing ASR in tongue and fluctuation in tonsil SCCs. The highest ASIRs for tongue and tonsil SCC were consistently seen in patients older than 50 years of age. CONCLUSION: The incidence of OCOP SCC is decreasing and continues to predominate among older men. The decreasing trend in incidence of tongue and tonsil SCC is unlike that reported elsewhere. This may be due to differences in sexual practices, small size of this study, or a lag time in emergence of a new trend.

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OBJECTIVE: To document the epidemiology of cutaneous malignant melanoma (CMM) in Jamaica over the 50-year period, 1958-2007. METHODS: All cases of CMM recorded in the Jamaica Cancer Registry (JCR), for the period 1958-2007, were collected. For each case, we documented method of ascertainment, age, gender and anatomical location. Age standardized incidence rates (ASRs) for the seven five-year periods from 1973-2007 were also obtained from the JCR. RESULTS: There were 220 cases of CMM from 218 patients (131 females, 87 males; male:female ratio 1:1.5), ranging in age from 21 to 98 years (median age 62 years). The majority of cases (94%) were ascertained via biopsy. The ASRs fluctuated around 0.9 per 100 000 per year from 1973 to 2007, ranging from 0.6-1.4 per 100 000 per year in females and 0.5-1.1 per 100 000 per year in males. Cutaneous malignant melanoma was most common in the lower limb (59% of males and 69% of females). The foot was the most common lower limb site (female: 77%, male: 83%) and the commonest site overall (female: 53%, male: 49%). CONCLUSION: In Jamaica, CMM is more common in females than in males. In both genders, the ASRs were noted to be low and fluctuated around 0.9 per 100 000 per year since 1973. The lower limb is the commonest anatomical site, with the majority of cases involving the foot. These findings are similar to those documented in other predominantly Black populations.

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OBJECTIVE: To determine the distribution of malignancies in adolescents and young adults (AYA; 15 to 29 years) in Jamaica. METHODS: All cases of malignancies diagnosed in AYA in the period 1988-2007, were extracted from the files of the Jamaica Cancer Registry. For each case, age, gender and diagnosis were recorded and the diagnoses categorized according to the recently proposed diagnostic groups for cancers in AYA. The data were used to calculate incidence rates and relative frequencies. RESULTS: Among males, the age-specific incidence rate for the oldest age group (25-29 years) was higher than that recorded for each of the younger groups. In females, there was a progressive increase in incidence with increasing age. The age-standardized rates (ASRs) per million were 131.4 (males) and 226.1 (females). In males, the highest ASRs (per million) were those for lymphoma (34.7), carcinoma (29.3) and soft tissue sarcoma (17.2), and in females, carcinoma (121.6), lymphoma (31.4) and germ cell and trophoblastic neoplasms (14.6). Lymphoma was the commonest diagnosis in younger males, and ranked second to carcinoma in the oldest. Carcinoma and lymphoma were the commonest and second commonest diagnoses, respectively, among all three age groups in females, with carcinomas accounting for progressively greater proportions of tumours with increasing age. CONCLUSION: The incidence of malignancy in AYA in Jamaica is higher in females than in males. In both genders, increasing age is accompanied by increasing incidence and a shift from non-epithelial to epithelial malignancies. This shift occurs at an earlier age in females.

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OBJECTIVES: There have been several modifications to the classification of childhood cancers since the first report (1968-1981) specific to the Jamaican paediatric population was published in 1988. This paper reports on paediatric cancer incidence in Kingston and St Andrew, Jamaica, for the 20-year period 1983-2002 based on these modifications. METHODS: All cases of cancer diagnosed in children (0-14 years), between 1983 and 2002 were extracted from the Jamaica Cancer Registry archives and classified using the International Classification of Childhood Cancer, third edition. Incidence figures were calculated as per the International Agency for Research on Cancer (IARC) reporting format for childhood cancer. RESULTS: There were 272 cases (133 males, 139 females) of childhood cancer identified in the 20-year period. The overall age standardized rate (ASR) was 69.4 per million; that for males was 67.8 per million, and for females, 70.9 per million. The three most common malignancies overall were leukaemia (21.3%), lymphoma (15.8%) and brain and spinal neoplasms (14.0%). In males, the highest ASRs were seen for leukaemia (14.8 per million), lymphoma (12.7 per million), and brain and spinal neoplasms (8.2 per million), and in females, leukaemia (14.4 per million), nephroblastoma (11.3 per million), and brain and spinal neoplasms (10.6 per million). CONCLUSIONS: The rankings of the most common childhood malignancies in Jamaica (leukaemia, brain and spinal neoplasms and lymphomas) have shown few changes since the last review. However, there are differences in frequency and gender distribution of nephroblastoma and brain and spinal neoplasms.

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OBJECTIVE: To determine the distribution of histologic subtypes of soft tissue sarcomas (STS) in Kingston and St Andrew, Jamaica, according to age and topography. METHODS: From the Jamaica Cancer Registry (JCR) archives, all cases of STS diagnosed between 1958 and 2007 were extracted. For each case, age, gender, histological diagnosis and anatomical site of tumour were recorded. Patients were categorized according to age at diagnosis as: children (0-14 years) and adults (> 14 years), and the distribution of histologic diagnoses with respect to age and anatomical site were analysed. RESULTS: There were 432 cases (67 children, 364 adults, one person of unknown age) of STS recorded in the JCR over the 50-year period (218 males, 214 females). The commonest STS in adults were "sarcoma, not otherwise specified [NOS]" (20.1%), malignant fibrous histiocytoma [MFH] (17.9%), fibrosarcoma (12.4%), liposarcoma (10.7%) and malignant peripheral nerve sheath tumour [MPNST] (10.2%). In children, they were neuroblastoma (38.8%), rhabdomyosarcoma (23.9%), "sarcoma, NOS" (9%), fibrosarcoma (6%) and MFH (6%). In adults, the lower limb was the commonest location, followed by trunk and/or upper limb for MFH, fibrosarcoma and liposarcoma, and head and neck for MPNST. In children, head and neck was the commonest site for rhabdomyosarcoma, head and neck and upper limb for MFH, retroperitoneum for neuroblastoma and trunk for fibrosarcoma. CONCLUSION: A high proportion of soft tissue sarcomas in Jamaica are unclassified and the anatomical distribution of common classified sarcomas shows some differences with the literature. Limited access to immunohistochemistry/molecular diagnostics and increasing core biopsy diagnosis may contribute to these phenomena.

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OBJECTIVE: To investigate the positive predictive value (PPV) of urinary vanillylmandelic acid (VMA) testing in the diagnosis of phaeochromocytoma and to describe the features associated with phaeochromocytoma at the University Hospital of the West Indies (UHWI). SUBJECTS AND METHODS: There were 551 VMA tests performed from January 2003 to June 2009 and 122 tests in 85 patients were elevated (ie > or = 35 micromol/24 hr). The study patients were categorized as: (i) 'surgical' (5 patients who underwent surgery) or (ii) 'non-surgical' (remaining 80 patients). Forty medical charts (out of 85) were reviewed using a standardized data extraction form. RESULTS: The median age for patients in the non-surgical group (with charts reviewed, n = 35) was 36 years (range 9-70) and the median VMA was 43 micromol/24 hr (IQR 38-51). Of these patients, 83% had one or no symptom typical of phaeochromocytoma. In the surgical group the median VMA was 58 micromol/24 hr (IQR 44-101); phaeochromocytoma was confirmed histologically in 3 patients, all of whom had several symptoms typical of catecholamine excess. VMA testing had a PPV of 8%, specificity of 79% and sensitivity of 100%. CONCLUSIONS: VMA testing at UHWI has poor specificity and high sensitivity. These results contrast with international data showing that VMA testing is poorly sensitive but highly specific. The use of assays with higher specificity (eg plasma or urinary metanephrines) may represent a more cost-effective approach to biochemical screening at UHWI.

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OBJECTIVE: To investigate the trends in incidence and age-distribution of prostate cancer in Kingston and St Andrew (KSA), Jamaica, over the 30-year period 1978-2007. METHODS: From published Jamaica Cancer Registry (JCR) data, we extracted age-standardized rates of prostate cancer for the six 5-year reporting periods that comprised the 30-year study span, and from the archived files of the JCR, the patient ages at diagnosis for all prostate cancer cases recorded over the 30-year period were extracted. The results were compared with data from other black populations. RESULTS: The incidence of prostate cancer in KSA, Jamaica, is lower than that in black men in the United States and United Kingdom. The KSA incidence showed a progressive increase since the 1983-1987 reporting period, and the greatest 5-year percentage increases were seen over the period 1983 to 1997. Men in the 60-74-year age group were the commonest contributors to prostate cancer total in all 5-year periods examined, and between 1988 and 2007, there were increases in the proportionate contributions from the 25-59 and 60-74-year age groups, and a decrease in contribution from men aged 75 years and older. CONCLUSION: The incidence of prostate cancer in KSA, Jamaica, has been progressively increasing since 1983, and there has been a concomitant increase in the proportionate contribution from younger men. Continued increase is likely over the next several years, but KSA currently appears to be a relatively low-risk region for prostate cancer, compared to black populations in developed Western countries.

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OBJECTIVE: To compare the distribution of histological subtypes of thyroid cancer in Kingston and St Andrew (KSA), Jamaica, within two consecutive 15-year periods. METHODS: We extracted all cases of thyroid carcinoma archived in the Jamaica Cancer Registry files over the 30-year period from 1978 to 2007. The cases were separated into two groups: 1978-1992 (Group I) and 1993-2007 (Group II). We analysed age, gender and histological subtype distribution within each group, and then made comparative analyses between the two periods. RESULTS: There were 311 cases in which the histological subtype was documented. The patients ranged in age from 12 to 94 years, with male to female ratios of 1:4.2 (group I) and 1:5.6 (group II). The highest frequencies of cases occurred in patients between the ages of 20 and 59 years. The commonest histological subtype in group I was follicular (52.7%); in group II, it was papillary (60%), followed by follicular (26.7%) and medullary (6.7%). There was an overall 263% increase in the papillary to follicular cancer ratio from group I (0.62) to group II (2.25). The increase in papillary carcinomas was statistically significant (p < 0.001) overall, and in patients less than 50 years of age (p < 0.001). CONCLUSION: The recent KSA thyroid cancer data show a histological profile similar to that described globally, with papillary carcinomas being commonest, followed by follicular and then medullary. The significant increase in papillary cancer frequency in KSA is most likely the result of gradual recognition of the entity follicular variant of papillary cancer

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A total of 4981 cancers were recorded in Kingston and St. Andrew during the period 2003-2007: 2536 in males and 2445 in females. Age standardized rates per 100,000 per year (ASR) were 188.8 and 144.2 for males and females respectively, and are relatively unchanged, compared to the previous report (188.6 for males and 144.2 for females, 1998-2002). In males, the leading sites for cancer were prostate, bronchus and large bowel, while in females, they were breast, cervix uteri and large bowel. The leading sites for both genders have been maintained in the same order as in the previous report, but for males, there were increases in the incidence of prostate (ASR 65.5 vs. 78.1 per 100,000 per year) and colorectal (ASR 13.7 vs. 17.2 per 100,000 per year) cancers and a decrease in the incidence of cancer of the bronchus (ASR 22.8 vs. 18.6 per 100,000 per year). For females, there was a modest decrease in incidence of cervical cancer (ASR 19 vs. 17.4 per 100,000 per year) while the incidence of cancers of the breast and large bowel remained relatively stable (ASR 40.1 vs. 43 per 100,000 per year for breast and ASR 13 vs. 12.8 per 100,000 per year for colorectal cancer). These data support the need for urgent institution of formal programmes for prevention and control of cancers of the breast and large bowel in the Jamaican population. Malignancies of unknown primary site were common in both genders and require further investigation.

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INTRODUCTION: A minority of patients with unlocalised massive lower gastrointestinal bleeding (LGIB) will require treatment with emergency subtotal colectomy (STC). METHODS: To determine the outcome of STC in this high-risk group, we retrospectively reviewed the histopathology reports and case records of all subtotal colectomies performed for LGIB over a 8-year period. RESULTS: Fifty-eight patients (mean age: 71 years; male to female ratio, 1 : 1) underwent emergency surgery for unlocalised LGIB, 45% of which were massive on admission, and unresponsive to resuscitation. The remainder had persistent or recurrent bleeding during the index hospitalisation. The hospitalisation for colectomy represented the first for LGIB for 56% of the study group, while 38% were on at least their third such admission. All but three patients underwent preoperative rigid proctosigmoidoscopy. Fifty-five of the 58 patients were treated with STC and primary ileorectal anastomosis. The major causes of bleeding were diverticular disease only (68%), angiodysplasia only (12%) and both diseases (12%). Overall mortality was 17%, with the main contributor being sepsis resulting from anastomotic leak. Non-fatal complications occurred in 20%, resulting in a mean postoperative length of stay of 13 days. All patients were doing well on their first follow-up visit with a mean number of four stools per day after 1 month. CONCLUSION: While emergency STC is an effective and definitive method of treating unlocalised massive LGIB, its associated morbidity and mortality may limit its usefulness.

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A total of 4737 cancers were recorded in Kingston and St Andrew during the period 1998-2002: 2387 in males and 2350 in females. Age standardized rates per 100,000 per year (ASR) were 188.6 and 144.2 for males and females respectively. In males, the leading sites for cancer were prostate (873 cases), bronchus (269 cases) and large bowel (176 cases) while in females, the leading sites were breast (639 cases), cervix uteri (318 cases) and large bowel (218 cases). The number of new cases has remained relatively stable, compared to the previous five-year period (1993-1997), but the ASR for females has fallen from 156.7 to 144.2 per 100,000 per year and that for males has increased from 176.7 to 188.6 per 100,000 per year. The leading sites of cancer for both males and females have also been maintained in the same order but there was a moderate increase in prostate cancer (ASR 56.4 vs 65.5 per 100,000 per year) and a moderate decrease in cervical cancer (ASR 25.2 vs 19 per 100,000 per year). The incidence of cancer of the female breast has remained relatively stable (ASR 43.2 vs 40.1 per 100,000 per year). In both males and females, colon cancer incidence rates remain high at ASR of 9.9 per 100,000 per year in males and 9.4 per 100,000 per year in females. These data support the continuation of existing programmes for prevention and control of cancers of the prostate, lung, breast and cervix uteri and the introduction of new programmes specifically for cancers of the large bowel in the Jamaican population.

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The objective of this study was to examine the clinicopathologic features of gastric cancer seen at the University Hospital of the West Indies (UHWI) and to compare the findings with other studies. A retrospective study was conducted using data obtained from the surgical pathology reports of all gastrectomies and gastric biopsies during the period January 1993 and December 2002. Additional cases were identified from the Department of Surgery's audit database. Demographic, clinical and pathological features were analyzed. Two hundred and sixteen patients were identified, 126 males and 90 females. One hundred and thirty-six underwent biopsy procedures but no definitive surgery aimed at cancer eradication, while 70 had gastrectomy. The peak age prevalence in both males and females was the 70-79-year age group. While the antrum was the commonest site, there was an overall increase in tumours of the gastro-oesophageal junction and tumours of the entire stomach in the latter five-year period of the review especially in the 50-59-year age group. Epigastric pain and constitutional symptoms were the common presenting features, and the most common gross tumour characteristic was an ulcerating mass, while histologically, the intestinal variety was most common. Lymph node metastases were common. Helicobacter pylori (Hpylori) were present in 16.7while chronic multifocal atrophic gastritis was present in 40. This study indicates that the gastric cancer pattern is typical of developing countries. However, the low prevalence of H pylori in the resected specimens may indicate the importance of other risk factors for gastric cancer development in this population. This warrants further study.

El objetivo de este estudio fue examinar los aspectos clínicopatológicos del cáncer gástrico observados en el Hospital Universitario de West Indies, y comparar nuestros hallazgos con los de otros estudios. Se llevó a cabo un estudio retrospectivo usando datos obtenidos de los reportes patológicos quirúrgicos de todas las gastrectomías y biopsias gástricas durante el período de enero de 1993 y diciembre de 2002. Se identificaron casos adicionales de la base de datos de auditoría del Departamento de Cirugía. Se analizaron aspectos demográficos, clínicos y patológicos. Se identificaron doscientos dieciséis pacientes, 126 hombres y 90 mujeres. Ciento treinta y seis fueron sometidos a procedimientos de biopsia, pero no se realizó ninguna cirugía definitiva encaminada a la erradicación del cáncer, en tanto que a setenta se les practicó gastrectomía. La prevalencia de edad pico tanto en hombres como mujeres fue el grupo de 70–79 años. Si bien el antro gástrico fue el sitio más común, hubo un aumento general en tumores de la unión gastroesofágica y tumores de todo el estómago en el último período quinquenal de la revisión especialmente en el grupo de 50–59 años de edad. El dolor epigástrico y los síntomas constitucionales fueron los síntomas más comunes que se presentaron, y la característica más común del tumor macroscópico fue una masa ulcerosa, mientras que histológicamente la variedad intestinal fue más común. Fueron comunes las metástasis del nódulo linfático. Helicobacter pylori (H pylori) estuvieron presentes en el 16.7 %, en tanto que la gastritis crónica atrófica multifocal estuvo presente en el 40%. Este estudio indica que nuestro patrón de cáncer gástrico es típico de los países en vías de desarrollo. Sin embargo, la baja prevalencia de H pylori en nuestros especímenes resecados, pueden ser un índice de la importancia de otros factores de riesgo tales como fumar, el uso consuetudinario del alcohol, o la dieta, en relación con el desarrollo del cáncer en nuestra población. Esto merece un estudio ulterior.

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The objective of this study was to examine the clinicopathologic features of gastric cancer seen at the University Hospital of the West Indies (UHWI) and to compare the findings with other studies. A retrospective study was conducted using data obtained from the surgical pathology reports of all gastrectomies and gastric biopsies during the period January 1993 and December 2002. Additional cases were identified from the Department of Surgery's audit database. Demographic, clinical and pathological features were analyzed. Two hundred and sixteen patients were identified, 126 males and 90 females. One hundred and thirty-six underwent biopsy procedures but no definitive surgery aimed at cancer eradication, while 70 had gastrectomy. The peak age prevalence in both males and females was the 70-79-year age group. While the antrum was the commonest site, there was an overall increase in tumours of the gastro-oesophageal junction and tumours of the entire stomach in the latter five-year period of the review especially in the 50-59-year age group. Epigastric pain and constitutional symptoms were the common presenting features, and the most common gross tumour characteristic was an ulcerating mass, while histologically, the intestinal variety was most common. Lymph node metastases were common. Helicobacter pylori (Hpylori) were present in 16.7% while chronic multifocal atrophic gastritis was present in 40%. This study indicates that the gastric cancer pattern is typical of developing countries. However, the low prevalence of H pylori in the resected specimens may indicate the importance of other risk factors for gastric cancer development in this population. This warrants further study.

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AIMS: It has previously been shown that the low necropsy request rate at the University Hospital of the West Indies (UHWI) in Jamaica (35.3%) results primarily from clinicians' confidence in clinical diagnoses and laboratory investigations. This study aimed to determine the rates of discrepancy between clinical and necropsy diagnoses at the UHWI, because many previous studies from other institutions have shown persistent high rates of discrepancy, despite advances in medical investigative technology over the past several years. METHODS: Data were extracted retrospectively from consecutive necropsies performed at the UHWI over a two year period. The data were analysed to determine the categories and rates of discrepancy, and to determine the relation between discrepancy rates and age, sex, type and number of diagnoses for each patient, hospital service, and length of hospitalisation. RESULTS: Necropsies were performed on 446 patients; 348 were suitable for further analysis. The overall discrepancy rate was 48.4% and the diagnoses with the highest individual discrepancy rates were pneumonia (73.5%), pulmonary thromboembolism (68.3%), and myocardial infarction (66.7%). Males and older patients were more likely to have discrepant diagnoses. There was a high frequency of discrepancies in patients who died within 24 hours of admission, but there was no consistent relation between length of hospitalisation and discrepancy rate. CONCLUSIONS: The high discrepancy rates documented at the UHWI are similar to those reported globally. This study supports previous attestations that the necropsy remains a vital tool for determining diagnostic accuracy, despite modern modalities of clinical investigation and diagnosis.

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This paper presents a case of the very rare multiple endocrine neoplasia Type 2B syndrome. It highlights that because of the presence of superficial neuromas in this condition, there is the possibility for early diagnosis. Recent knowledge of the molecular genetics of this syndrome and the ability to screen family members is also stressed since early thyroidectomy is now recommended to prevent the development of thyroid carcinoma which is the main determinant of prognosis

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AIM: To investigate necropsy request practices at the University Hospital of the West Indies, Jamaica, to determine the extent to which these might influence the declining necropsy rates. This is the first such study from a developing country. METHODS: The necropsy service was audited prospectively over a six month period, and data relating to non-coroner's (hospital) necropsy requests, including the clinical service and post of the clinician involved, were documented. The reasons for non-request were recorded for deaths in which a necropsy was not requested, in addition to the reasons given by pathologists for not performing necropsies in cases that were requested but not done. The overall, non-coroner's, and coroner's necropsy rates in addition to the non-coroner's necropsy request and success rates were calculated. RESULTS: There were 364 deaths comprising 323 non-coroner's and 41 coroner's cases. The overall, non-coroner's, and coroner's necropsy rates were 29.2%, 20.2%, and 38.7%, respectively. The non-coroner's necropsy request rate was 35.3% with a success rate of 65%. Seventy five per cent of the requests were made by non-consultant clinicians and on the internal medicine service, which accounted for most of the non-coroner's deaths; necropsy requests were biased towards younger patients (p < 0.0001). Confident clinical diagnosis was the main reason for not requesting a necropsy, and the primary reason for refusing to perform a necropsy was that the request had been made too long after death. CONCLUSIONS: These findings show a relatively high necropsy success rate in the face of a comparatively low necropsy request rate, and indicate that necropsy rates can be increased if clinicians make more necropsy requests in a timely manner in patients of all ages.

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