Autopsy in Barbados - abstract

Prussia, Patsy R; Martin, P

ABSTRACT

Since 1977, the status of the autopsy has been the subject of much debate. The following questions have been posed (i) Has the autopsy outlived its usefulness? (ii) Is the autopsy worth the expended effort and cost? (iii) How can the contributions of this physician service achieve their maximum usefulness and receive appropriate recognition? The College of American Pathologists' Foundation Conference has made an appeal to revitalize the autopsy. There was concern about the falling rate of autopsies in teaching hospitals. The Queen Elizabeth Hospital has been one of the hospitals involved in the Eastern Caribbean Medical Scheme since 1965. There is undergraduate and postgraduate teaching. Medical students have been doing their Pathology and Microbiology clerkships at this hospital since 1981. The morbid anatomy sub-department of Pathology also services the whole island. Is the autopsy rate at this institution, a teaching hospital, acceptable? Is maximum benefit being gained from the autopsies performed? In order to answer the above questions, the autopsy reports from the Pathology Department were reviewed for the four-year period (1979-1982). The autopsy rates were 17 percent, 14 percent, 13 percent and 16 percent respectively. The concordance score of 303 of the 400 autopsies performed during this period was calculated. Ninety-seven cases had to be excluded because of insufficient data. In 149 cases, the primary disease as diagnosed at autopsy had been recognized clinically, but in 154 cases it had not. The predominant diseases missed included sepsis, pulmonary thrombo-embolism, pulmonary oedema and gastrointestinal haemorrhage. Though the autopsy rate is low, there is a high discordant rate. The autopsy in Barbados is therefore potentially capable of improving medical care, not only through the teaching of medical students, but through the interest and involvement of the clinicians in autopsies requested (AU)