The Value of Autopsy
The Value of Autopsy
“Whether a death is criminal or natural, an autopsy can confirm the cause and reveal valuable medical information.”
By Brian Berkenstock
When someone dies at home or in the hospital and the death isn't part of a criminal investigation, hospital pathologists will often perform an autopsy to confirm the cause of death and to identify what other diseases are present. This is how we learned, for instance, that many older men possess some degree of prostate cancer even though they died of some other cause.
"Autopsies are important because a lot of public policy is based on cause of death," says Barbara Crain, M.D., associate professor of pathology at Johns Hopkins. "That's how we determine whether rates of cancer are up or down and where resources should be spent." It was during an autopsy that the first death from complications of AIDS was determined. Legionnaires' disease and other new and emerging diseases were also first described at autopsy.
Autopsies have added valuable information to what we know about existing health issues. "Prostate cancer and heart disease are investigated at nearly every autopsy," Dr. Crain says. "If we know, for example, that coronary artery disease is important in a particular case, we'll go through some extra testing stages during the autopsy, requesting radiographic studies. In other situations, we may need certain cultures or chemical tests to add to our understanding of how the disease progressed or contributed to the death."
In a teaching hospital, autopsies also serve an educational role. Students, residents, and faculty get to see - many for the first time - how a particular disease manifests itself in a way that can't be fully appreciated by simply reading a textbook. "Medical students, in their first exposure to an autopsy, are most surprised by what they can learn from the naked eye," Dr. Crain says. "Pneumonia looks and feels like a firm area in the lung and may look redder or paler than the rest of the lung."
Finally, an autopsy serves as the "ultimate quality control mechanism," in Dr. Crain's words. "It goes back to determining cause of death and seeing how accurate the clinical impression was," she says. That is, does the doctor's diagnosis match the pathologist's finding?
The Process
The first step is to review the medical chart. Then the doctor makes plans for the autopsy based on what was learned. An external exam comes first. "You're looking for rashes, scars, identifying marks, bedsores, any external manifestations of disease, such as jaundice or signs of rheumatoid arthritis," says Dr. Crain. "You could almost call it a dermatological exam."
Next, the pathologist opens the thoracic and abdominal cavities and examines the organs in their natural position, then removes the organs for a more thorough exam. The organs are weighed (a
heavy heart may indicate hypertension, while a smaller-than-usual organ can signal disease). Whether or not any organ looks unusual, it is dissected. (Sometimes the family of the deceased requests that organs not be removed, making it considerably harder to examine the organs, especially the deep or hidden ones.)
In a full autopsy, the brain is removed next. The incision is made in back of the scalp so that it won't be visible during an open-casket viewing. "We look at the brain for neurological diseases such as stroke and Alzheimer's disease, and also for unsuspected trauma," Dr. Crain says.
By the time she's completed this initial macroscopic exam, Dr. Crain has a pretty good idea of the underlying disease processes, at least enough to form a preliminary hypothesis about the likely cause of death. To confirm the hypothesis, and to gather more data, slides of tissue samples are often made for examination.
Commonly tested samples include blood and liver and lung sections. "In the hospital, we're looking for infections or other natural causes of death," says Dr. Crain. "Testing for drugs, alcohol and poisons doesn't usually come up as an issue in hospital cases, unless the person died right after admission."
The time it takes to complete an autopsy varies greatly. An autopsy for someone who had been in previously good health and who died of accidental trauma can take one to two hours. In a more complicated case, in which slides have to be sent for testing, the length of time grows. In general, results are completed in a couple of weeks, though complicated cases at teaching hospitals can take four to six weeks.
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