Post-mortem diagnosis: evolving a team approach

The decline in autopsy rates in the past four decades in developed countries (to less than 5% in the USA1) has paralleled continued discrepancies between clinical and autopsy diagnoses of up to 20-30%.2,3 The interconnected causes of low autopsy rates include absence of predictable funding, clinical overconfidence in diagnostic modalities, reluctance to request and undertake autopsies, decreased expertise in autopsy, a scarcity of auditable standards and mandated autopsy rates, and reluctance of families to consent to autopsy.1,4 The need for mortality data based on accurate post-mortem diagnosis of disease and identification of cause of death has increased interest in minimally or less-invasive procedures to replace or augment conventional autopsy.5 However, uncertainty about the accuracy of less-invasive diagnostic techniques for post mortems and about integration with conventional autopsy has raised concerns about whether reliable population-based determination of cause of death can be maintained.