Aim: A retrospective study of adult autopsies and its value in a French university hospital.
Introduction: Despite its decline, the medical autopsy remains a major diagnostic tool to understand death mechanisms and to improve the quality of cares.
Objectives: Our purpose is to assess the current motivations of hospital autopsy demands, to analyze the concerned patients' medical characteristics, to determine the contribution of these with regard to the clinicians' questioning and to put the light on its limits.
Material and methods: We reviewed the demands of adults' autopsies made in our hospital center between November 2005 and June 2008.
Results: Eighteen demands were sent during the considered period. More than half of these demands came from intensive care units, and had for main motivations to eliminate diagnostic hypotheses or to understand the fast lethal evolution in spite of the administered treatments. The median duration of hospitalization before death was about 12 days. The average age of the patients was about 61 years. These patients had suffered on average three important pathological histories before their admittance at the hospital, which were directly responsible for the death in 56% of the observations. The autopsy allowed to establish a diagnosis in 10 cases, to complete a diagnosis in five observations and to confirm a diagnosis in four cases. The absences of diagnoses are especially due to the fast degradation of the patients' state before the realization of the adapted additional examinations. The diagnostic errors concern pathologies with a poor specific or atypical semiology, or when there is one intricacy of important pathologies.
Conclusion: The autopsy remains a contributory examination in the reviews of morbimortality and in the improvement of the care. However, for its results to be useful, they have to join a critical multidisciplinary discussion.