Child/Adolescent Health

Pediatric autopsies shed more light on cause of death in more than half of cases

Bereaved parents are often reluctant to allow autopsies of their children. However, a new study finds that pediatric autopsies often shed light on the actual cause of death, and can affect parents' decisions about their living and future children.

Researchers at the University of Pennsylvania School of Medicine studied autopsy records of 100 children between the age of 1 and 24, who died at the Children's Hospital of Philadelphia between 2003 and 2004. In more than half the cases (53 percent), autopsies were able to clarify why the child died. For example, when a child died of a metabolic disorder (50 percent) or cancer (40 percent), the autopsy gave parents a clearer explanation for why their child died. Having this information also enabled 20 percent of the parents to make more informed decisions about having future children and to discuss the implications of having children with their surviving children.

Hospitals also benefited from autopsy results, especially in cardiac cases or when a metabolic or genetic diagnosis was difficult. In those cases, autopsy data provided insight into quality assurance and quality control processes (36 percent) or resulted in published articles that expanded the knowledge base about a condition (7 percent). The authors state that clinicians and pathologists, by partnering routinely to review autopsy results and communicating the results to parents, may also be able to identify ways to improve care quality at their institution.

The authors recommend that when clinicians are in the uncomfortable position of recommending an autopsy, they rely less on cold percentages and communicate in ways parents understand, such as natural frequencies. For example, clinicians should say one of every two—not 50 percent of—autopsies give parents more information on the cause of their child's death. This study was funded in part by the Agency for Healthcare Research and Quality (HS00002).

See "What new information pediatric autopsies can provide: A retrospective evaluation of 100 consecutive autopsies using family-centered criteria," by James A. Feinstein, M.D., Linda M. Ernst, M.D., Jaya Ganesh, M.D., and Chris Feudtner, M.D., Ph.D., M.P.H., in the December 2007 Archives of Pediatric and Adolescent Medicine 161(12), pp. 1190-1196.

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