D. Scantling1, R. Kucejko1, A. Teichman1, B. McCracken1, R. Burns1, J. Eakins2 1Hahnemann University Hospital/Drexel University College Of Medicine,Surgery,Philadelphia, PA, USA 2Atlanticare,Trauma,Atlantic City, NJ, USA
Introduction:
Missing a life threatening injury is a persistent concern in any trauma program. Autopsy is routinely utilized to determine an otherwise occult cause of death in medicine. It has been adopted as a required component of the trauma peer review process by both the American College of Surgeons and the Pennsylvania Trauma Foundation.
Methods:
A retrospective chart review using our institutional trauma registry of all trauma deaths between January 2012 and December 2015 was performed. Per the protocol of our Level 1 center, all trauma deaths are referred to the medical examiner (ME) and all autopsy results are evaluated with ISS, TRISS, nature of death, injuries added by autopsy and referral to peer review noted. Results were compared with chi square calculation.
Results:
173 patient deaths were referred to the ME with 123 responses received. Average LOS was 2.61 days. 26 patients had autopsy declined by the ME, 25 received an external examination only and 72 received a full autopsy. Autopsy identified one case referred to peer review (p=0.603), however the previous preventability determination was not affected. No preventable cause of death uncovered. Autopsy did identify injuries in 7 cases that initially did not have findings consistent with expected death (p=.022). Mean ISS was 31.64 and mean TRISS was 0.35 among all patients. The most commonly identified injuries added by autopsy were ICH, lung injuries, rib injury, extremity fractures, liver injuries and cardiac injuries (n=36, 32, 32, 19, 13 respectively).
Conclusion:
Inclusion of autopsy in the peer review process does not identify causes of preventable death in an otherwise highly functioning trauma program and may be a poor use of institutional resources. It does add data regarding cause of death when external injuries are not consistent with a fatal wound and may be of use to grieving families and in select situations.