15283-B-Blokker

167 General discussion 9 THE MINIMALLY INVASIVE AUTOPSY The aim of this thesis is to evaluate the current status of the conventional autopsy and its alternatives. We evaluated the trends of nationwide and in-hospital autopsy rates in the Netherlands, and the attitudes towards autopsy among clinicians and next-of-kin in our own hospital. We reviewed studies investigating the accuracy of non-invasive or minimally invasive autopsy methods for naturally deceased adults. Furthermore, we improved our own minimally invasive autopsy method, tested its performance in a large study, and explored its limitations, possibilities, and value. In this chapter I will further discuss our findings and compare them to the literature. Representativeness of our study cohort Our study cohort had only a few exclusion criteria, to ensure that the studied population would be representative for the patients dying and autopsied in our hospital. Besides the cases not included for logistic reasons, there were four cases with known infectious diseases; two cases with too large abdominal wounds; and one case with a body size that did not fit into theMRI. In one of the 100 included cases the findings at conventional autopsy (CA) after minimally invasive autopsy (MIA) necessitated a forensic autopsy and thus exclusion of the case from the cohort. Like in many other autopsy studies, 32,33,56,58,78 the ratio of male and female cases in this cohort was in favour of men. Not surprisingly, most cases came from the ICUs and ER, where often critically ill patients are treated. According to the WHO, 142 in high-income countries death is most often caused by cardiovascular disease, followed by brain (e.g. stroke) and pulmonary pathologies. In this study cohort the same organ systems were involved, however, in a different order with most patients dying from pulmonary pathology, like in our pilot study. 57 Studies performed in Finland, Denmark and Germany (Berlin) found cardiovascular pathologies as the main cause of death. 10,74 The clinically unknown major diagnoses were most often in the respiratory system. Wichmann et al. found most clinically unknown diagnoses in the cardiovascular system, however, their results are probably biased, because they enrolled cases selected towards cardiac pathology. 80 The 43% of clinically unknown diagnoses that were related to cause of death are similar to those found by autopsy in a study from 1989, although diagnostic techniques were not as advanced as today. 37 Overall, the in-hospital deceased undergoing MIA in our cohort are a fair representation of common pathology in high-income Western societies.