15283-B-Blokker

19 Autopsy rates in the Netherlands: 35 years of decline 2 INTRODUCTION Background The relevance of the clinical autopsy is well recognized; it provides bereaved relatives with information on the cause of death and clinicians with feedback on diagnosis and treatment, thus making it an important instrument for healthcare quality control. 21,22 In spite of the advanced diagnostic technologies used in modern medicine, there are still discrepancies found between clinical diagnoses and post-mortem findings 7,8,13 with a significant rate of class-I-discrepancies (major diagnoses). 10 By identifying these, the autopsy improves the accuracy of both death certificates 15 and epidemiologic databases. 19 Moreover, it contributes to medical knowledge 24 provides for evidence- based research, and is a resource for biomedical research, e.g. by procurement of normal and pathological tissues. 26 Despite these benefits, clinical autopsy rates have rapidly declined worldwide in the past decades, and alternative less invasive post- mortemmethods are currently being developed to improve or replace the conventional autopsy. 56 Several studies have shown local or national trends of autopsy rates. 22,23,32,58-61 Few studies have reported on Dutch autopsy rates 21,62 and only one study evaluated potential factors that might have influenced autopsy rates, based on a small population in the early sixties. 63 Purpose In this analysis of national statistics we describe the 35-year trends in the Netherlands of adult deaths, both in-hospital deceased patients and deaths due to external cause, and the clinical and forensic autopsy rates over the same period. We analysed the effects of age, sex and hospital type on the autopsy rates. MATERIALS AND METHODS Data collection For each year in the period of 1977 to 2011, 35 years in all, we obtained the total number of registered adult deaths, the number of in-hospital deceased adult patients, the number of deaths due to external cause, the number of clinical and forensic autopsies performed, and if available, information on age, sex and hospital category. These variables were derived from logbooks of the Netherlands Forensic Institute (NFI),