15283-B-Blokker

203 A SUMMARY The autopsy is a post-mortem investigation that ismainly used for identifying the cause of death. Besides that, it also fulfills other important roles in today’s clinical practice. For example, by providing feedback on diagnostics and therapies, the autopsy helps us to improve these and thus, keep up the high quality of modern medicine. Nevertheless, autopsy rates have been declining in many Western countries. To objectify the autopsy rates in the Netherlands and, by that, the severity of the decline in our country, we performed a retrospective study. In chapter 2 , we describe 35 years of Dutch national death counts and autopsy rates among adults, covering the years 1977 through 2011, and including trends per sex, age, and hospital type. We found that each year more people had died, but relatively fewer people had died in hospitals, and that even fewer deceased had been autopsied. The autopsy rates were highest among men, young patients, and patients dying in academic hospitals. The overall autopsy rates in the Netherlands declined by 0.3% per calendar year and the autopsy rates of in-hospital deceased declined even more, 0.7% per calendar year, from 31.4% to 7.7%. We wondered why the autopsy rates had declined so rapidly, and found several explanations in the literature: among others, there was overconfidence of clinicians in the advanced diagnostic techniques used clinically, and the autopsy causing disfigurement of the deceased’s body. To further investigate this, we performed a prospective observational study based on thousand questionnaires. In chapter 3 , we describe that 17.4% of our clinicians did not even request permission for autopsy, mainly because they were convinced that it would not show anything other than what was already known through pre-mortem diagnostics. Apparently in many of the other cases, clinicians did not feel the necessity of performing autopsy either, because 51% of next-of-kin did not permit autopsy for this very same reason: cause of death was already known. Only in 16.1% of cases the next-of-kin feared for disfigurement of the deceased’s body, which is less than we expected. To increase autopsy rates, the above named assumption, that the cause of death is known, which is a self-fulfilling prophecy, should be addressed. Moreover autopsy methods should be developed that require less mutilation of the deceased’s body. To evaluate whichmethods have already been developed to substitute the conventional autopsy (CA) in adults, we searched six different databases for original prospective validation studies on this topic, which we systematically reviewed. In chapter 4 , we compare sixteen different studies, of which thirteen studies investigated radiological imaging techniques, either non-invasive or minimally invasive methods. The minimally invasive autopsy techniques used CT-angiography and/or biopsies in combination with unenhanced MRI and/or CT scans, and usually performed better than the non-invasive Summary