15283-B-Blokker

26 Chapter 2 Despite these and other policy differences, the general trend is declining autopsy rates. To illustrate this, we plotted national autopsy rates of Western European countries during the investigated time period, using overall autopsy rates collected from the WHO European Health Information Gateway, including deceased under 18 years of age (Fig 3, S3 Table). Since we included adult cases only, our clinical autopsy rates are somewhat different from those reported in the literature. Fetuses and neonates are usually more often autopsied than adults. 77 Autopsy rates were consistently higher for men than women. This phenomenon is also seen in other studies 58,78 and one could wonder why. Is it because men are usually younger than women, when they die? Do we try harder to explain the cause of death in men than that in women? Are bereaved wives more willing to give consent, than bereaved husbands? Thatautopsyrateswerehigherinacademichospitalsthaninnon-academichospitalswas expected. 61,73 Patients in academic hospitals generally have more complex pathologies than those in non-academic hospitals. If such patients die, it is more likely that the clinicians (and next-of-kin) feel the need for post-mortem investigation. In addition, academic doctors might have a more active approach to (further) investigation, than specialists in non-academic hospitals. Also, the teaching and research responsibilities in the academic hospital are probably in favour of autopsies. Various other explanations for the (worldwide) declining autopsy rates have been mentioned, such as religious or cultural convictions of both doctors and next-of- kin, funeral delay, fear for mutilation of the deceased’s body, absence of a defined minimum autopsy rate, cost reduction policies, pathologist’s resistance to autopsy, adverse media attention 22,24,38,40 and improved pre-mortem diagnostic techniques. It is generally assumed that the decline of autopsy rates in the recent years was speeded up by the improved diagnostic value of the imaging techniques. In our study, however, linear regression showed the largest decline of clinical autopsy rates in the first time period (1977-1988), when the two revolutionary new imaging techniques had not yet been implemented in Dutch hospitals. In the seventies ultrasound and endoscopic techniques were introduced in clinical practice, but due to restrictive governmental policies, computed tomography (CT) was introduced relatively late. Only since the late eighties all radiology departments in Dutch hospitals had a CT- scan, and at that same time magnetic resonance imaging (MRI) was introduced. 79 We hypothesize that the imaging techniques improved along with many other diagnostic techniques, and that together they may have led to the phenomenon of overconfident