Autopsies in trauma do not add to peer review or quality assurance

The literature supports the concept that autopsies are useful in uncovering missed injuries or undiagnosed conditions that contribute to death after injury, especially late deaths that take place in the intensive care unit. Review of autopsies are also used as part of the trauma quality assurance (QA) process, and autopsy rates are queried by the American College of Surgeons Committee on Trauma in their reviews. Our hypothesis was that autopsies add little useful clinical or diagnostic information compared with QA peer review analysis in a mature trauma program.

Autopsies for all mortalities at a Level I trauma center between January 1998 and October 1999 were reviewed. The autopsies were reviewed in a "blinded" fashion such that each review occurred before examination of the chart, the trauma registry, and the findings of the trauma QA peer review. Findings from all sources were compared and examined for Goldman type errors (I-IV).

Two hundred sixty-three mortalities were identified, with 216 autopsies reviewed. One hundred two (39%) mortalities were considered dead on arrival to the trauma center by QA review, with no management errors identified (group 1) (Immediate Death group). Sixty-one patients survived more than 48 hours after injury (group 2). One hundred sixty-one (61%) patients were admitted to the hospital. Ninety-nine patients died within 48 hours (Early Death group) and 62 died between 2 and 143 days (Late Death group). There were no Goldman type I errors (major diagnostic discrepancies that might have influenced mortality) identified in either group. Autopsy data did uncover one potentially technical error in a death that was considered nonpreventable on peer review analysis.

We conclude that autopsy information for either group appeared to add little useful information to the QA peer review of deaths in a mature trauma program. This was true even in cases where the final QA determination was held pending the results of the autopsy. Autopsy rates may not be a useful parameter in evaluating a trauma QA program.