UC's Clinical Autopsies Aid the Living
Published August 2006
Usually associated by the public with TV whodunits, most autopsies have little to do with crime. Unlike “forensic” autopsies at the Hamilton County Coroner’s Office, which seek clues in murder or suspicious cases or the cause of death in accidents, medical autopsies performed by UC pathologists yield information that benefits the living.
The results of the painstakingly careful procedures provide not only peace of mind, but also invaluable health-related information—such as identification of hereditable or contagious diseases—for surviving family members. An autopsy also significantly contributes to medical education and improvement of care.
The pathology and laboratory medicine department’s morgue recently moved from its 30-yearold facilities on the first floor of the Medical Sciences Building to new, state-of-the-art space on the R-level.
The new facilities, which include the latest adjustable tables, improved lighting and negative atmospheric pressure to keep airborne pathogens inside the unit, provide workspace for about 10 pathologists, 12 pathology residents and support staff.
The morgue staff does about 100 autopsies a year for University Hospital and other Health Alliance hospitals, as well as for other facilities in the region, mostly Ohio hospitals and nursing homes.
Like any medical procedure, an autopsy requires informed consent from the family or next of kin. When families receive adequate information about its importance, says Roger Smith, MD, attending pathologist and professor emeritus, they usually agree to an autopsy,a nd an increasing number (now 15 to 20 percent) are doing so.
“An autopsy actually helps in grieving,” says Smith, “by answering questions about whether the
patient received the needed care, and whether there were factors we didn’t know about. There are many emotional uncertainties when a loved one dies, and an autopsy helps alleviate them.”
“As pathologists we also want to know about other conditions,” adds Patricia Revelo, MD, director of autopsy services. “Alzheimer’s disease, for example, can’t be definitively diagnosed clinically. A lot of conditions look like it. In fact, 20 to 30 percent of diagnosed patients don’t have Alzheimer’s at all, but some other neurodegenerative or vascular disease.”
Since Alzheimer’s runs in families, she says, proper diagnosis can result in surviving children and other family members getting timely genetic counseling or treatment.
A main difference between a forensic autopsy and a clinical autopsy, says Revelo, is that “we do a lot more tissue-section studies and other supplementary testing.
“We spend more time looking at charts and talking to physicians, getting medical history, trying to determine the hospital course and establishing clinical-pathological correlations.”
The average autopsy at UC takes at least six to eight hours, Revelo explains. The dissection itself requires about two hours. The rest of the time is spent studying the sampled tissues and then writing a detailed report for the clinicians involved in the patient’s care.
“It’s hard work, but it’s necessary,” says Smith. “Even today’s sophisticated imaging technology doesn’t provide all the answers.”