Skip to main content
SpringerLink
Log in

Essential Techniques in Certain Decedent Populations

  • Chapter
  • First Online:
Autopsy in the 21st Century

  • 846 Accesses

Abstract

The autopsy has been and continues to be the gold standard for quality assurance in medicine. As new scientific and medical techniques are discovered, they do not replace the autopsy but instead enhance this valued medical procedure. Not all patients are the same, and not all postmortem examinations will be the same. Some cases present definite challenges for the autopsy pathologist. Based on the decedent, past medical history, family history, and social history, certain ancillary studies and/or special techniques should be undertaken to allow accurate certification of the cause of death. That being said, the purpose of the autopsy is more than determining why an individual died. It is also to identify any underlying congenital, hereditary, or contributory conditions or diseases, as well as to contribute to epidemiological knowledge, improve public health, and prevent injury and disease. This chapter will focus on decedent patient populations that often require a different postmortem approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sanchez H. Historical perspective on the autopsy. In: Collins KA, editor. Chapter 2 in autopsy performance and reporting. 3rd ed. Northfield: College of American Pathologists Press; 2017. p. 17–22.

    Google Scholar 

  2. Collins KA, Cina SJ, Hooper JE. Getting the most out of the autopsy: ancillary studies. In: Collins KA, editor. Chapter 28 in autopsy performance and reporting. 3rd ed. Northfield/Illinois: College of American Pathologists; 2017.

    Google Scholar 

  3. Belsey SL, Flanagan RJ. Postmortem biochemistry update: current applications. J Forensic Legal Med. 2016;40:49–57.

    Article  Google Scholar 

  4. Collins KA. Postmortem vitreous analyses. NewsPath. updated 2016. https://emedicine.medscape.com/article/1966150-overview.

  5. Palmiere C. Postmortem diagnosis of diabetes mellitus and its complications. Croat Med J. 2015;56:181–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Elisaf M, Milionis H, Siamopoulos KC. Hypomagnesemic hypokalemia and hypocalcemia: clinical and laboratory characteristics. Miner Electrolyte Metab. 1997;23(2):105–12.

    CAS  PubMed  Google Scholar 

  7. Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K. Hypokalemia in alcoholic patients. Drug Alcohol Rev. 2002;21(1):73–6.

    Article  PubMed  Google Scholar 

  8. Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC. Pathogenetic mechanisms of hypomagnesemia in alcoholic patients. J Trace Elem Med Biol. 1995;9(4):210–4.

    Article  CAS  PubMed  Google Scholar 

  9. Girard C, Scarpelli MP, Tettamanti C, Palmiere C. Postmortem evaluation of cholesterol, triglyceride, and apolipoprotein levels. Int J Legal Med. 2017;131(6):1777–82.

    Article  PubMed  Google Scholar 

  10. Schirripa ML, Scarpelli MP, Palmiere C. Mediators of inflammation of asthma: a forensic perspective. Am J Forensic Med Pathol. 2017;38(2):153–8.

    Article  PubMed  Google Scholar 

  11. Palmiere C, Bardy D, Mangin P, Werner D. Postmortem diagnosis of unsuspected diabetes mellitus. Forensic Sci Int. 2013;226(1–3):160–7.

    Article  CAS  PubMed  Google Scholar 

  12. Khuu HM, Robinson CA, Brissie RM, Konrad RJ. Postmortem diagnosis of unsuspected diabetes mellitus established by determination of decedent’s hemoglobin A1c level. J Forensic Sci. 1999;44(3):643–6.

    Article  CAS  PubMed  Google Scholar 

  13. Palmiere C, Augsburger M. The postmortem diagnosis of alcoholic ketoacidosis. Alcohol Alcohol. 2014;49(3):271–81.

    Article  CAS  PubMed  Google Scholar 

  14. Collins KA. In: Collins KA, editor. Special procedures appendix in special autopsy dissections step-by-step diagrams. Northfield: College of American Pathologists Press; 2010. p. 46–8.

    Google Scholar 

  15. Low Blood Pressure (Hypotension). Mayo clinic. www.mayoclinic.org/diseases-conditions. Mayo foundation for medical education and research, 2018. Accessed 21 Mar 2018.

  16. Maggio PM. Sepsis and septic shock. Merck manual. www.merckmanuals.com/professional/critical-care-medicine/sepsis-and-septic-shock. Accessed 21 Mar 2018.

  17. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315:801–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Marik PE, Abdalsamih MT. SIRS, qSOFA, and new sepsis definitions. J Thorac Dis. 2017;9(4):943–5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372:1629–38.

    Article  CAS  PubMed  Google Scholar 

  20. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Cooper DJ, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311(3):1308–16.

    Article  CAS  PubMed  Google Scholar 

  21. Peach BC. Implications of the new sepsis definition on research and practice. J Crit Care. 2017;38:259–62.

    Article  PubMed  Google Scholar 

  22. Balk RA. Systemic inflammatory response syndrome (SIRS): where did it come from and is it still relent today? Virulence. 2014;5(1):20–6.

    Article  PubMed  Google Scholar 

  23. Simpson SQ. New sepsis criteria: a change we should not make. Chest. 2016;149(5):1117–8.

    Article  PubMed  Google Scholar 

  24. Bell M, Collins KA. Postmortem microbiologic testing. In: Collins KA, editor. Chapter 29 in autopsy performance and reporting. 3rd ed. Northfield: College of American Pathologists Press; 2017.

    Google Scholar 

  25. Riedel S. The value of the postmortem microbiology cultures. J Clin Microbiol. 2014;52(4):1028–32.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tsokos M, Puschel K. Postmortem bacteriology in forensic pathology: diagnostic value and interpretation. Legal Med. 2001;3:15–22.

    Article  CAS  PubMed  Google Scholar 

  27. Carpenter HM, Wilkins RM. Autopsy bacteriology: review of 2,033 cases. Arch Pathol. 1964;77:73–81.

    CAS  PubMed  Google Scholar 

  28. Morris JA, Harrison LM, Partridge SM. Practical and theoretical aspect of postmortem bacteriology. Curr Diagn Pathol. 2007;13:65–74.

    Article  Google Scholar 

  29. Kavita I, Michael G, Jie W, Jaime G, Jerome L, Joseph L, Tao H. Identification of Bacteria in formalin-fixed, paraffin-embedded heart valve tissue via 16S rRNA gene nucleotide sequencing. J Clin Microbiol. 2006;44(7):2609–11.

    Article  CAS  Google Scholar 

  30. Martinez RM. Genes in your tissue: probe identification and sequencing microbial targets from formalin-fixed, paraffin-embedded tissue. Clin Microbiol Newslett. 2014;36(18):139–47.

    Article  Google Scholar 

  31. Rapid Influenza Diagnostic Tests. Centers for disease control and prevention, national center for immunization and respiratory diseases (NCIRD), Center for Disease Control and Prevention (CDC) Atlanta. https://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm. Last accessed 2018.

  32. DeBiasi RL, Tyler KL. Molecular methods for diagnosis of viral encephalitis. Clin Microbiol Rev. 2004;17(4):903–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Hans R, Marwaha N. Nucleic acid testing-benefits and constraints. Asian J Transfus Sci. 2014;8(1):2–3.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lucia HL, Kangwanpong D. Identification of dengue virus-infected cells in paraffin-embedded tissue using in situ polymerase chain reaction and DNA hybridization. J Virol Methods. 1994;48(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  35. Health, United States 2016. Table 20. US department of health and human services, center for disease control and prevention. National Center for Health Statistics. May 2017. DHHS Publication No. 2017–1232.

    Google Scholar 

  36. Collins KA, Presnell SE. Elder neglect and the pathophysiology of aging. Am J Forensic Med Pathol. 2007;28(2):157–62.

    Article  PubMed  Google Scholar 

  37. Collins KA. Elder Abuse. In: Seigel JA, Saukko PJ, editors. Chapter 171 in encyclopedia of forensic sciences. 2nd ed. Waltham: Elsevier Publishing; 2013.

    Google Scholar 

  38. Collins KA. The underweight elder: maltreatment, self-neglect, or normal aging? Acad Forensic Pathol. 2013;3(1):40–5.

    Article  Google Scholar 

  39. Howe JA, Collins KA, King PS, Yeoman C. Investigation of elder deaths. Acad Forensic Pathol. 2014;4(3):290–304.

    Article  Google Scholar 

  40. Collins KA. The negative older adult autopsy: why do they die? Acad Forensic Pathol. 2015;5(1):83–90.

    Article  Google Scholar 

  41. Collins KA. Elder maltreatment. In: Payne-James J, Byard RW, editors. Chapter 161 in encyclopedia of forensic and legal medicine. 2nd ed. Waltham: Elsevier; 2014.

    Google Scholar 

  42. National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. NPUAP, 13 Apr 2016.

    Google Scholar 

  43. Tajiri K, Shimizu Y. Liver physiology and liver diseases in the elderly. World J Gastroenterol. 2013;19(46):8459–67.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hoyert DL, Xu J. Deaths: preliminary data for 2011. Natl Vital Stat Rep. 2012;61:1–52.

    PubMed  Google Scholar 

  45. The health effects of overweight and obesity. Center for disease control and prevention. www.cdc.gov/healthyweight/effects/index.html. Accessed 21 Mar 2018.

  46. NHLBI. 2013. Managing overweight and obesity in adults: systematic evidence review from the obesity expert panel. www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/obesity-evidence-review.pdf.

  47. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. www.nhlbi.nih.gov/files/docs/guildelines/ob_gdlns.pdf. Accessed 21 Mar 2018.

  48. Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon Dam Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lancet. 2014;384(9945):755–65.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Overweight and obesity fact sheet. World Health Organization. February 2018. www.who.int/mediacentre/factsheets/fs311en.

  50. Dietz WH, Bellizzi MC. Introduction: the use of BMI to assess obesity in children. Am J Clin Nutr. 1999;70(suppl):123s–5s.

    Article  CAS  PubMed  Google Scholar 

  51. Guo SS, Roche AF, Chumlea WC, Gardner JD, Siervogel RM. The predictive value of childhood body mass index values for overweight at age 35 years. Am J Clin Nutr. 1994;59:810–9.

    Article  CAS  PubMed  Google Scholar 

  52. Hammer LD, Kraemer HC, Wilson DM, Ritter PL, Dornbusch SM. Standardized percentile curves of body mass index for children and adolescents. Am J Dis Child. 1991;145:259–63.

    CAS  PubMed  Google Scholar 

  53. Himes JH, Dietz WH. Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. Am J Clin Nutr. 1994;59:307–16.

    Article  CAS  PubMed  Google Scholar 

  54. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis. 1972;25:329–43.

    Article  CAS  PubMed  Google Scholar 

  55. Petrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G, Heymsfield SB. Body mass index as a measure of adiposity among children and adolescents: a validation study. J Pediatr. 1998;132:204–10.

    Article  Google Scholar 

  56. CDC table for calculated body mass index values for selected heights and weights for ages 2 to 20. http://www.cdc.gov/nccdphp/dnpa/bmi/00binaries/bmi-tables.pdf.

  57. Khaodhiar L, McCowen KC, Blackburn GL. Obesity and its comorbid conditions. Clin Cornerstone. 1999;2(3):17–31.

    Article  CAS  PubMed  Google Scholar 

  58. Mandel R, Loeffler AG, Salamat S, Fritsch MK. Organ weight changes associated with body mass index determined from a medical autopsy population. Am J Forensic Med Pathol. 2012;33(4):382–9.

    Article  Google Scholar 

  59. National health and nutrition examination survey. NCHS fact sheet. December 2017. National Center for Health Statistics 2017.

    Google Scholar 

  60. Peeters A, Barendregt JJ, Willekens F, Mackkenbach JP, Mamun AA, Bonneux L. Obesity in adulthood and it consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138:24–32.

    Article  PubMed  Google Scholar 

  61. Strawbridge WJ, Wallagen MI, Sherma SJ. New NHLBI clinical guidelines for obesity and overweight: will they promote health? Am J Pub Health. 2000;90:340–3.

    Article  CAS  Google Scholar 

  62. Golay A, Ybarra J. Link between obesity and type 2 diabetes. Best Pract Res Clin Endocrinol Metab. 2005;19(4):649–63.

    Article  CAS  PubMed  Google Scholar 

  63. Jauregui-Garrido B, Jauregui-Lobera I. Sudden death in eating disorders. Vasc Health Risk Manag. 2012;8:91–8.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hewitt PL, Coren S, Steel GD. Death from anorexia nervosa: age span and sex differences. Aging Ment Health. 2001;5(1):41–6.

    Article  CAS  PubMed  Google Scholar 

  65. Ratnasuriya RH, Eisler I, Szmuhter GL, Russell GF. Anorexia nervosa: outcome and prognostic factors after 20 years. Br J Psychiatry. 1991;158:495–502.

    Article  CAS  PubMed  Google Scholar 

  66. Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the national comorbidity survey replications. Biol Psychiatry. 2007;61(3):348–58.

    Article  PubMed  Google Scholar 

  67. Le Grange D, Swanson SA, Crow SJ, Merikangas KR. Eating disorder not otherwise specified presentation in the US population. Int J Eat Disord. 2012;45(5):711–8.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724–31.

    Article  PubMed  Google Scholar 

  69. Citrome L. Binge eating disorder and comorbid conditions: differential diagnosis and implications for treatment. Clin Psychiatry. 2017;78(suppl 1):9–13.

    Article  Google Scholar 

  70. Marques L, Alegria M, Becker AE, Chen C, Fang A, Chosak A, Diniz JB. Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: implications for reducing ethnic disparities in health care access for eating disorders. Int J Eat Disord. 2011;44(5):412–20.

    Article  PubMed  Google Scholar 

  71. Rushing JM, Jones LE, Carney C. Bulimia nervosa: a primary care review. Prim Care Companion J Clin Psychiatry. 2003;5(5):217–24.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Smink FRE, van Hoeken D, Hoek HW. Epidemiology for eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14(4):406–14.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Ouellette JD. Statistic on Bulimia. http://www.mirror-mirror.org/bulimia/statistics-on-bulimia.htm. Accessed 21 Mar 2018.

  74. Frati P, Busardo FP, Cipolloni L, De Dominicis E, Fineschi V. Anabolic androgenic steroid (AAS) related deaths: autoptic, histopathological and toxicological findings. Curr Neuropharmacol. 2015;13:146–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Turillazzi E, Perilli G, Di Paolo M, Neri M, Riezzo I, Fineschi V. Side effects of AAS abuse: an overview. Mini Rev Med Chem. 2011;11(5):374–89.

    Article  CAS  PubMed  Google Scholar 

  76. Montisci M, El Mazloum R, Cecchetto G, Terranova C, Ferrara SD, Thiene G, Basso C. Anabolic steroids abuse and cardiac death in athletes: morphological and toxicological findings in four fatal cases. Forensic Sci Int. 2012;217(1–3):e13–8.

    Article  CAS  PubMed  Google Scholar 

  77. Kutscher EC, Lund BC, Perry PJ. Anabolic steroids: a review for the clinician. Sports Med. 2002;32(5):285–96.

    Article  PubMed  Google Scholar 

  78. Anabolic steroids. National Institute on drug abuse. National Institutes of Health. US Department of Health and Human Services. 2016. www.drugabuse.gov.

  79. Solimini R, Rotolo MC, Mastrobattista L, Mortali C, Minutillo A, Pichini S, PAcifici R, Palmi L. Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping. Eur Rev Med Pharmocol Sci. 2017;21:7–16.

    CAS  Google Scholar 

  80. Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected errors over time. JAMA. 2003;289:2849–56.

    Article  PubMed  Google Scholar 

  81. Burton EC. The autopsy: a professional responsibility in assuring quality of care. Am J Med Qual. 2002;17:56–60.

    Article  PubMed  Google Scholar 

  82. Collins KA. Beyond the autopsy: special procedures performed postmortem. Acad Forensic Pathol. 2015;5(2):280–90.

    Article  Google Scholar 

  83. Bean SM, Nagler A, Buckley PJ. What are the pathology education requirements for all nonpathology ACGME-accredited programs in an academic center? Am J Clin Pathol. 2012;138:327–31.

    Article  PubMed  Google Scholar 

  84. Oluwasola OA, Fawole OI, Otegbayo AJ, Ogun GO, Adebamowo CA, Bamigboye AE. The autopsy: knowledge, attitude, and perceptions of doctors and relatives of the deceased. Arch Pathol Lab Med. 2009;133:78–82.

    PubMed  Google Scholar 

  85. O’Grady G. Death of the teaching autopsy. BMJ. 2003;327(7418):802–3.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Hull MJ, Nazarian RM, Wheeler AE, et al. Resident physician opinions on autopsy importance and procurement. Hum Pathol. 2007;38:342–50.

    Article  PubMed  Google Scholar 

  87. Harrington DE, Sayre EA. Managed care and measuring medical outcomes: did the rise of HOMs contribute to the fall in the autopsy rate? Soc Sci Med. 2010;70:191–8.

    Article  PubMed  Google Scholar 

  88. Lowe JA, Davis CJ. Need we revive falling autopsy rates? PAS Rep. 1977;15:1–7.

    CAS  PubMed  Google Scholar 

  89. McPhee SJ, Bottles K. Autopsy moribund art of vital science? Am J Med. 1985;78:107–13.

    Article  CAS  PubMed  Google Scholar 

  90. Heller J, Friedlander D, Celler SA. Autopsy findings as a modifier of diagnosis related group classification and hospital reimbursement. Mt Sinai J Med. 1985;52(5):311–4.

    CAS  PubMed  Google Scholar 

  91. Turnbull A, Osborn M, Nicholas N. Hospital autopsy: endangered or extinct? J Clin Pathol. 2015;0:104. http://jcp.bmj.com/. Accessed 18 Mar 2018.

    Google Scholar 

  92. Bamber AR, Quince TA. The value of postmortem experience in undergraduate medical education: current perspectives. Adv Med Educ Pract. 2015;6:159–70.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Hoyert DL. The changing profile of autopsied deaths in the United States, 1972–2007. NCHC data brief no. 67. Hyattsville: National Center for Health Statistics; 2011.

    Google Scholar 

  94. Hoyert DL, Kung HC, Xu J. Autopsy patterns in 2003. National center for health statistics. Vital Health Stat. 2007;20(32):1–27.

    Google Scholar 

  95. Xu J, Kockanek KD, Murphy SL, Tejada-Vera B. Deaths: final data for 2007, National vital statistics reports;58(19). Hyattsville: national Center for Health Statistics; 2010.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Newberry Pathology Associates, Newberry, SC, USA

    Kim A. Collins

  2. Sharing Hope South Carolina, Charleston, SC, USA

    Kim A. Collins

Authors
  1. Kim A. Collins
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Pathology, Johns Hopkins University, Baltimore, MD, USA

    Jody E. Hooper

  2. Department of Pathology & Laboratory Medicine, Zucker School of Medicine at Hofstra / Northwell, Hempstead, NY, USA

    Alex K. Williamson

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Collins, K.A. (2019). Essential Techniques in Certain Decedent Populations. In: Hooper, J., Williamson, A. (eds) Autopsy in the 21st Century. Springer, Cham. https://doi.org/10.1007/978-3-319-98373-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98373-8_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98372-1

  • Online ISBN: 978-3-319-98373-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation