The aims of this study were to identify: 1.) trends in pediatric autopsy rates over the last decade, 2.) concordance between antemortem and postmortem diagnoses, and 3.) characteristics influencing autopsy rates and yield of information on autopsy. All pediatric deaths between Jan. 1, 1984 and Dec. 31, 1993 were reviewed. Antemortem diagnoses were defined as those that were either established or considered sufficiently likely to initiate specific treatment prior to death. Unexpected autopsy findings were divided into four classes: Class I - major diagnoses, which if detected before death, would have likely resulted in cure or prolonged survival; Class II - major diagnoses in which antemortem detection was unlikely to change the patient's outcome; Class III - minor diagnoses contributing to the cause of death; and Class IV - diagnoses unrelated to the patient's outcome. Autopsies were obtained in 107(36%) of 297 pediatric deaths during the study period. The autopsy rate was not associated with child gender, race or insurance status. Also, autopsy rates did not change significantly between the first five years (41%) and the latter five years (32%) of the study period (X2, p=0.14). However, autopsy rates were significantly associated with age, so that the older the child, the more likely the autopsy (X2, p<.0001). Age-specific autopsy rates were: 26% in infants ≤ 12 mos. of age, 59.6% in children 13-60 mos., and 100% in children ≥ 61 mos. of age. In 66% of cases with autopsy, there was complete concordance between antemortem and postmortem diagnoses. In the remaining 34% of cases, a total of 45 new diagnoses were made at autopsy consisting of 6.5% Class I findings, 6.5% of Class II findings, 12% Class III findings, and 8.4% Class IV findings. The incidence of both major (class I, II) and minor findings (class III, IV) did not change significantly between the first and latter five years of the study (13.8 vs 12.2%, 20.6% vs 20.4%, respectively; p>.05). There was also no relationship between new findings at autopsy and either the child's age, length of hospital stay, or antemortem imaging studies. This study reveals that autopsy can provide additional information in over a third of pediatric deaths. Pediatric autopsy continues to provide clinically significant data and remains a valuable tool in modern pediatric practice.
