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The Autopsy, Medicine, and Mortality Statistics The Autopsy, Medicine, and 2001 Mortality Statistics October 32 Number 3, ies Ser Copyright information All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Suggested citation Hoyert D. The autopsy, medicine, and mortality statistics. National Center for Health Statistics. Vital Health Stat 3(32). 2001. Library of Congress Cataloging-in-Publication Data The autopsy, medicine & mortality statistics : an anthology of autopsy cases illustrating the value of the autopsy to the practice of medicine and the vital statistics system / Randy Hanzlick (editor) and the Autopsy Committee of the College of American Pathologists. p.; cm. — (DHHS publication ; no. (PHS) 2000-1416) (Vital and health statistics. Series 3, Analytical and epidemiological studies ; no. 32) ‘‘Articles previously published separately in archives of internal medicine’’—T.p. ‘‘August, 2001’’—T.p. Includes bibliographical references and index. ISBN 0-8406-0572-2 1. Autopsy—Case studies. I. Title: Autopsy, medicine, and mortality statistics. II. Hanzlick, Randy. III. College of American Pathologists. Autopsy Committee. IV. Archives of internal medicine. V. Series. VI. Vital & health statistics. Series 3, Analytical and epidemiological studies ; no. 32 [DNLM: 1. Autopsy—United States—Case Report. 2. Autopsy—United States—Collected Works. 3. Cause of Death—United States—Case Report. 4. Cause of Death—United States—Collected Works. W2 A N148vc no. 32 2001] RB57 .A89 2001 616.07'59—dc21 2001044077 [362.18′0973] 2001044051 For sale by the U.S. Government Printing Office Superintendent of Documents Mail Stop: SSOP Washington, DC 20402-9328 Printed on acid-free paper. Series 3, Number 32 The Autopsy, Medicine, and Mortality Statistics Articles previously published separately in Archives of Internal Medicine. Randy Hanzlick, M.D. (Editor) and the Autopsy Committee of the College of American Pathologists. Produced with Permission of the Archives of Internal Medicine and the American Medical Association. Published by the National Center for Health Statistics. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Hyattsville, Maryland October 2001 DHHS Publication No. (PHS) 2001-1416 National Center for Health Statistics Edward J. Sondik, Ph.D., Director Jack R. Anderson, Deputy Director Jack R. Anderson, Acting Associate Director for International Statistics Jennifer H. Madans, Ph.D., Associate Director for Science Lawrence H. Cox, Ph.D., Associate Director for Research and Methodology Jennifer H. Madans, Ph.D., Acting Associate Director for Analysis, Epidemiology, and Health Promotion Edward L. Hunter, Associate Director for Planning, Budget, and Legislation Jennifer H. Madans, Ph.D., Acting Associate Director for Vital and Health Statistics Systems Douglas L. Zinn, Acting Associate Director for Management Charles J. Rothwell, Associate Director for Information Technology and Services Division of Vital Statistics Mary Anne Freedman, M.A., Director James A. Weed, Ph.D., Deputy Director James A. Weed, Ph.D., Acting Chief, Mortality Statistics Branch The Autopsy Committee of the College of American Pathologists The year 2001 charge statement for the Autopsy Committee of the College of American Pathologists is: ‘‘To improve the performance and reporting of the autopsy and to promote utilization of the autopsy for quality improvement, research, education, and public health.’’ Individuals who were members of the Autopsy Committee during the preparation of the material in this publication include: Pamela Amato (CAP staff) Dean Havlik, M.D. Peter Baker, M.D. Grover Hutchins, M.D. Johannes Bjornsson, M.D. Eun Young Lee, M.D. Kevin Bove, M.D. Larry Nichols, M.D. John Buchino, M.D. Joseph Parisi, M.D. Steven Campman, M.D. John Sinard, M.D., Ph.D. Kim Collins, M.D. J. Thomas Stocker, M.D. Gregory J. Davis, M.D. Jessica Troup, M.T. (CAP staff) Marcella Fierro, M.D. Keith Volmar, M.D. Stephen Geller, M.D. Nancy Young, M.D. Randy Hanzlick, M.D. Contributing Authors Individuals who served as an author for the case studies presented in this publication include: Peter Baker, M.D. Rebecca Irvine, M.D. Allan Bennett, M.D. Eric Kiesel, M.D., Ph.D. Johannes Bjornsson, M.D. Eun Young Lee, M.D. Michael Cibull, M.D. Jeff Lee, D.O. Kim Collins, M.D. Julio Martinez, M.D. Linda Dallasta, M.D., Ph.D. Jesse McKenney, M.D. Amanda Davis, M.D. Mario Mosunjac, M.D. Gregory J. Davis, M.D. Clay Nichols, M.D. Angela Fields, M.D., Ph.D. Larry Nichols, M.D. Randy Hanzlick, M.D. Eric Pfeiffer, M.D. Dean Havlik, M.D. Ann Smith, M.D. Charles Hill, M.D. Wilbur Williams, M.D. Grover Hutchins, M.D. iii Foreword Comments from the National Center for Health Statistics The series of articles in this report document the value of provides additional examples of cause-of-death autopsy in health care and health statistics and provides statements to supplement those available educational information about completing cause-of-death from State and Federal vital statistics programs statements. Autopsy information has long been an essential (e.g., http://www.cdc.gov/nchs/about/major/dvs/handbk.htm). tool for quality control of medical care and for enhancing the Dr. Hanzlick, the editor of the report, continues his quality of cause-of-death information reported on the death important contribution to the National Vital Statistics System certificate. Recognizing that the use of autopsy has declined and in particular to the quality of national mortality data. considerably in the past 50 years as documented in vital NCHS is pleased to assist the College of American statistics, the autopsy is nevertheless regarded as an important Pathologists in promoting the distribution of these articles, tool in medical practice and in improving the cause-of-death which previously appeared in Archives of Internal Medicine. data. An ample body of literature shows not only the medical values of autopsy, but also its importance in bench marking the quality of cause-of-death data. Harry M. Rosenberg, Ph.D. Death certificate information is a major source of Special Assistant statistical data to identify public health problems, to monitor Division of Vital Statistics progress in public health, to allocate research funds, and to National Center for Health Statistics conduct scientific research. For these reasons, good reporting Centers for Disease Control and Prevention of cause of death is very important. The articles illustrate many of the basic principles in cause-of-death reporting: intellectual process of determining the best medical opinion of Donna L. Hoyert, Ph.D. cause of death, separation of contributing causes in Part 2 of Statistician (Demographer) the medical certification from the sequence of conditions Mortality Statistics Branch reported in Part 1, report of a single condition per line, Division of Vital Statistics avoidance of abbreviations, and amendment of the record if National Center for Health Statistics additional information becomes available later. This report Centers for Disease Control and Prevention iv Preface Finally, the committee wishes to thank Joe Schramm, Ayrika Gunn, and Jessica Troup of the CAP for their he Autopsy Committee of the dedicated service in producing the draft College of American Pathologists for publication. T undertook the ‘‘Autopsy and The Autopsy Committee feels that Medicine’’ series in 1997 with two this publication will be especially useful major goals in mind: for the following individuals: + To illustrate the continued value of + Physicians in medical specialties in the autopsy to the practice of which the deaths of some patients medicine; and will occur, making knowledge of the + To provide educational material and autopsy and cause-of-death discussion concerning cause-of-death statements a desired attribute; statements and completion of the + Pathologists and other physicians death certificate. who have a need to educate others on the value of the autopsy; and These goals arose out of recognition + Legislators and policy makers whose that autopsy rates in the United States, duties include analysis of the especially in medical institutions, had autopsy and its role in the practice fallen to unacceptable levels for quality of medicine and public health. assurance/improvement purposes. Studies also show a need for improving Authors who reference the articles our national mortality data derived from included in this publication should cite death certificates, which, in turn, should the original reference from Archives of reflect information obtained at autopsy. Internal Medicine when possible. The committee is grateful to Dr. Complete references are included in James Dalen, Editor of Archives of ‘‘Wrapping Things Up,’’ the last case Internal Medicine, who agreed to report in this collection. publish the series which began in August of 1997 and ran through November 2000. Twenty-nine case reports and one summary article were published during that time. The committee also wishes to thank Archives of Internal Medicine and The American Medical Association for authorizing reproduction of the articles that appear in the Autopsy and Medicine Series. Some of the articles have been edited slightly or given subtitles since their original publication. Also deserving thanks is the National Center for Health Statistics (NCHS), which agreed to print the series as a freestanding publication. Comments from NCHS are printed on the following
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