OBJECTIVETo determine the validity of the diagnostic evidence for deceased cases in hospitals.

METHODSAll information collected from medical records of the deceased cases in tertiary care health facilities was input into our database. Four diagnosis levels were determined based on level of diagnostic evidence: level I was based on autopsy, pathology or operative exploration, level II on physical and laboratory tests plus expert clinical judgment, level III on expert clinical judgment, level IV on postmortem assumptions. After the diagnostic evidence of each deceased case was reviewed by a panel of three experts, the diagnostic level of each diagnosis was determined.

RESULTSAmong the 2102 medical cases for verbal autopsy study, only 26 (1.24%) afforded diagnostic evidence for level III. Among the level III evidence-based cases of death, the major causes of death were cardiovascular diseases, respiratory diseases, and gastroenterological diseases. According to some special symptoms and medical histories, these cases could be diagnosed by comprehensive clinical judgment. Only one case met the criteria for level IV.

CONCLUSIONLevel I diagnostic evidence is hard to attain in China because of the traditional concept and economic restriction. The causes for 2101 deaths can be validated by level II or III diagnostic evidence.

Autopsy ; Cause of Death ; China ; Cities ; Hospitals ; standards ; Humans ; Urban Population

Autopsy ; legislation & jurisprudence ; standards ; Cause of Death ; Dissent and Disputes ; Forensic Pathology ; Humans ; Malpractice ; legislation & jurisprudence ; Medical Errors ; legislation & jurisprudence

Autopsy ; China ; Diagnosis, Differential ; Gene Expression Profiling ; Humans ; Immunohistochemistry ; Pathology ; manpower ; organization & administration ; standards ; Practice Guidelines as Topic ; Quality Control

COVID-19 has been included in Category B infectious diseases and is prevented and controlled according to Category A infectious diseases. In order to establish a diagnosis or conduct further research, a post-mortem examination may be desired on a possible COVID-19 death. To guide the personnel engaged in the autopsy to carry out the correct operation, and ensure the safety of the pathologists and disease control staffs during the epidemic, the Chinese Pathological Society, the Chinese Pathologist Association and the Pathology and Pathophysiology national key discipline at Shantou University Medical College, formulated this guidance for the autopsy for deaths associated with COVID-19 during the prevention and control period of COVID-19 in China.
Autopsy ; methods ; standards ; Betacoronavirus ; China ; Coronavirus Infections ; epidemiology ; Humans ; Infection Control ; methods ; Pandemics ; Pneumonia, Viral ; epidemiology ; Practice Guidelines as Topic

OBJECTIVE: To study reasons that the quality of medico-legal autopsy in the medical tangle varies from different area. METHODS: Collecting the cases of medical tangle in two medico-legal agencies, then counting percent of classes on the ten key-points, analyzing the data of the cases by chi-square test and t-test. RESULTS: It is indicated that the applied methods and standards of the two agencies are different. There are more different in seven keypoint of medicolegal autopsy by chi-square test. CONCLUSION Six key-points are found to be more important to medico-legal appraiser, standardization of forensic autopsy, standardization of picking up specimen from the body, diagnosis standardization of the cause of death, consultation system and standardization of writing documents on medico-legal autopsy.
Analysis of Variance ; Autopsy/standards* ; Cause of Death ; Coroners and Medical Examiners/education* ; Forensic Pathology ; Humans ; Liability, Legal ; Malpractice ; Medical Errors ; Quality Control

Recently, the special characteristics of work with SARS require particular attention to the facilities, equipment, policies and procedures involved. In fact, an autopsy also subject prosectors and others to a wide variety of hazards, including bloodborne, aerosolized pathogens and others (for example SARS). Forensic pathologists and other persons in close proximity to an autopsy need personal protective equipment, fourthemore, laboratory procedure and facility design principles of biosafety should be established for the protection of all personnal involved in the work.
Autopsy ; Forensic Pathology ; Humans ; Infection Control/methods* ; Inhalation Exposure/prevention & control* ; Masks/standards* ; Occupational Exposure/prevention & control* ; Protective Clothing/standards* ; Protective Devices/standards* ; Risk Factors ; Severe Acute Respiratory Syndrome/transmission*

OBJECTIVEEighteen to twenty-four percent of patients with infective endocarditis (IE) proved pathologically were clinically possible IE by the Duke criteria. In order to improve the sensitivity, the new criteria (trial) for the diagnosis of IE was proposed by Pediatric Cardiology Association of China and Editorial Committee of Chinese Journal of Pediatrics. The aim of this study was to evaluate and compare the value of the new criteria (trial) for the diagnosis of IE with the Duke criteria.

METHODSGroup A consisted of 193 patients proved with IE at autopsy or surgery, where the cases had the results of blood culture and echocardiography data, and Group B had 23 patients with clinical diagnosis of IE in whom evidence of IE was not found at surgery. All the above cases were collected from 15 hospitals. They were analyzed and classified by the new criteria and at the same time by the Duke criteria. The sensitivity and specificity of both criteria for the diagnosis of IE were compared.

RESULTS(1) In Group A, same microorganisms were detected twice in blood culture in 50 patients (25.9%), while 36 patients (18.7%) had only one positive blood culture. Endocardial involvement was found by echocardiography in 165 cases (85.5%), including vegetation in 160 (82.9%), perforation of aortic valve in 4 (2.1%), and partial dehiscence of ventricular septal defect (VSD) patch in one (0.5%). Vegetation appeared oscillating masses in 100 cases (62.5%). One hundred and eighty (93.3%) patients had predisposing heart conditions, and 151 (72.8%) with congenital heart diseases. Fever was revealed in 178 cases (92.2%). Vegetation or perforation of aortic valve was detected in all patients without fever. Heart failure was complicated in 91 patients, 7 of whom had no fever. Vascular phenomena including petechiae and major arterial emboli occurred in 21 and 28 cases, respectively. Among immunologic phenomena, glomerulonephritis occurred in 9, elevated rheumatoid factor in 17/25 and elevated CRP in 51/71. In Group B, the same microorganism was detected in blood culture twice in only 3 patients and 2 patients had one positive blood culture. Vegetation in tricuspid valve was found by echocardiography in one patient. (2) Ninety-four cases (48.7%) of Group A were clinically confirmed IE by the Duke criteria. The diagnosis was made on the basis of two major criteria in 42, one major and 3 minor criteria in 52.14 of 99 as possible IE were excluded by the modified Duke criteria. On the other hand, a definite diagnosis of IE was made in 156 patients (80.8%) by the new criteria. Of them, 94 met with definite criteria of the Duke criteria, 62 (32%) met with echocardiographic evidence of endocardial involvement (major criteria) and two minor criteria. No patient of Group B was clinically definite with the Duke criteria, but one patient was clinically definite with the new criteria (trial). (3) The sensitivity and specificity for the diagnosis of IE were 80.8% and 95.7%, respectively, with the new criteria (trial), 48.7% and 100%, respectively, with the Duke criteria.

CONCLUSIONWith the addition of echocardiographic evidence of endocardial involvement (major criteria) and 2 minor criteria as definite diagnostic criteria, the sensitivity of the new criteria (trial) is superior to that of the Duke criteria, but there is no significant difference in specificity for the diagnosis of IE between the two criteria.

Adolescent ; Adult ; Autopsy ; Bacteria ; isolation & purification ; Child ; Child, Preschool ; Echocardiography ; Endocarditis, Bacterial ; diagnosis ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Practice Guidelines as Topic ; standards ; Risk Factors