Pre-Registration Not Required — Open to All Meeting Attendees
ES1 Adding Forensic Relevance to the Pediatric Autopsy With Defined Preautopsy Goals and Practical Techniques Using a Case-Based Approach
Tuesday February 19, 2019
8:00 p.m. – 10:00 p.m.
|Michael J. Caplan, MD*
Suffolk County Office of the Medical Examiner
|Amy T. Sheil, MD*
Waukesha County Medical Examiner’s Office
Learning Overview: After attending this presentation, attendees will be able to: (1) describe the purpose of the autopsy in the evaluation of sudden unexplained or unexpected deaths in the setting of pediatric cardiac conditions (including therapeutic interventions and their complications); (2) highlight the added benefits of an autopsy when accompanied by ancillary studies in the evaluation of sudden unexplained deaths in infants and children with undiagnosed infectious diseases or metabolic or genetic disorders; (3) identify mimics of child maltreatment (abuse and neglect) revealed by postmortem examination; (4) describe and guide an approach to a pediatric autopsy in a death during or following (and potentially related to) a therapeutic procedure; (5) effectively communicate the value of the negative findings in a pediatric autopsy (“negative autopsy”) to clinicians and families; (6) improve their own institution’s autopsy practices through learning points gleaned by exposure to case-based examples; and (7) gain experience and proficiency with particular techniques relevant to the pediatric autopsy through use of a supplementary tutorial of specialized autopsy procedures and dissections.
Impact on the Forensic Science Community: This presentation will impact the forensic science community by improving attitudes and practices regarding autopsies and by making the pediatric autopsy a more useful and serviceable tool for the consumers of the information imparted by the autopsy. The two primary goals of the presentation are to: (1) provide an initiative to enhance the practical value (diagnostic and educational yield) of a pediatric autopsy; and (2) apply the lessons gleaned from the autopsy to improve patient outcomes and reduce risks of recurrence of adverse outcomes.
Autopsy training in pathology residency varies greatly among teaching institutions, and resources including case material and faculty time are unevenly distributed. With diminishing numbers of hospital autopsies, including pediatric and perinatal autopsies, the opportunity for pediatric pathologists to gain proficiency and competence in performing autopsies has become more limited. Many pathologists in practice perform too few autopsies to maintain optimal skills and practices. Increasing reliance upon pathologists’ assistants to conduct gross examinations further restricts the experience of practicing pathologists. There exists a real risk among pediatric pathologists of insufficient ongoing experience with pediatric autopsies. There is also a tendency to include data in the body of the autopsy report that has limited clinical significance or that is incompletely addressed. All of these factors conspire to undermine the potential value and utility of the pediatric autopsy in clinical practice. These issues illustrate gaps in practice experience and current knowledge. There exists a definite need to provide education for practicing pediatric pathologists to enhance the clinical usefulness and relevance of autopsy reports. Forensic pathologists are in a potentially advantageous position to help pediatric pathologists with this challenge because, since autopsies are the mainstay of their primary activities, they understand the practical importance of delivering meaning and relevance to individuals to whom they need to present their findings in various medicolegal settings. The ultimate goal of this presentation is to facilitate communication and crosstalk between forensic and pediatric pathologists in order to achieve optimal benefits of pediatric autopsy results.