A NATIONWIDE SURVEY OF MEDICAL EXAMINERS AND CORONERS ON DOCUMENTATION OF SUDDEN UNEXPLAINED DEATH IN EPILEPSY (SUDEP): EXTENT OF AUTOPSY PERFORMANCE BY PROFESSIONAL TITLE AND COMMUNITY LOCATION
Abstract number :
2.015
Submission category :
Year :
2003
Submission ID :
1850
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Paul L. Schraeder, Kristen M. Delin, Robyn L. McClelland, Elson L. So Department of Neurology, Drexel University College of Medicine, Philadelphia, PA; Clinical Effectiveness Quality Improvement, Jefferson Health System, Main Line Health, Bryn Mawr, PA; D
We determined the extent and quality of autopsies on persons with epilepsy by utilizing a national survey of coroners and medical examiners. Data on the incidence of SUDEP based on death certificates are of variable accuracy. This survey attempts to determine postmortem quality in persons with epilepsy. We analyzed the approach to the autopsy procedure as a function of professional title and of location (urban vs. non-urban) of the examiner.
A survey form developed with the assistance of the Survey Research Center of the Mayo Clinic was sent to all 2997 medical examiners and coroners. We determined whether the following data were documented as part of the autopsy procedure: death witnessed, cardiac history, medication use, tongue, lip, and buccal mucosal bites, organ weights, brain examination, consultation with a neuropatholgist, tissue histology, and toxicological examination.
Of 510 responses received, 292 (57%) acknowledged encountering cases with epilepsy. Only 31% of respondents who routinely encountered persons with epilepsy used the SUDEP diagnosis in more than half of the cases in which autopsy revealed no cause of death. However pathologists tended to use the diagnosis of Definite SUDEP more frequently than others. The postmortem results by professional title of the survey respondent indicate that there was no significant difference between pathologists and non-pathologists in obtaining history of premorbid events, examining the victim for signs of injury, examining the brain, the thoroughness of the autopsy, and conducting a histological examination. Pathologists were more likely to consult a neuropathologist than were non-pathologists. There was no difference in the frequency of performing histological examinations or in the extent of the postmortem examination between urban and non-urban settings. Pathologists more frequently test for anticonvulsant and psychotrophic drug concentrations.
In general, the type and the extent of postmortem examination in persons with epilepsy do not vary significantly by professional title or by location (urban vs. non-urban) of the examiner. Pathologists more frequently consult a neuropathologist, and more frequently test for anticonvulsant and psychotrophic drug concentrations. They were also more likely to use the category of Definite SUDEP as a diagnosis.
[Supported by: Grant from the Albert Einstein Foundation, Philadelphia, PA, and the Mayo Foundation, Rochester, MN.]