COMPARAISON DE DEUX SERIES D'AUTOPSIES, OBSERVEES AU JOHNS HOPKINS MEDICAL INSTITUTIONS, BALTIMORE (JHMI) ET A L'INSTITUT NEUCHATELOIS D'ANATOMIE PATHOLOGIQUE (INAP)

We are reporting the first results of a comparative study of 100 consecutive autopsies and their clinical diagnoses, observed at the Johns Hopkins Medical Institutions (JHMI) and at the Institut Neuchatelois d'Anatomie Pathologique (INAP). The diagnoses of the two series were coded according to the two different systems used currently at the two institutions. The data from Baltimore were automatically classified by a special 'key word method' using the categories of the Index Medicus (MeSH = Medical subject headings). We proceeded then to a second recording by SNOMED codes, introduced into the computer system in the same way as we document the autopsy diagnoses in Neuchatel. The two series could be compared in detail according to topographical, morphological and aetiological parameters. The over-all repartition of the examined cases shows a higher incidence of newborns in Baltimore (23), in Neuchatel we observed only 7 newborn autopsies. The mean age was inferior in Baltimore (males: 53.5 years for JHMI, 73.1 years for INAP; females: 58.4 years for JHMI, 66.2 years for INAP). The number of diagnoses per autopsy was 31.9 at JHMI, and 50.1 in Neuchatel. The topographical distribution of clinical and autopsy diagnoses showed a higher frequency of central nervous system lesions in JHMI which might be explained by the activity of a neuropathological division. Findings concerning the morphological categories revealed a higher frequency in JHMI for traumatic abnormalities (7.2% vs 2.5%), malformations (4.3% vs 0.8%), whereas inflammation and fibrosis and degenerative lesions were more often encountered in Neuchatel. The differences in morphological observations could be attributed to a higher proportion of newborn cases in JHMI with complex malformation syndromes. Surgical complications are documented as traumatic lesions, and there were some observations of serious accidents which are rarely seen (or autopsied) in Neuchatel. The analysis of identified aetiological factors indicates for JHMI a higher frequency of infectious diseases (including especially mycoses), side effects of drugs and surgical complications and heavy smokers. In Neuchatel, one is impressed by the frequency of lesions connected with chronic alcoholism. We think that some of the stated differences are related to the more selective practice of autopsies at JHMI, there were several cases of brain autopsies without examination of the whole body. The severity of medical and surgical complications might be attributed to the high incidence of complex observations (transplant of heart, liver and bone marrow) with immunosuppressive treatment. Our first results illustrate thus the influence of the selection of autopsy cases and of the standard of medical practice.