死後CTの導入は日常診療において従来の剖検率に悪影響を与えることなく死後検診率を向上させる：実施研究

Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study.

• Max G Mentink
• Frans C H Bakers
• Casper Mihl
• Max J Lahaye
• Roger J M W Rennenberg
• Bart G H Latten
• Bela Kubat
• Paul A M Hofman

抄録

エイム:

この実施研究の目的は、（伝統的な）剖検と死後検査率に対する死後CT（PMCT）と死後サンプリング（PMS）の効果を評価することであった。さらに、日常診療におけるPMCTとPMSの実施可能性を評価した。

AIM: The aim of this implementation study was to assess the effect of postmortem CT (PMCT) and postmortem sampling (PMS) on (traditional) autopsy and postmortem examination rates. Additionally, the feasibility of PMCT and PMS in daily practice was assessed.

方法:

23ヶ月間、内科での剖検にPMCTとPMSを追加モダリティとして使用した。近親者は123件の死後検査に同意した。剖検率はオランダ病理学レジストリから算出し、死後検査率は試験期間の前後、期間中、期間中に算出し、除外率、テーブルタイム、結果を紹介する臨床医に通知するまでの時間間隔、Multidisciplinary Mortality Review Board (MMRB)の会議までの時間間隔を客観化して、実現可能性を評価した。

METHODS: For a period of 23 months, PMCT and PMS were used as additional modalities to the autopsy at the Department of Internal Medicine. The next of kin provided consent for 123 postmortem examinations. Autopsy rates were derived from the Dutch Pathology Registry, and postmortem examination rates were calculated for the period before, during and after the study period, and the exclusion rate, table time, time interval to informing the referring clinicians with results and the time interval to the Multidisciplinary Mortality Review Board (MMRB) meeting were objectified to assess the feasibility.

結果:

死後検死率の上昇（18.8％→32.5％、p＜0.001）はあったが、検死率の低下はなかった。剖検率は実施後も大きな変化はなかった（0.2％減）。除外率は2％、テーブルタイムは23分、PMCTから紹介医と結果を話し合うまでの時間間隔は中央値で4.1時間であった。さらに、MMRB会議の80％以上が患者の死亡後8週間以内に開催されていた。

RESULTS: The postmortem examination rate increased (from 18.8% to 32.5%, p<0.001) without a decline in the autopsy rate. The autopsy rate did not change substantially after implementation (0.2% decrease). The exclusion rate was 2%, the table time was 23 min, and a median time interval of 4.1 hours between PMCT and discussing its results with the referring clinicians was observed. Additionally, more than 80% of the MMRB meetings were held within 8 weeks after the death of the patient.

結論:

我々の研究では、集学的な死後検診の導入は日常診療で実現可能であり、死後検診率を高めながらも解剖率に悪影響を与えないことを示している。

CONCLUSIONS: Our study shows that the implementation of a multidisciplinary postmortem examination is feasible in daily practice and does not adversely affect the autopsy rate, while increasing the postmortem examination rate.

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