Role of pathological autopsy in determining the cause of death in cases of unexpected clinical deterioration or medical incidents

BackgroundThe extent to which autopsies are conducted and their role in determining the cause of death has not been sufficiently examined. We aimed to evaluate the contribution of autopsy in determining the cause of death in cases of unexpected clinical deterioration or medical accidents, using data from the Japan Center for Quality Health Care database.MethodsWe analysed data from patients with unexpected clinical deterioration who required pathological autopsy between January 2010 and November 2024. Cases were categorised based on whether autopsies were performed, and the reasons for not performing autopsies were examined.ResultsIn total, 682 reports were identified. Pathological autopsies were performed in 341 patients, and the cause of death was determined in 64.2% of cases (219 patients). The cause of death remained undetermined in 25.2% of cases (86 patients) despite autopsy. Among the 341 patients in whom autopsies were not performed, the primary reason was the family refusal (81.5%, 278 patients).ConclusionsPathological autopsies are essential for determining the cause of death in cases of unexpected clinical deterioration. Family refusal was identified as the principal barrier to autopsy, whereas lack of autopsy proposal accounted for only a small proportion of cases.