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March 24, 1993

Temporal and Geographic Trends in the Autopsy Frequency of Blunt and Penetrating Trauma Deaths in the United States

Author Affiliations

From the National Center for Injury Prevention and Control (Drs Pollock and Annest and Ms O'Neil) and the National Center for Environmental Health (Dr Parrish and Ms Combs), Centers for Disease Control and Prevention, US Public Health Service, Atlanta, Ga.

JAMA. 1993;269(12):1525-1531. doi:10.1001/jama.1993.03500120063027

Objective.  —To examine national trends in the percentage of blunt and penetrating trauma deaths autopsied.

Design, Setting, and Participatns.  —For each year from 1980 through 1989, we used national mortality data files to determine the autopsy frequency (percentage of deaths autopsied) of all deaths in the United States. We analyzed variation in the autopsy frequency of blunt and penetrating trauma deaths by cause of injury and place of occurrence of death.

Results.  —The autopsy frequency of blunt and penetrating trauma deaths in the United States increased by 14.3% during the 1980s to 58.9% in 1989 (62 004 of 105 309 deaths autopsied), while the autopsy frequency of all deaths decreased by 23.6% during the same period to 11.5% in 1989 (248 272 of 2153859 deaths autopsied). Among trauma deaths, homicides remained far more likely to be autopsied than nonhomicides (deaths due to unintentional injuries, suicides, and injuries of undetermined intentionality). The autopsy frequency of homicidal trauma deaths in 1989 was 90.0% or higher in 44 states and ranged from 79.6% in Mississippi to 100.0% in six states. The autopsy frequency of nonhomicidal trauma deaths in 1989 was 90.0% or higher in two states and ranged from 10.3% in Oklahoma to 94.5% in Hawaii. Nationwide, we found significant differences in the autopsy frequency of trauma deaths in 1989 between metropolitan and nonmetropolitan counties, both for homicides (97.7% vs 89.3%; P<.001) and nonhomicides (58.2% vs 29.9%; P<.001).

Conclusions.  —The percentage of blunt and penetrating trauma deaths autopsied has increased recently in the United States, but extensive geographic variation in autopsy frequency suggests that the benefits of autopsy findings for trauma care quality improvement and public health surveillance of injuries are distributed unevenly throughout the nation.(JAMA. 1993;269:1525-1531)