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An evaluation of overnight fixation to facilitate neuropathological examination in Coroner's autopsies: our experience of over 200 cases
  1. Ian Stuart Scott1,
  2. Alastair Wray MacDonald2,3
  1. 1Department of Cellular Pathology, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
  2. 2Department of Cellular Pathology, Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK
  3. 3Deputy Coroner, East Riding and Kingston-upon-Hull Coroner's District, Coroner's Court & Office, The Guildhall, Kingston-upon-Hull, UK
  1. Correspondence to Dr Ian Stuart Scott, Department of Cellular Pathology, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham NG7 2UH, UK; ian.scott{at}nuh.nhs.uk

Abstract

Aims Following recent changes in Coroner's Rules, there has been a desire to examine brains at the time of autopsy, rather than after a prolonged period of immersion fixation. Examination of the fresh brain at postmortem can yield unsatisfactory results where detailed histological examination is required. We aim to provide a compromise, where detailed examination of the brain is possible, without the requirement for prolonged fixation, interference with funeral arrangements and delay in the Coronial process.

Methods A retrospective audit of over 200 neuropathology cases requested by HM Coroner for the East Riding of Yorkshire between 2007 and 2010 was performed. The cases consisted of full neuropathology autopsies (n=212) and brains referred by general pathology colleagues (n=26).

Results Of the 238 brains examined, approximately half (n=109) of the brains were sectioned fresh in the mortuary. The remaining brains (n=129) were immersion fixed overnight in 20% formalin prior to cutting and sampling for histology (n=127). The median time for reporting was 31 days (range 1–167; n=101) for brains requiring histology. This equates to a median turnaround time of 1 month for a neuropathological autopsy requiring detailed histology. In all cases, the report was prepared and available to HM Coroner in advance of the Inquest.

Conclusions This method provides reliable histological diagnoses in neuropathological autopsies and does not interfere with funeral arrangements for bereaved families following deaths falling under Coronial jurisdiction. In all cases, the body could be released to relatives, at Coroner's discretion, within two working days of the autopsy.

  • Brain
  • Neuropathology
  • Audit
  • Medical Law
  • Autopsy Pathology

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Footnotes

  • Competing interest None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Justification This paper is an audit study of a method we have used over the past 5 years in neuropathological investigations referred by HM Coroner for the East Riding and Kingston-upon-Hull districts. The method was developed because of the unsatisfactory delay produced by conventional immersion fixation that had proved highly distressing for relatives and disruptive to the timely conduct of the Inquest. This study has shown that the method is reliable and produces minimal delay in the Coronial investigation process. Furthermore, it causes no additional distress to relatives above that of the original autopsy and does not delay funeral arrangements. The method has met with approval from histopathology colleagues, HM Coroner, Coroner's Officers and bereaved relatives. We would like to make our experience available to other Coroners and pathologists responsible for performing Coroner's autopsies because it removes many of the obstacles that are encountered in the examination of brain pathology in this context.

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