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American Journal of Epidemiology Vol. 133, No. 9: 922-931
Copyright © 1991 by The Johns Hopkins University School of Hygiene and Public Health

other

In-Vivo and Post-Mortem Gallstones: Support for Validity of the "Epidemiologic Necropsy" Screening Technique

Nelson J. F. Simonovis1, Carolyn K Wells2 and Alvan R. Feinstein3,

1 Formerly, Guest Scholar, Robert Wood Johnson Clinical Scholars Program, Yale University New Haven Connecticut Currently, Assistant Professor of Medicine, Central University of Venezuela Caracas, Venezuela
2 Yale University School of Medicine New Haven, CT
3 Clinical Epidemiology Unit and The Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine New Haven, CT Cooperative Studies Program Coordinating Center, Veterans Administration Medical Center West Haven, CT

Dr. Alvan R Feinstein, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510-8025

This research was done to evaluate the "epidemiologic necropsy" procedure as a "screening" technique for disease that has been clinically unsuspected or inactive during life. The post-mortem occurrence rates of gallstones in necropsies at Yale-New Haven Hospital were compared and found reasonably similar to the analogous rates of gallstones detected in-vivo via ultrasonographic screening of large general populations. Because the authors could not find an appropriate in-vivo screening study done in the United States, they used data mainly from screening studies in Copenhagen, Denmark, and Rome and Sirmione, Italy. Two additional ultrasonographic screening studies have been done in Norway and in populations of Hispanic Americans Previous disparities between post-mortem and in-vivo screening results probably arose because of failure to stratify for age and sex, to remove patients with cholecystectomy from the analysis, or to account for small-size stones that would be detected at necropsy but not with ultrasonography The current results help confirm the value of the epidemiologic necropsy procedure in estimating the size of the substantial reservoir of undetected disease that does not appear in the customary tabulations of "vital statistics." Am J Epidemiol 1991; 133: 922–31

autopsy; cholelithiasis; incidence; necropsy; screening; ultrasonic diagnosis


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