The coroner's necropsy--an epidemiological treasure trove.

regulatory protein expression in adult soft tissue sarcomas. A sensitive and specific marker of skeletal muscle differentiation.typic sarcomas with myogenic and neural differentiation express the Ewing's sarcoma EWS/FLI1 fusion gene. The coroner's necropsy is suited to classic epidemiological studies, not only for those conditions leading to death but also for coincident disease. In the general population there is an iceberg of hidden pathology. This pathology may occur as pre-symptomatic, quiescent or burnt out disease. These silent processes do not necessarily appear in returns generated from hospitals or other clinical sources. The changing pattern of this disease can provide clues to causation as well as early signs that shifts in health care provision may be required. As the coroner's investigation is a local enquiry the information is of direct relevance to the community from which it is generated. Clustering of pathology according to micro-geography of a city might give aetiological clues. For example, is there a relation with local industry? Or with sources of pollution? Or with ethnic or other community subsets? Furthermore, locally produced and available statistics encourages early and responsive health care planning , which is of benefit to the entire community. While population epidemiology has been primarily concerned with determinants of health status of large populations , clinical epidemiology tends to deal with diagnostic and therapeutic aspects in subpopulations of diseased individuals.' The coroner's necropsy also has a role in this area. Sensitivity and specificity are characteristics which have been used to appraise a test. Together they assess the ability to pick up a target condition, or they can evaluate a new test according to a gold standard. These characteristics may be applied to a clinical diagnosis and the 'gold stand-ard' necropsy result.2 For a population of patients dying in hospital, such measures indicate clinical diagnostic accuracy. It must be conceded that the reason many of these cases are referred to the coroner is that the cause of death is unknown. Even so, there will be a provisional working diagnosis or diagnoses. Thus, calculation of sensitivity and specificity for a variety of pre-mortem clinical diagnoses might form the basis for a comparison of performance between hospitals. Care must be taken with the use of information generated from coroners' necropsies. Firstly, there will be bias in selection of deaths which are referred to the coroner and which of these are then subsequently the subject of a postmortem examination. There …