Neuropathology consultation rates in medical-legal autopsies show substantial within-country variation—a nationwide Finnish study

Abstract Neuropathology consultations are an essential part of medico-legal cause-of-death investigations. However, there are little data on the rates of neuropathological examinations in medico-legal autopsies. The present nationwide, retrospective, register-based study aimed to report and compare neuropathology consultation rates (i.e., the percentages of medico-legal autopsies with a neuropathology consultation) in five Finnish regions from 2016 to 2021. The dataset comprised 50 547 medico-legal autopsies with 1274 neuropathology consultations. Overall, approximately 1 in 40 autopsies (2.5%) involved a neuropathology consultation. Consultation rates were lowest in the Southern Finland region (1.4%) and highest in the Southwestern Finland and Åland region (6.5%). Throughout the study period, the consultation rates of Southwestern Finland and Åland were 1.5 to 9.4 times those of other regions (P < 0.001). In conclusion, the present nationwide Finnish study identified substantial differences in neuropathology consultation rates between regions, which may indicate regional differences in conventions and policies. However, the ‘optimal’ consultation rate remains unknown. Future studies are required to further understand the differences in autopsy practices within the Finnish context as well as in medico-legal institutions elsewhere.