Natural, Unexpected Deaths: Reliability of a Presumptive Diagnosis
IA Scordi-Bello, JR Gill. New York City, New York, NY; New York University School of Medicine, New York, NY
Background: Despite declining hospital autopsy rates, medical examiner and coroner offices receive numerous inquiries about autopsies each year from the next of kin. Many of these family inquiries involve deaths that normally would undergo postmortem examination due to the decedent's medical history and circumstances of death. A small number of them, however, involve deaths in which an autopsy is performed because of suspicions and concerns expressed by the family.
Design: We retrospectively analyzed 100 of these deaths and compared the pre-autopsy proximate cause of death, as determined by a thorough review of the clinical data and circumstances, to the autopsy-derived cause of death determined at the New York City Office of Chief Medical Examiner.
Results: In the majority (91/100), the pre-autopsy and post-autopsy proximate causes of death were in agreement. In 9% (9/100), the autopsy provided information that resulted in a proximate cause of death different than anticipated. In 4 instances, the manner of death also was incorrect and was determined to be an accident rather than the originally presumed natural. No homicides or suicides were misclassified. In another 9 instances, where the premortem and postmortem proximate causes of death were in agreement, the autopsy provided a specific mechanism of death.
Conclusions: With a quality initial medicolegal death investigation, a subset of sudden deaths in adults may be reliably certified without an autopsy.
Monday, March 9, 2009 9:00 AM
Platform Session: Section H1, Monday Morning