Elderly deaths in Bursa, Turkey: a comprehensive forensic autopsy study

Background/Aim. Autopsy studies rarely investigate the causes of natural death in psychiatric population. The aim of this study was to examine the causes of death among the subjects with various psychiatric disorders in whom a clinical (pathoanatomical) autopsy was requested. Methods. The study group included 118 patients (65% men, 35% women, mean age 58.2 ? 13.6 years) with a psychiatric diagnosis, in whom a clinical autopsy was performed. We compared the distribution of causes of natural death among psychiatric patients and other patients, representatives of the general population who died of natural causes. We also analyzed the difference between clinical diagnoses of cause of death and the autopsy findings in psychiatric patients. Results. Psychiatric patients died earlier than the control group (58 vs. 69 years), usually due to the respiratory (46%) and cardiovascular diseases (37%). The most common diagnoses in psychiatric patients were organic psychoses and dementias (F00-F09) and schizophrenia and schizoaffective disorders (F20-F29). Majority of the patients (55%) died in general hospitals vs. specialized psychiatric hospitals (45%) due to somatic diseases. There was a significant difference in the distribution of causes of death compared to the control group in which the cardiovascular diseases dominated. Even in 64% of psychiatric patients there was a discrepancy between the clinical diagnosis of the cause of death and definite autopsy findings. Conclusion. The assessment of somatic diseases in psychiatric patients is insufficient, especially in specialized psychiatric hospitals. That leads to a significant discrepancy between clinical diagnosis of the cause of death and autopsy findings. Therefore, it is necessary to pay additional attention in diagnostics and treatment of somatic diseases in these patients to improve their health care.

BACKGROUND AND AIMSSaudi Arabia has no precise data on causes of death. We sought to ascertain the commonest causes of death as stated in death certificates of adults and evaluate the completeness of death certificates at a teaching hospital in Riyadh.DESIGN AND SETTINGA cross-sectional study carried out at King Khalid University Hospital in Riyadh, Saudi Arabia, during the year 2008.METHODSAll death certificates that were issued in 2008 were reviewed and data were checked by two reviewers. Causes of death were coded according to specially-designed codes.RESULTSThe mean (SD) age of death was 63.9 (20.7) years. More than 80% arrived alive at the hospital. Among the 410 certificates, 62.2% had the first reported cause of death being classified as “inappropriate” and this tended to be slightly, but significantly more frequent among women. The first most common appropriately reported cause of death was malignancy of any type (7.3%) followed by ischemic heart diseases (4.9%). Accidents and fractures were more common in the younger age groups and among men.CONCLUSIONSThis is the first study that documents the possible gaps among healthcare professionals in Saudi Arabia in their understanding of death and its certification based on the clinical assessment of the deceased. The findings needs to be validated by similar studies from other health care sectors. It is clear, however, that proven educational, system-related and legal interventions to improve the accuracy of death certification are strongly needed if the health care priorities are to be properly identified.

Profile of unnatural mortalities in Northern part of Ghana; a forensic-based autopsy study

Elderly deaths in Ankara, Turkey

Deaths among women of reproductive age: A forensic autopsy study

Communications

Cost–consequence analysis of cause of death investigation in Finland and in Denmark

Ergenlik döneminde gerçekleşen ve adli olgular kapsamında değerlendirilen çocuk ölümlerinin irdelenmesi ile bu dönemin davranış özelliklerinin ölüm sebepleri ve ölümün gerçekleşme şekli üzerine etkilerinin ortaya konması amaçlanan bu çalışmada, 1994-1996 yıllarında İstanbul Adli Tıp Kurumu Morg İhtisas Dairesinde otopsileri yapılan 11-20 yaş grubundaki toplam 564 olgu incelenmiştir. Olgulardan 538’incte kesin ölüm sebebi belirlenirken, 26 olguda ölüm sebebi belirlenememiş ve çalışma dışı bırakılmıştır. 538 olgunun %76,8’ini erkek,%23,2’sini kız çocuklar oluşturmaktadırlar. Ölüm şekline göre ayırım yapıldığında; ilk sırada 207(% 41,3) olgu ile kaza ölümlerinin geldiği, bunu 181(%36,2) olguyla cinayetlerin izlediği, 88(%17,6) olguda ise ölüm şeklinin intihar olarak belirlendiği, 25 olguda ise belirlenemediği görülmüştür. Ölüm sebeplerine göre incelendiğinde ise, 501 olguda ölümün doğal olmayan sebeplerle oluştuğu, yalnız 37 olguda doğal ölüm tanısı konduğu saptanmıştır. Doğal olmayan ölüm sebepleri arasında en yüksek oranın %18,4 ile ateşli silah yaralanmaları olduğu, bunu %14,8 ile kesici delici alet yaralanmaları ve %13,6 ile asıların izlediği gözlenmiştir. Elde edilen sonuçlar irdelendiğinde, adli olguların ergenlik döneminde sıklıkla gözlenen şiddet içerikli davranış biçimlerini önemli oranda yansıttığı söylenebilir.Anahtar Kelimeler: Çocuk, Adolesan, Şiddet, Ölüm.

The aim of this study is to assess the accuracy of postmortem CT (PMCT) in determining the cause of death in children who underwent a forensic autopsy because of a suspected nonnatural death. We selected forensic pediatric autopsies at the Netherlands Forensic Institute, whereby the subject underwent PMCT between 1-1-2008 and 31-12-2012. Cause of death was independently scored by a radiologist and a pathologist. Cause of death was classified (1) in categories being natural, unnatural, and unknown; (2) according to the ICD-10; and (3) according to institutional classification. In the study period, 189 pediatric forensic autopsies were performed. Fifteen were excluded because of putrefaction. Of the remaining 174 autopsies, 98 (56%) underwent PMCT. PMCT and autopsy identified the same category in 69/98 cases (70%, kappa 0.49). They identified the same cause of death in 66/98 cases (67%, kappa 0.5) using ICD-10; in 71/98 (72%, kappa 0.62) using a forensic classification. PMCT performed better in unnatural deaths (59-67 % agreement) than in natural deaths (0 % agreement). If no cause of death was detected with autopsy, PMCT failed to identify a cause of death in 98% (39/40). Pediatric PMCT does identify the majority of unnatural causes of death, but does not identify new diagnoses (true positives) if no cause of death is found during autopsy. Diagnostic accuracy in natural deaths is low. • The case mix is an important predictor for the concordance between PMCT and autopsy. • In case of an unnatural death, 72--81% of PMCT results matches autopsy results. • In case of a natural death, 0% of PMCT results matches autopsy results. • If no cause of death is identified with autopsy, 98% of PMCT results concurs.

Maternal deaths are rare events in industrial nations due to high quality medical services. These are often unexpected deaths occurring during pregnancy and labor, thus often requiring forensic autopsies. Our analysis will provide an overview of the expected range of causes of death. A retrospective analysis was carried out on all autopsies performed at the Department of Legal Medicine in Hamburg, Germany, over the last 34years. Autopsies were carried out on 57 cases of maternal death over the 34- year period, i.e. 1 or 2 cases per year. The average age of women was 30years. Approximately two thirds of deaths occurred during pregnancy. Cardiovascular events accounted for the leading causes of death from natural causes, suicides were the leading causes of non-natural death. Maternal deaths remained consistently rare over the examination period. There was a wide range of causes of death involving natural and non-natural causes.

To investigate causes of and contributors to newborn deaths in eastern Uganda using a three delays audit approach. Methods Data collected on 64 neonatal deaths from a demographic surveillance site were coded for causes of deaths using a hierarchical model and analysed using a modified three delays model to determine contributing delays. A survey was conducted in 16 health facilities to determine capacity for newborn care. Of the newborn babies, 33% died in a hospital/health centre, 13% in a private clinic and 54% died away from a health facility. 47% of the deaths occurred on the day of birth and 78% in the first week. Major contributing delays to newborn death were caretaker delay in problem recognition or in deciding to seek care (50%, 32/64); delay to receive quality care at a health facility (30%; 19/64); and transport delay (20%; 13/64). The median time to seeking care outside the home was 3 days from onset of illness (IQR 1-6). The leading causes of death were sepsis or pneumonia (31%), birth asphyxia (30%) and preterm birth (25%). Health facilities did not have capacity for newborn care, and health workers had correct knowledge on only 31% of the survey questions related to newborn care. Household and health facility-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently. Understanding why newborn babies die can be improved by using the three delays model, originally developed for understanding maternal death.

AimsThe purpose of this study is to evaluate the accuracy and validity of the determination of cause of death (COD) and manner of death (MOD) at the completion of the...

See Original Article here See Author’s Response here Editor, It was with interest that we read the study on the use of routine histology in trauma-related deaths such as suspension-, fire-, immersion-, and traffic-related [1]. The authors concluded that in the assessment of causes and manners of death, histology did not contribute to the assessment in a meaningful way, since the cause of death was changed only in a small proportion of cases, 0.5%–4% [1]. The main objective of a forensic autopsy is to uncover hidden homicides, as far as we know such cases are rare. In 2021, there were 113 deaths due to lethal violence in Sweden according to the Swedish Council for Crime Prevention [2]. Still, in Sweden, we performed 5727 forensic autopsies in the year 2021 [3] making the homicide yield 2.0% (113/5727). However, we could estimate that in 50 cases per year, the forensic autopsy is of importance to discover or to correctly assess the cause and manner of death in those homicides, bringing the yield down to 0.9% (50/5727). This percentage is like those obtained in the study [1]. But, despite this, the forensic autopsy is not in question because the rule of law in our modern society depends on the citizens’ trust that each questionable death is thoroughly investigated by the authorities. We recognize that our example is not totally fair since we compare the use of the forensic autopsy in unnatural deaths to the use of histology in selected trauma deaths, but we argue that the comparison highlights the implied cost–benefit analysis. The authors refer to a statement in Swedish law “the sampling of tissues should be necessary to fulfill the purpose of the autopsy” [1, 4] implying a restrictive attitude toward tissue sampling in forensic autopsies. In our opinion, the purpose of the autopsy is not only to determine the cause and manner of death but also to ensure that the assessment is robust to later scrutiny. A forensic autopsy is often performed in the initial stages of a police investigation. At any later stage, the circumstances surrounding the case might change, which underlines the importance of a generous approach to ancillary analyses. If circumstances are such that a forensic autopsy is invoked, this trumps a potential need for a clinical autopsy. Highlighting that the forensic autopsy in some cases needs to cover aspects in the realm of the clinical autopsy. Also, other aspects such as communication with next of kin and training might need to be considered. If the incentive behind a more restrictive approach to tissue sampling is economic, this calls for a more nuanced discussion about the system in which the forensic autopsy is performed. Perhaps, greater efforts should be made in selecting the right cases for the forensic autopsy, or aspects in the administration of the forensic autopsies should be optimized. We perceive that the authors are of the opinion that a forensic autopsy requires a high level of competence, and that each case is unique, to which we fully agree. Hence, in each case, an experienced forensic pathologist is to make the decision on which ancillary investigations, for example, toxicology, histology, which are to be called upon. But the study highlights a disagreement in at which rates an ancillary investigation is redundant and we argue a generous approach to tissue sampling for histological evaluation.

Coding ill-defined and unknown cause of death is 13 times more frequent in Denmark than in Finland

Paediatrics is a branch of medicine which is concerned with wellbeing of infants, children, adolescents, their physical, mental, and psychological development. Paediatric forensic autopsy is useful to evaluate us the natural and unnatural childhood deaths, their reasons, steps for prevention and their management, which is both useful to the branch of Forensic Medicine and the Medical researchers. A 3year retrospective study was conducted in M.P. Shah Government Medical College, Jamnagar during the period of January 2014 to December 2016. Out of total 3743 autopsies performed, a total of 253 cases belonging to paediatric age-group were the material of the study. Accidental deaths are the most common manner of deaths and mostly affected age-group is 12-17 years. The leading cause of death are burns, drowning, road traffic accidents and snake bite. Accidental burns and suicidal hanging were more common in females in the age-group 12-17 years. Accidental drowning and RTA were common in the males. In the present study, snake bite envenomation was also one of the leading causes of unnatural deaths in children and was mostly seen in the age range of 2-10 years. In India, both natural and unnatural childhood deaths are emerging as major public health problem. Various educational programmes, preventive strategies, and dissemination of information are necessary to create awareness and is must to reduce the unnatural deaths. Keywords: Paediatric autopsy, Unnatural children deaths, Trauma, Manner of death.