Brought In Dead Research Articles

Characteristics and health insurance profile of brought-in-dead children in a rural tertiary hospital

BackgroundDespite the regular occurrence of brought-in-dead (BID) phenomenon, little is known about their prevalence, pattern and prehospital contributors in rural settings in Nigeria. In addition, the impact of health insurance...

Factors associated with COVID-19 brought-in deaths: A data-linkage comparative cross-sectional study

BackgroundThe phenomenon of Coronavirus disease 2019 (COVID-19) brought-in-dead (BID), i.e., COVID-19 deaths occurring outside hospital settings, suggests missed opportunities for life-saving care. However, much is still unknown with regards to its potential determinants. The present study aimed to examine the factors associated with COVID-19 BID by integrating new variables from multiple databases. MethodsThis multi-database comparative cross-sectional study examined COVID-19 in-patient deaths (IPD) and COVID-19 BID (n = 244 in each group) in Selangor, Malaysia. BID cases, IPD cases, and their sociodemographic, clinical, and health behaviour factors were identified from the COVID-19 mortality investigation reports submitted to the Selangor State Health Department between 14 February 2022 and 31 March 2023. Data linkage was used to connect three open-source databases—GitHub-MOH, Socioeconomic Data and Applications Center, and OpenStreetMap—and identify health infrastructure and geospatial factors. The groups were compared using chi-square tests, independent t-tests, and logistic regression analyses to identify factors associated with COVID-19 BID. ResultsThe COVID-19 IPD and BID cases were comparable. After adjusting for confounders, non-Malaysian nationality (AOR: 3.765, 95% CI: 1.163, 12.190), obesity (AOR: 5.272, 95% CI: 1.131, 24.567), not seeking treatment while unwell (AOR: 5.385, 95% CI: 3.157, 9.186), and a higher percentage of COVID-19-dedicated beds occupied on the date of death (AOR: 1.165, 95% CI: 1.078, 1.259) were associated with increased odds of COVID-19 BID. On the other hand, being married (AOR: 0.396, 95% CI: 0.158, 0.997) and the interaction between the percentage of COVID-19-dedicated beds occupied and the percentage of ventilators in use (AOR: 0.996, 95% CI: 0.994, 0.999) emerged as protective factors. ConclusionThese findings indicated that certain groups have higher odds of COVID-19 BID and thus, require closer monitoring. Considering that COVID-19 BID is influenced by various elements beyond clinical factors, intensifying public health initiatives and multi-organisational collaboration is necessary to address this issue.

The pattern of Deaths in the Accident and Emergency Units of Ekiti State University Teaching Hospital

Background: Background: Death is common in accidents and emergency units (AEU), and its causes vary. Some are brought-in-dead (BID) with unknown causes and contribute to hospital mortality statistics. This study aimed to determine the causes and patterns of death in the AEU of the Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria Methods: This was a 5-year retrospective study of all patients who died in the AEU of Ekiti State University Teaching Hospital, including those brought in dead. The information needed was extracted from the case notes and entered into SPSS version 23 for analysis. Results: A total of 7,682 patients were observed during the study period, with 275 deaths repre-senting a mortality rate of 3.6%. One hundred and fifty-six (56.7%) patients were BID. The mean age was 50.8 years. Most deaths (n=233, 84.7%) were from non-traumatic causes, with stroke and heart failure being the most common causes. Head injury (3.3%) was the most common traumatic cause of death. The median interval from presentation to death was 5 hours (IQR 3 – 6). Most patients (n=54, 45.4%) died within the first 8 hours of admission. None of the patients underwent an autopsy. Hypertension and diabetes were the most common co-morbid conditions reported. Conclusion: Brought-in-dead patients were the most commonly recorded death pattern in AEU at the Ekiti State University Teaching Hospital, and the overall mortality rate was 3.6%. Non-traumatic causes are the leading causes of death.

COVID-19 Inpatient Deaths and Brought-in-Dead Cases in Malaysia.

Coronavirus disease 2019 (COVID-19) deaths can occur in hospitals or otherwise. In Malaysia, COVID-19 deaths occurring outside of the hospital and subsequently brought to the hospital are known as brought-in-dead (BID) cases. To date, the characteristics of BID COVID-19 cases in Malaysia are not clear. The objectives of this study are 2-fold: to explore the characteristics of 29,155 mortality cases in Malaysia and determine the factors associated with the high probability of BID, using the multilevel logistic regression model. Data on COVID-19 mortality cases from the entire country between March 17, 2020 and November 3, 2021 were retrieved from a national open data source. Of the 29,155 COVID-19 mortality cases, 5,903 (20.2%) were BID. A higher probability of BID (p < 0.05) was seen among individuals aged between 18 and 59 years, non-Malaysians, had no comorbidities, did not receive COVID-19 vaccination, and the interval between the date of death and diagnosis. A high prevalence of BID is an alarming public health issue, as this may signal health system failure at one or several levels and, hence, need urgent attention from relevant stakeholders. Based on the findings of this study, increasing the intensity of the vaccination campaign, addressing any issues faced by noncitizens about to COVID-19 management in- and out-of-hospital, increasing the awareness of signs and symptoms of worsening COVID-19 and, hence, the significance of self-monitoring, and determining the potential gaps in the health system may contribute to their increased risk of deaths.

Comparison of the Causes of Death Identified Using Automated Verbal Autopsy and Complete Autopsy among Brought-in-Dead Cases at a Tertiary Hospital in Sub-Sahara Africa.

Background Over one-third of deaths recorded at health facilities in Zambia are brought in dead (BID) and the causes of death (CODs) are not fully analyzed. The use of automated verbal autopsy (VA) has reportedly determined the CODs of more BID cases than the death notification form issued by the hospital. However, the validity of automated VA is yet to be fully investigated. Objectives To compare the CODs identified by automated VA with those by complete autopsy to examine the validity of a VA tool. Methods The study site was the tertiary hospital in the capital city of Zambia. From September 2019 to January 2020, all BID cases aged 13 years and older brought to the hospital during the daytime on weekdays were enrolled in this study. External COD cases were excluded. The deceased's relatives were interviewed using the 2016 World Health Organization VA questionnaire. The data were analyzed using InterVA, an automated VA tool, to determine the CODs, which were compared with the results of complete autopsies. Results A total of 63 cases were included. The CODs of 50 BID cases were determined by both InterVA and complete autopsies. The positive predictive value of InterVA was 22%. InterVA determined the CODs correctly in 100% cases of maternal CODs, 27.5% cases of noncommunicable disease CODs, and 5.3% cases of communicable disease CODs. Using the three broader disease groups, 56.0% cases were classified in the same groups by both methods. Conclusion While the positive predictive value was low, more than half of the cases were categorized into the same broader categories. However, there are several limitations in this study, including small sample size. More research is required to investigate the factors leading to discrepancies between the CODs determined by both methods to optimize the use of automated VA in Zambia.

Epidemiology of prehospital trauma deaths in Malawi: A retrospective cohort study.

IntroductionTrauma is among the leading causes of death and disability in both adults and children worldwide. In Malawi, trauma patients are commonly brought in dead (BID). We aimed to describe the prevalence, sociodemographic, and injury-related characteristics of patients BID to Kamuzu Central Hospital (KCH), a referral hospital in Lilongwe, Malawi.MethodsWe retrospectively reviewed records of all patients BID in the trauma surveillance registry at KCH from February 2008 to September 2019. We excluded patients BID that did not present to the emergency centre, and were instead taken to the mortuary directly. We used descriptive statistics to evaluate the epidemiology of patients BID.ResultsWe reviewed 106,198 trauma records and 1889 (1.8%) were BID patients. Most patients BID were male, in both adult (n = 1337/1528, 88.4%) and children (n = 231/360, 64.9%) cohorts. The mean age was 34.7 (SD 11.9) years in adults and 7.8 (SD 5.4) years in children. Among the adult BID patients, 33.2% were unemployed, 25.6% were construction workers, and 10.1% were small business owners or managers. The common injury mechanisms in adults were road traffic-related injuries (RTIs) (47.1%) and assaults (23.6%). In children, injuries resulted from RTIs (39.7%), with 74.4% of those were pedestrians hit by cars, drowning (22.9%), and burns (12.4%). In both groups, most injuries occurred on roads (60.2%) or at home (22.1%). Reported alcohol use at the time of trauma was present in 6.3%. The police (57.9%) and privately-owned vehicles (26.6%) transported most BID patients to KCH.ConclusionEfforts to reduce prehospital trauma mortality must focus on improving prehospital care, including training the police and community in basic life support and improving resources towards prehospital trauma care. Further efforts to reduce prehospital mortality must aim to decrease injuries on the roads and at home.

Retrospective Study of Abandoned Dead Bodies in the Morgue of a Tertiary Health Institution: The Identified, Unidentified and Unclaimed.

Dead bodies in a morgue can be grouped into any of the following: identified- but-not-abandoned, unidentified/unclaimed and identified-but-abandoned. The first group, usually poses no challenge. The unidentified/unclaimed group is always a challenge to every morgue management, while little or nothing is known about the identified-but-abandoned group. This is a retrospective study of all the unidentified/unclaimed dead bodies and the identified-but-abandoned dead bodies seen in the morgue of University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria. The information for this study were gotten from UUTH morgue register and the data obtained were analyzed using Standard Package for Social Science (SPSS) version 20. 114 dead bodies deposited in the morgue were studied, 89 of these bodies were identified-but-abandoned, while 25 were unidentified/unclaimed.For the identified-but-abandoned, the youngest bodies were that of day old neonates and the oldest body was an 87 year old male giving a mean age of 37.01 ± 20.88. Males accounted for 57.3% (n=51), while females accounted for 42.7% (n=38), with a male to female ratio of 1.3:1. Age groups 0-39 years accounted for 60.7% of the identified-but-abandoned bodies.The 25 unidentified/unclaimed bodies include 22 males and 3 females giving a male to female sex ratio of 7.3:1. There ages were not known. About 73.7% of the study population (n=84) were in-patients on treatment in the various wards of the hospital and died during the course of treatment while 30 dead bodies (26.3%), were brought in dead (BID). Direct relatives of the deceased (siblings or parents or children or spouse) deposited the bodies in the morgue in 37.8% of occasions, potters (ward maids) in 23.7% and security/uniform agencies in 23.7%. Identified-but-abandoned dead bodies exist. Relatives should be made to understand that the only right a dead person has, is at least a decent burial.

Profile of Brought in Dead Cases in a Tertiary Care Centre of South India

Most of the times it is noticed that incidence of Brought in dead (BID) cases in a tertiary care hospital is very high. But there are limited data of the statistics of such cases due to lack of records or audit. These cases can be due to natural cause or unnatural. The doctor attending such cases should be aware of all procedures and formalities associated with BID cases. Diagnosis of death should be ascertained clinically and hospitals should be aware of the legal responsibilities of these cases. This study was conducted in a tertiary care institution where BID cases were profiled with the available data and records. The study throws light in to not only the demographic profile like age, sex, month wise distribution but also to time of reporting to Emergency department (ED) as well as the probable cause based on history of the informant. Males dominated in the total number of 307 cases compiled in 4 years, i.e, 2015 to 2018. Age of above 60 years cases made the major share with sudden death as well as road traffic accident (RTA) being the major culprits. Maximum number of BID were reported during early morning hours (12am to 6 am) followed by late evening hours (6pm to 12am).

How to care for the brought in dead and their relatives. A qualitative study protocol based on interpretive description.

This project has two aims: (a) What do relatives to brought in dead (BID) describe as helpful and supportive care when they arrive at the emergency department to see and say goodbye to a deceased? (b) What do nurses describe as good nursing practice for BID persons and their relatives and what may hinder or facilitate this practice in an emergency setting? A qualitative study in the methodology interpretive description. Data will be collected through three data sources: Individual interviews with relatives to BID persons, participant observations of relatives to BID persons during their presence in the emergency department and focus group interviews with emergency nurses. Brought in dead persons and their relatives are received and cared for in emergency departments by emergency nurses. Knowledge of how to render care for the relatives to BID persons in an acute setting including what skills and competences this require of the nurses is warranted. We need to explore, describe, and comprehend the experiences of both the relatives and the nurses to point out potential areas of improvement. This study is a protocol of an Interpretive Description study offering insight into considerations and reflections in designing the study.

Characteristics of people brought in dead at the Ndola Teaching Hospital in Zambia between 2012 and 2016

Background: Death is the end spectrum of everyone's life. From a policy maker's point of view, the cause of death and the place of death are important variables as they have a bearing on the diagnostic capacity of a health system and the level of health services utilization by a population respectively. A study done in Zambia showed that 51 per cent of the adult deaths occurred in a health facility, 41.5% occurred at home and 7.7% happened elsewhere. This finding contrasted those of a systematic review of statistics on cause of deaths in hospitals: strengthening the evidence for policy makers by the WHO which reported that more than 50% of deaths in most developing countries occur outside hospitals. It is common to see people brought in dead (BID) in hospitals in Zambia. A literature review showed that no study has been done to characterize the people who are brought into health facilities already dead in Zambia. Our study proposes to collect the age and sex distribution of the people brought in dead, as well as their area of residence and cause of death as is captured in the registers.&#x0D; Objectives1. To describe the sex and age distribution of the people brought in dead in Ndola Teaching Hospital&#x0D; 2. To determine the areas of residence of these cases&#x0D; 3. To establish the causes of death for these cases of BID&#x0D; 4. To assess the completeness of the information recorded in the register&#x0D; Methods: This study was done at the Ndola Teaching Hospital in the Copper-belt province of Zambia. It was a cross sectional, retrospective record review of the mortuary registers where all people brought in dead or dying within 24 hours of admission to Ndola Teaching Hospital are recorded. All cases of BIDs recorded in the Mortuary registers of Ndola Teaching Hospital between 2012 and 2016 were eligible. The age, sex, area of residence and the recorded cause of death were entered on a standardized form designed for the study. The data was entered on an excel sheet and double checked for completeness. It was then analyzed using excel&#x0D; Results: There were 6931 cases of brought in dead at the Ndola Teaching Hospital between 2012 and 2016 with the average number of 1386 cases per year. The age group affected most was 24-55 years (60.34%), mainly comprised of males (61.81%) and coming from densely populated areas (81.50%). 96.75% of cases had undetermined mode of death while 2.35% of cases died of road traffic accidents&#x0D; Conclusion: A big number of people are still dying outside health facilities or within 24 hours of admission to hospitals in Zambia today. The most affected group is males in their most productive period of their lives and mainly residing in densely populated areas. Additionally, our data capturing tools are not adequate and need revision.

Demographic and clinical profile of brought in dead cases to pediatric emergency department of a tertiary care hospital

Background: The incidence of brought in dead (BID) is high in tertiary hospitals, but there is a lack of proper audit and relevant data of these cases. Objective: The current study aimed to assess the demographic characteristics and clinical profile of BID patients presenting in emergency department (ED) of a tertiary hospital. Materials and Methods: This was a retrospective observational study. All children between 0 and 12 years who were BID at the pediatric ED in a tertiary hospital between February 2018 and December 2018 were included. Data were collected on demography, history of illness, treatment seeking history, and details about transport to the hospital. Microsoft Excel was used for analysis. Results: A total of 64 BID cases were included in the study, of which 39% cases belonged to the neonatal age group. Most of the referrals were from government hospitals. Of total neonatal deaths, 44% were preterm babies; 52% of neonates had a previous history of hospitalization. Among previously hospitalized cases, 56% were discharged and 22% took their child against medical advices. Conclusion: It is crucial that the government reinforces the measures to avoid the existence of clandestine health centers. Improving referralcounter-referral system will permit the limitation of fatal medical errors. This study expects to bring the focus on BID so that future studies explore the possible strategies to contain this problem.

Hypertension and Sudden Unexpected Deaths: An Autopsy Study of Four Hundred and Seventy-Seven Brought-in-Dead in a Tertiary Health Center.

Introduction:Hypertension is an important and major public health concern globally. One of the major causes of sudden death worldwide is hypertension. This study is to present the morphological pattern of deaths at autopsy of those patients who were brought-in-dead (BID) and who had hypertensive heart disease (HHD) as the underlying illness.Materials and Methods:This is a 6-year retrospective autopsy study of BID patients as a result of HHD seen at our department between January 1, 2010, and December 31, 2015. The autopsy findings and data retrieved were analyzed using IBM Statistical Package for Social Sciences version 20. Test for statistical significance was set at P < 0.05.Results:A total of 477 deaths (44%) as a result of HHD were recorded out of the 1016 BID during the period under study. The age ranged from 21 to 92 years with a mean age of 52 ± 14.0 years and a male to female ratio of 1.8:1. The 5th decade of life was the most common age group encountered. The most common cause of death was acute left ventricular failure (67.8%), and myocardial infarction was the least common (1.7%).Conclusions:Acute left ventricular heart failure was the most common cause of sudden death as a result of hypertension and was followed by intracerebral hemorrhage. In the female gender, sudden deaths were most common in the 6th decade and in the male gender most sudden deaths were seen in the 5th decade.

Prevalence and pattern of cardiovascular-related causes of out-of-hospital deaths in Lagos, Nigeria

In developed countries 50% - 75% of deaths from cardiovascular-diseases occurs out-of-hospital. In Nigeria where patronage of orthodox health facilities is low, the impact of cardiovascular-related diseases on out-of-hospital mortality has been sparsely studied. To determine the prevalence and pattern of cardiovascular-related causes of out-of-hospital deaths in Lagos, Nigeria. A 5-year retrospective review of all autopsied medical decedents brought-in-dead (BID) to a Nigerian tertiary health facility to identify cardiovascular-related causes of death. A total of 90 cardiovascular-related deaths out of 176 medical BID cases were identified, giving a prevalence of 51.1%. Mean age was 65.2 ± 15.6 years. Male: Female ratio was 1.4: 1, the females were older (68.29 ± 14.89) vs (61.63 ± 15.55) years. Age group > 60 years accounted for 63.3% of deaths. Commonest primary diseases were hypertensive heart disease (48.9%) and cerebrovascular accident (24.4%). Myocardial infarction occurred in 8.9%. Heart failure, cerebral dysfunction and unspecified circulatory collapse were the causes of death in 54.4%, 23.3% and 14.4% respectively. Cardiovascular-related diseases are major contributors to out-of-hospital medical deaths occurring chiefly in those >60 years. Hypertensive heart disease and heart failure are the greatest contributors to this cardiovascular-related disease mortality.

An autopsy review of five hundred and sixty nine non-traumatic brought in dead patients in Lagos, Nigeria

BackgroundThere are many cases that present to the emergency room as brought in dead (BID) and in such cases, previous medical history of the deceased is unknown. Many of the medical problems are either preventable or treatable if managed on time. This study is aimed to determine the age, gender and causes of BID.ResultsThis is a 6 year retrospective autopsy study of all BID patients in Lagos State University Teaching Hospital, Ikeja between 1st January 2010 and 31st December 2015. The data were retrieved from the autopsy reports and were analysed using Statistical Package for Social Sciences version 18. Test for statistical significance was set as p < 0.05. There were 1016 BID recorded representing 9.3% of all deaths during the period under study. A total of 569 cases of BID that were analysed in this study after excluding hypertension related deaths. The male to female ratio was 1.37:1. The 4th decade was the predominant age group (22.7%). Cardiovascular (25.5%), Asphyxia related (23.0%), Gastrointestinal tract [GIT] (16.5%) and respiratory (15.1%) were the common system seen. Thromboembolism and haemorrhage, drowning, severe dehydration and tuberculosis were the most common causes of cardiovascular, asphyxia, GIT and respiratory system deaths respectively.ConclusionsCardiovascular system related death was the most common cause of BID with thromboembolism and haemorrhage as major secondary causes. Tuberculosis was the commonest cause of respiratory system death. BIDs are seen more in male than the female gender. There is need for the government to increase the awareness and health seeking behaviour among the populace.

Hypothesis on the Forensic Recognition of Cases "Brought in Dead" and Others "Brought in Dying"

Hypothesis on the Forensic Recognition of Cases "Brought in Dead" and Others "Brought in Dying"

Brought in Dead: An Avoidable Delay in Maternal Deaths.

Maternal brought in dead are the patient who dies in the need of adequate medical care. These deaths are often not analyzed sincerely as they are not institutional deaths. Our aim is to find out actual life threatening cause of delay leading to death. Patients brought dead to casualty were seen by the doctors on duty in Department of Obstetrics and Gynaecology,Gandhi Medical College, Bhopal round the clock. Cause of death was analyzed by verbal autopsy of attendants and referral letter from the institute. In this analytical study a complete evaluation of brought deaths from January 2011 to Decmeber 2014 was done. A total of 64 brought in deaths were reported in this 4year duration. Most common cause of death was postpartum hemorrhage (54.68%) followed by hypertension (15.62%) and the most common cause of delay was delay in getting adequate treatment (56.25%). The brought in dead are the indicator of the three delays in getting health care. Challenges appear to be enormous to be tackled. Timely management proves to be critical in preventing maternal death. Thus it appears that community education about pregnancy and its complications, EmOC training at FRU and strict adherence to referral protocol may help us to reduce the brought dead burden.

Cases of Brought in Dead Patients in the Accident and Emergency Unit of a Referral Hospital in the Western Region of Ghana

The objective of this study was to evaluate cases of brought in dead (BID) patients in the accident and emergency unit of Effia-Nkwanta Regional Hospital through a retrospective study of a period of 3 years. A retrospective descriptive study of BID cases from the death register and patients’ records of the accident and emergency unit of the hospital was carried out from January 2011 to December 2013. 31% (180/574) of BID cases were recorded over the study period with the age range from below 1 year to over 70 years. They were 58.5% male and 41.5% female with a ratio of 1.4:1. The majority of the BID cases (20.7%) were patients above 70 years and most cases (40.8%) have no known clinical condition associated with the death. The majority of the unexplained deaths were highest among young adults between the ages 30 and 40 years (22.6%). The highest cases of BID (20%) were seen in the month of December and majority of the cases (72.5%) lived within the metropolis. This study showed a concerning trend of BID cases in the hospital with a high prevalence among the elderly and unexplained death among the young adults. Hence there is an urgent need to upgrade hospitals in the area with the hope of relieving the burden off Effia-Nkwanta Regional Hospital and also a need to increase health promotion strategies among the people of the area so as to instill health seeking behavior in order to prevent avoidable deaths.

Challenges of Mass Casualty Management at a Regional Trauma Centre in Sub-Saharan Africa

Background: Mass Casualty incidents usually overwhelm the capabilities of any centre. It is an event whose nature is undetermined, unexpected and disrupts the normal trauma care in a hospital. Hospitals have established protocols to deal with mass casualty when it arises. Objectives: We sought to profile the presentations of mass casualty incidents and challenges in management in a regional trauma Centre in North-West Nigeria. Methodology: A retrospective look at the records of mass casualty presentations in our centre over a 12-month period (January-December 2011) was done. A mass casualty event in our setting is the presentation to our facility of eight or more patients from the same cause at the same. Results: There were a total of 18 mass casualty presentations with an average of 1.5 per month. There were a total of 236 victims including those brought in dead (BID). Males were 203 (86%) and females 33 (16%) with an M:F ratio of 6:1. Majority of the victims 222 (94%) were above 16 years and all the victims had a common mechanism of injury which was Road traffic crashes. One hundred and forty-three (61%) of the victims sustained lacerations and bruises while 31 (13%) were polytraumatized. Sixty-two (26%) of the victims were BID’S from the scenes of the Road Crashes. The outcome was that 131 (75%) of the victims were treated and discharged while 41 (24%) were admitted for further management. Two (1%) patients died during resuscitation and within 24 hours. Conclusion: Mass casualty presentations are a regular event in our centre hence there is the need for the establishment of a protocol and regular mass casualty drills to cope with future occurrences.

Pattern Of Extremity Gunshot Injuries Seen In Lagos University Teaching Hospital,

The rising incidence of gunshot injuries (GSI) remains one of the leading causes of death, long hospitalization and economic losses worldwide. This study was undertaken due to rising incidence of civilian GSI in Lagos, Nigeria. To determine the epidemiological characteristics of extremity gunshot injuries in Lagos, Nigeria. This three year crossectional study of extremity gunshot injuries was conducted at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria between 1st January 2000 and 31st December 2002. Two hundred and fifty four patients with extremity gunshot injuries presented with 240 analyzed. Those brought in dead (BID) were excluded from the study. Ninety-five percent of the patients were males. One hundred and twenty six patients (52.5%) were in the 21-40 years age group. The patients were shot mainly (75%) at night and mostly (80%) by armed robbers. Shot guns were used in shooting 47.5% of patients. The study showed that young adult males were more affected by GSI. Most of the shootings occurred at night by armed robbers.

Brought in Dead

In a replication and extension of Sudnow's observations, it is seen that social factors are primary in determining whether to resuscitate, the effort put into resuscitation, and the treatment of the recently-deceased body. Social deviancy has a significant mortality.