Retrospective Autopsy Study Research Articles

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.

PP19 Opioid Poisoning Deaths: A National Picture

Introduction:The factors associated with opioid poisoning death are poorly understood. We performed a retrospective autopsy study of decedents (a term used for people who are deceased) of opioid poisoning in Wales in 2015. Using anonymized linked data, we describe demographic characteristics, patterns of emergency service utilization, and clinical presentation prior to death.Methods:Decedents of opioid poisoning in Wales in 2015 were identified from the Office of National Statistics (ONS) mortality dataset. Records were linked with the Emergency Department Dataset (EDDS) by the National Welsh Informatics Service (NWIS); and held in the Secure Anonymized Information Linkage (SAIL) databank. The data were accessed and analyzed in the SAIL gateway.Results:Age at death ranged from eighteen to seventy-eight years, with a mean age of forty-two years. Average male age was forty-one years and average female age was forty-four and a half years. Seventy-three percent of decedents were men (n = 228/312). Eight-seven percent of decedents (n = 281/312) attended the emergency department in the three years prior to death. In total 2081 attendances were made, forty-one percent of which involved conveyance by ambulance. Attendances per individual ranged from one to 114, with over half of decedents attending more than three times. Diagnostic codes were mostly missing or non-specific, with only seven and a half percent of attendances representing eighty-two decedents, coded as drug related. Treatment codes were also mostly missing or non-specific, with sixteen percent of attendances representing 148 attendees attributed a treatment code. Thirty-nine percent of attendances (n = 822) ended in treatment and discharge, whilst twenty-seven percent (n = 562) led to hospital admission.Conclusions:Matching previously published data, we found that fatal opioid poisoning is preceded by a period of high emergency health service utilization. On average decedents were in their fifth decade and more likely to be male than female. Attendances varied widely, with men less likely to attend than women.

The significance of preexisting medical conditions, alcohol/drug use and suicidal behavior for drivers in fatal motor vehicle crashes: a retrospective autopsy study.

Driver fatalities in motor vehicle collisions (MVCs) encompass accidents, suicides, and natural deaths when driving. The objective of this study was to determine the significance of pathology and other autopsy findings for drivers in fatal MVCs. Forensic autopsy records of driver fatalities in southeast Norway between 2000 and 2014 were studied retrospectively. Data from individual police and collision investigation reports were also collected and analyzed. In 406 driver fatalities, the male/female ratio was 340/66; 9% died from natural causes, 9% were suicides, 65% were culpable accidental deaths, 14% were nonculpable deaths, and 3% were undetermined deaths. Head injuries and thoracic injuries were the most common causes of death. A seatbelt had been worn in 50% of the fatalities, and its prevalence did not differ between accidental deaths and suicides. Blood levels of alcohol and/or drugs that indicated impairment at the time of the collision were found in 40% (105/262) of all culpable accidental deaths but in 50% (64/127) of drivers aged up to 35years. Pathology (most often cardiovascular disease) suggestive of sudden incapacitation before the collision was present in 24% (62/264) of drivers who were culpable in the accident and in 70% (46/66) of culpable drivers older than 55years. A substantial proportion of drivers are killed in accidental collisions that may have occurred as a result of either alcohol/drug impairment or preexisting disease. Suicides and natural deaths both constitute significant proportions of MVC fatalities and may be misclassified unless a full inquest including an autopsy is performed.

Retrospective Autopsy Study of Custodial Deaths in Rajindra Hospital (GMC) Patiala

Retrospective Autopsy Study of Custodial Deaths in Rajindra Hospital (GMC) Patiala

Childhood neoplasms presenting at autopsy: A 20-year experience.

The aims of the review are to establish the number of undiagnosed neoplasms presenting at autopsy in a single centre and to determine the incidence and most common causes of sudden unexpected death due to neoplasia in infancy and childhood (SUDNIC). Retrospective observational study of paediatric autopsies performed on behalf of Her Majesty's Coroner over a 20-year period (1996-2015; n = 2,432). Neoplasms first diagnosed at autopsy were identified from an established database and cases meeting the criteria for sudden unexpected death were further categorised. Thirteen previously undiagnosed neoplasms were identified, including five haematological malignancies, two medulloblastomas, two neuroblastomas, two cardiac tumours and two malignancies of renal origin. Eight cases met the criteria for SUDNIC (0.33% of autopsies), the commonest group of which were haematological malignancies (n = 3). Neoplasms presenting as unexpected death in infancy and childhood and diagnosed at autopsy are rare. The findings suggest that haematological malignancies are the commonest cause of SUDNIC and highlight the importance of specialist autopsy in cases of sudden unexpected death.

The Configuration and Variations in the Developing Circle of Willis – A Retrospective Autopsy Study

The Configuration and Variations in the Developing Circle of Willis – A Retrospective Autopsy Study

Depressive Symptoms on the Geriatric Depression Scale and Suicide Deaths in Older Middle-aged Men: A Prospective Cohort Study.

Objectives:Prospective evaluations of the associations between depressive symptoms and suicide deaths have been mainly performed in high-risk populations, such as individuals with psychiatric disorders or histories of self-harm. The purpose of this study was to prospectively examine whether more severe depressive symptoms assessed using the Geriatric Depression Scale (GDS) were associated with a greater risk of death from suicide in a general-risk population.Methods:A total of 113 478 men from the Korean Veterans Health Study (mean age, 58.9 years) who participated in a postal survey in 2004 were followed up for suicide mortality until 2010.Results:Over 6.4 years of follow-up, 400 men died by suicide (56.7 deaths per 100 000 person-years). More severe depressive symptoms were associated with greater risk of suicide death (p for trend <0.001). The unadjusted hazard ratios (HRs) in comparison to the absence of depression were 2.18 for mild depression, 2.13 for moderate depression, 3.33 for severe depression, and 3.67 for extreme depression. After adjusting for potential confounders, men with a potential depressive disorder had an approximate 90% higher mortality from suicide (adjusted HR, 1.92; 95% confidence interval [CI], 1.38 to 2.68; p<0.001) than men without depression. Each five-point increase in the GDS score was associated with a higher risk of death by suicide (adjusted HR, 1.22; p<0.001). The value of the area under the receiver operating characteristics curve of GDS scores for suicide deaths was 0.61 (95% CI, 0.58 to 0.64).Conclusions:Depressive symptoms assessed using the GDS were found to be a strong independent predictor of future suicide. However, the estimate of relative risk was weaker than would be expected based on retrospective psychological autopsy studies.

The influence of alcohol on pedestrians: A different approach to the effectiveness of the new traffic safety law

ABSTRACTObjective: The aim of this study was to explore the effects of the new traffic safety law on pedestrian mortality by exploring hazardous behaviors of pedestrians in terms of alcohol use and blood alcohol concentration (BAC).Methods: A retrospective autopsy study was performed, covering a 7-year period (from 2006 to 2012), including cases of fatally injured pedestrians who died at the scene of the incident. Blood samples obtained from the femoral vein during autopsy were analyzed for BAC. The entire sample was divided into 2 groups. The first included cases from 2006 to 2009, at which time the old traffic safety law was in force, and the second included cases from 2010 to 2012, under the new traffic safety law.Results: A total of 247 cases were examined, covering a 7-year period. The average age was 57.5 ± 19.7 years (median 61.0 years) with a significant male predominance of 147 men to 100 women. This predominance also applied to alcohol use (54 vs. 13). The results show a significant decrease in the total annual number of fatally injured pedestrians, starting from 2009, compared to previous years, reaching a low in 2010, one year after implementation of the new traffic safety law. In contrast, the proportion of alcohol-intoxicated pedestrians showed no significant difference in the years preceding and following the new traffic safety law, nor did the annual distribution of BAC or mean BAC before and after application of the new law.Conclusion: The present study indicates that the new traffic safety law has been quite effective in reducing pedestrian mortality. However, alcohol consumption and intoxication in pedestrians remains a fairly important factor in motor vehicle accidents involving pedestrians, because the proportion of pedestrians positive for alcohol, the proportion of severely intoxicated pedestrians with BAC > 1 g/L, and annual mean BAC have remained unchanged.

Fatal burn injuries: A five year retrospective autopsy study in Temple town, Tirupati

Fatal burn injuries: A five year retrospective autopsy study in Temple town, Tirupati

Histopathologic Findings in Autopsies with Emphasis on Interesting and Incidental Findings-A Pathologist's Perspective.

Autopsy aids to the knowledge of pathology by unveiling the rare lesions which are a source of learning from a pathologist's perspective Some of them are only diagnosed at autopsy as they do not cause any functional derangement. This study emphasizes the various incidental lesions which otherwise would have been unnoticed during a person's life. The aim of this study was to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death. It was also aimed to highlight various incidental and interesting lesions in autopsies. A retrospective study of medicolegal autopsies for six years was undertaken in a tertiary care centre to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death and to highlight various incidental and interesting lesions in autopsies. Statistical Analysis: Individual lesions were described in numbers and incidence in percentage. The study consisted of a series of 269 autopsy cases and histopathological findings were studied only in 202 cases. The commonest cause of death was pulmonary oedema. The most common incidental histopathological finding noted was atherosclerosis in 55 (27.2%) cases followed by fatty liver in 40 (19.8%) cases. Neoplastic lesions accounted for 2.47% of cases. This study has contributed a handful of findings to the pool of rare lesions in pathology. Some of these lesions encountered which served as feast to a pathologist are tumour to tumour metastasis, a case with coexistent triple lesions, Dubin Johnson syndrome, von Meyenburg complex, Multilocular Cystic Renal Cell Carcinoma (MCRCC), Autosomal Dominant Polycystic Kidney Disease (ADPKD), liver carcinod and an undiagnosed vaso-occlusive sickle cell crisis. Autopsy studies help in the detection of unexpected findings significant enough to have changed patient management had they been recognized before death.

Motorcycle accident mortality in Lagos, Nigeria: Impact of a traffic law

Introduction: The use of the motorcycles for commercial purposes has been associated with a high rate of road traffic injuries and mortality in Nigeria. This study is to examine the effects of newly introduced traffic laws on the mortality rate as well as pattern of injury following the enforcement of the laws. Methodology: This is a 4-year retrospective autopsy study of motorcycle accident deaths in Lagos State University Teaching Hospital, Ikeja. The study period was divided into two parts; 2 years before the law, August 2010–July 2012 and 2 years after the law, August 2012–July 2014. The anatomical location of the injuries as well as the cause of death of the patients was extracted from the register and the data were analyzed using SPSS version 20. Test for statistical significance was set as P < 0.05. Results: There were 128 motorcycle death autopsies recorded during the period of study with 96 cases (75%) before the law and 32 cases (25%) after the law. The frequency of head injury was 39.8% before the law and 43.6% after the law. The proportion of road traffic accident deaths due to motorcycle crashes was from 23.4% before the law to 11.2% after the law. Conclusion: Head injury is the most frequent anatomical region of injury in both periods. There is a 3-fold decrease in the proportion of death from motorcycle crashes following the enforcement of the traffic law.

CPR-related rib and sternum fractures after unsuccessful resuscitation by means of manual or mechanical chest compressions with the LUCAS™ device

Purpose of the study: The reported incidence of rib and sternum fractures after unsuccessful cardiopulmonary resuscitation by manual chest compressions (manual CPR) in the twentieth century varied greatly, and it was generally considered that at least 1/3 of resuscitated patients sustained rib fractures and at least 1/5 sternum fractures. However, recent studies indicate amuch higher incidence of such injuries. Increasing use of the LUCASTM device (mechanical CPR) raises the question of whether it has any adverse effects. Our goal was to compare the incidence and number of rib and sternum fractures after manual and mechanical CPR. Materials and methods: This retrospective autopsy study included 946 patients (802 manual CPR and 144 mechanical CPR) resuscitated in the period 2011–2014, i.e., when Guidelines 2010 were applied. Results: At least one rib fracture was found in 86.9% of the patients resuscitated manually and in 88.9% of those resuscitated mechanically (p=0.512). Sternum fractures were found in 64.2% of the patients resuscitated manually and in 72.9% of those resuscitated mechanically (p=0.043). Either rib or sternum fractures or both were found in 88.8% of the patients in the manual CPR group and 93.1% of the patients in the mechanical CPR group (p=0.854). The average number of rib and sternum fractures per injured patient was 12.04 in the manual CPR group and 11.88 in the mechanical CPR group. Conclusion: In the studied population, mechanical CPR caused approximately 4% more rib and/or sternum fractures than manual CPR. However, the average number of fractures per injured patient was slightly lower in the mechanical CPR group.1,2

Using transpulmonary thermodilution leads successful fluid resuscitation in early phase of septic shock

Purpose of the study: The reported incidence of rib and sternum fractures after unsuccessful cardiopulmonary resuscitation by manual chest compressions (manual CPR) in the twentieth century varied greatly, and it was generally considered that at least 1/3 of resuscitated patients sustained rib fractures and at least 1/5 sternum fractures. However, recent studies indicate amuch higher incidence of such injuries. Increasing use of the LUCASTM device (mechanical CPR) raises the question of whether it has any adverse effects. Our goal was to compare the incidence and number of rib and sternum fractures after manual and mechanical CPR. Materials and methods: This retrospective autopsy study included 946 patients (802 manual CPR and 144 mechanical CPR) resuscitated in the period 2011–2014, i.e., when Guidelines 2010 were applied. Results: At least one rib fracture was found in 86.9% of the patients resuscitated manually and in 88.9% of those resuscitated mechanically (p=0.512). Sternum fractures were found in 64.2% of the patients resuscitated manually and in 72.9% of those resuscitated mechanically (p=0.043). Either rib or sternum fractures or both were found in 88.8% of the patients in the manual CPR group and 93.1% of the patients in the mechanical CPR group (p=0.854). The average number of rib and sternum fractures per injured patient was 12.04 in the manual CPR group and 11.88 in the mechanical CPR group. Conclusion: In the studied population, mechanical CPR caused approximately 4% more rib and/or sternum fractures than manual CPR. However, the average number of fractures per injured patient was slightly lower in the mechanical CPR group.1,2

Pattern of Drowning Cases in Rural Area: A Retrospective Autopsy Study

Pattern of Drowning Cases in Rural Area: A Retrospective Autopsy Study

Hepatic steatosis is prevalent in stillborns delivered to women with diabetes mellitus.

Maternal diabetes is a risk factor for pregnancy complications, including stillbirth and macrosomia. Evolving data suggest that diabetes during pregnancy also has long-term consequences for offspring, putting them at risk for obesity and the metabolic syndrome in childhood. Because nonalcoholic fatty liver disease is known to occur in adults and children with insulin resistance, we hypothesized that altered lipid metabolism in fetuses of diabetic mothers may manifest with hepatic steatosis. We undertook a retrospective autopsy study to compare the presence and degree of hepatic steatosis between stillborns delivered to women with pregestational or gestational diabetes mellitus (gestational age 20-40 weeks; n = 33) and age-matched nondiabetic control stillbirth cases (n = 48), the latter enriched for maternal obesity, macrosomia, and similar cause of demise. Histopathologic hepatic steatosis was significantly more prevalent and severe in the diabetic subjects (26/33, 78.8%) than in the controls (8/48, 16.6%) (P < 0.001). Within the diabetic cohort, the severity of steatosis was related directly to gestational age, birth weight, and liver weight, with no correlation of presence or severity of steatosis in the control group to maternal or fetal factors, including maternal body mass index or fetal macrosomia. Although macrosomic stillborns were more common in diabetic women with %hemoglobin A1c >6 and body mass index >30 kg/m, fetal steatosis was independent of glycemic control, maternal obesity, type of diabetes, ethnicity, or fetal sex in our cohort. This study is the first to our knowledge to demonstrate a specific association between fetal hepatic steatosis and maternal diabetes.

Evaluation of Relationship Between Accident Types, Localization of Occupants In The Vehicle And Injury Pattern in Fatalities Resulting From Road Traffic Accident: Retrospective Autopsy Study

Evaluation of Relationship Between Accident Types, Localization of Occupants In The Vehicle And Injury Pattern in Fatalities Resulting From Road Traffic Accident: Retrospective Autopsy Study

A Retrospective Autopsy Study of Pattern of Injuries Sustained by Pedestrians of Fatal Road Traffic Accidents

As per the commission for Global Road Safety (2009), Road Traffic Accidents (RTAs) kill an estimated 1.3 million and injure 15 million people every year globally. In Asia, it is about 700,000 per year which is more than 50% of world's fatalities. As per 2009 statistics of India, RTA was around 4.9 lakhs, killing 1, 25,660 persons and injuring more than 5 lakhs. This can be deduced as one RTA occurring every minute and a fatality every 4 minutes. More than 50% of these fatalities are in the age group of 25-65 years, a productive wage earning and child raising age group, thus snatching the bread earner. The top five States in RTA are Maharashtra, Tamil Nadu, Madhya Pradesh, Karnataka and Andhra Pradesh. As per 2009 statistics, Bangalore stands second to Ahmadabad in fatal RTAs. The pedestrian fatalities are maximum due to non availability of safe foot paths; erratic and reckless movement of traffic in busy lanes. Many cosmopolitan cities of India have become death traps for pedestrians (67.9%.) 1 The roads are poorly constructed with least importance given to pedestrian. The vehicle drivers in peak hours often use foot path too, if available! This study was conducted in IT hub of Bangalore, Whitefield. The movement of traffic is at its peak in morning (8AM-10AM) and evening (4PM- 6PM), being office going and leaving hours. This study is undertaken to evaluate the factors responsible to study the pattern of injuries to the pedestrians & also to suggest measures to prevent pedestrian accidents & thereby preventing morbidity & mortality. Language: en

Retrospective Autopsy Study of Deaths Due to Rodenticides

Rodents are mammals of the order Rodentia, characterized by a single pair of continuously growing incisors in each of the upper and lower jaws. About forty percent of all species of mammals are rodents, and they are found in vast numbers on all continents except Antartica. Rodenticides are commonly used to kill variety of rodents which cause great loss of food grains. Simple access and easy availability to these rodenticides results in their consumption. A detailed autopsy study of deaths due to rodenticides has been made, there by studying the various factors like age, sex, manner of death, reasons for death etc. Majority were suicidal deaths, ill-healthbeing the leading reason for death among suicides.

Hydrophilic polymer embolism and associated vasculopathy of the lung: prevalence in a retrospective autopsy study

Hydrophilic polymers are commonly applied as surface coatings on vascular devices and have been shown to dissociate during endovascular use, causing hydrophilic polymer embolism (HPE). Adverse effects related to this phenomenon have been recognized and reported. The prevalence of this complication is unknown. We conducted a retrospective study to determine the prevalence of HPE among hospital autopsies over a 29-month period. Postmortem tissue was histologically evaluated for the presence, location(s) and extent of HPE. HPE findings were correlated with documented clinical and laboratory data and patient outcome. Of 136 hospital autopsies examined, 18 (13%) showed evidence of HPE involving the lungs (n = 18), heart (n = 1) or central nervous system (n = 1). Localized pulmonary HPE was seen in 12 patients (9%). Multifocal pulmonary HPE was found in 6 patients (4%) and was associated with clinical vasculitis (33%; P < .0001), suspected pulmonary ischemia (50%; P = .008), coagulopathy (67%; P = .002), and constitutional disease (83%; P = .01). Within affected lung, associated histopathologic changes included occlusive intravascular or perivascular inflammation (89%), intravascular fibrous response (56%), microthrombus formation (44%), vasculitis (28%), and/or pulmonary microinfarction (28%). Statistically significant differences in hospital days (P = .008) and number of vascular interventions (P = .01) were noted between affected and unaffected patients. We conclude that HPE is an underdiagnosed phenomenon with primary involvement of the lungs, where secondary vascular changes are common. Additional studies may be needed to clarify risks and to identify preventative strategies for this iatrogenic complication of catheterizations and "minimally invasive" endovascular techniques.

Sudden death in a teaching hospital of the Wuxi area: a retrospective autopsy study

Sudden death (SD) has a great impact on the medical community and on society in general. The aim of this study was to investigate the autopsy causes and associated pathological characteristics of SD in a teaching hospital of the Wuxi area and to discuss suitable methods for diagnosis and prophylaxis. In this retrospective study, data were collected from 134 SD patients. Ancillary studies covering histology and toxicology were also performed and analysed for the presence of risk factors. The subjects included 94 men and 40 women (M:F ratio = 2.35:1; P < 0.05). The peak age was 20–39 years, accounting for 32.1% (43 cases) of the total number of cases. The most common cause of SD in all cases was cardiovascular disease (n = 79, 59.0%). Cases in which coronary atherosclerotic heart disease was the prime culprit were named sudden cardiac death (SCD). Other causes of death included respiratory disease, neurological disease, and other diseases. Sudden death causes are numerous. This study aims to help prevent SD and to improve the processes of diagnosis and prevention. The results of completely accurate autopsies are necessary, in order to encourage epidemiological and preventive studies on sudden death.