Role of autopsy in sudden natural deaths in adults
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The aim of this study was to determine the extent to which the cause of death in sudden natural death in adults could be ascertained without autopsy, based on information provided in the police report, and to evaluate any degree of error between that and the officially certified cause of death. Two methods were carried out: 1. A questionnaire-based retrospective survey of sudden natural deaths distributed to practitioners. The predicted cause of death was compared with the actual cause of death as determined after autopsy. The difference between the two causes of death was classified into 'no difference', minor and major difference according to the classification scheme developed for this study. 2. A prospective study of adult sudden natural deaths referred by the procurators fiscal in Lothian and Borders to the department during 2009 and 2010. The police reports were reviewed and a cause of death was ascribed by the author. This cause was compared with the actual cause of death in the final autopsy report and any difference assessed according to the classification scheme. In the view of the retrospective study results, it is possible to determine the cause of death which is with no or minor difference to that determined by autopsy if, in addition to provide sufficient information regarding deceased’s medical history and circumstances of death, the participants are given the option to select which cases should undergo external examination only. The prospective study results indicate that in certain circumstances the cause of death could be ascribed correctly based on the available information prior to autopsy. Causes of death such as ischaemic heart disease, hypertensive heart disease and alcohol related death are more frequently ascribed correctly. However, ischaemic and hypertensive heart disease were over-predicted. Results indicate that there are criteria to select which cases might be subject to a "view and grant" procedure with no significant loss of accuracy. The implications of the study for the development of medico-legal services are considered with specific reference to Kuwait.