Differences in the Determination of Cause and Manner of 127 Natural Death Cases by Postmortem Inspection and Autopsy / 대한법의학회지

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.

Inadequacies of Death Certification: The Role of Forensic Pathologist / 대한법의학회지

Death certification is a public health surveillance tool and a valuable source of information at the national and local levels. Among activities that benefit from the availability of cause-of-death statistics obtained from death certificates are the monitoring of the health of populations, the setting of priorities and the targeting of intervention. Such statistics are also the keystone of much epidemiological study. So adequate writing cause-of-death statements for death is very important. The present study was undertaken to evaluate death certification in Seoul and Kyung-in area of Korea. The available 203 death certificates were obtained from the 1026 autopsy files of National Institute of Scientific Investigation(june, 2002-september, 2002). The summary of the results were: 1. Cases that writing the phenomenon such as cardiac or respiratory arrest, heart failure in the box of cause-of-death were 64 cases(31.5%). Cases that writing the immediate cause of death in the second or third line of box were 50 cases(24.6%). Cases that writing two or more immediate cause-of-death in one line of box were 36 cases(17.7%). 2. Cases that the statement of cause-of-death not correlated with the statement of manner-of-death were 18 cases(8.4%). 3. Cases that the immediate cause-of-death and manner-of-death is changed after autopsy were 179 cases(88.2%). The results of this study showed inadequacies of death certification in Seoul, Kyung-in area of Korea. We thought the reasons for this inadequacies of death certification were mainly insufficient education and campaign for physicians about accurate understanding of cause of death, manner of death. The forensic pathologists certified a number of deaths and have responsibility for education about cause of death, manner of death. So we emphasized need for forensic pathologists to be involved in works related with death certification forms and policies.