kjlm The Korean Journal of Laboratory Medicine Korean J Leg Med 2383-5702 2383-5710 The Korean Society for Legal Medicine 10.7580/kjlm.2013.37.1.14 kjlm-37-14 원 저 Forensic Analysis of the Cause of Death and Death on Arrival of Patients at the Emergency Room ParkJong Hyeok 1 KimYoung Joo 1 HamSuk Hoon 1 YeomSeok Ran 2 AhnRyeok 3 HaHongil 1 Department of Forensic Medicine, Southern District Office, National Forensic Service, Yangsan, Korea Department of Emergency Medicine, Pusan National Universitiy Hospital, Busan, Korea Department of Emergency Medicine, Ulsan Universitiy Hospital, University of Ulsan College of Medicine, Ulsan, Korea 이 논문은 2012년도 과학수사 감정기법 연구개발 사업의 재원으로 수행된 것임(과 제번호 2012-중장기-25). 책임저자 : 하홍일 (626-742) 경남 양산시 물금읍 금오로 50 국립과학수사연구원 남부분원 법의학과 전화 : +82-55-380-4050 FAX : +82-55-380-4060 E-mail : sanchee@korea.kr 12013 1712013 371 1418 01022013 15022013 22022013 Copyright © 2013 The Korean Society for Legal Medicine 2013 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

From January 2007 to June 2012, 55 autopsy cases were reviewed, in which death occurred outside the hospital and the patients were declared dead on arrival at the emergency departments, in order to compare the clinical and postmortem examination diagnoses of death-on-arrival patients in tertiary hospitals in Busan, Yangsan and Ulsan city. Of 22 non-traumatic deaths, 21 occurred from natural causes and 1 from unknown cause (sudden infant death syndrome, SIDS). Clinical diagnoses were cardiovascular diseases or “non-traumatic” / “unknown” while autopsy diagnoses were majorly cardiovascular diseases, especially coronary artery diseases (72.7%). Of 33 unnatural deaths, the cause of death was blunt trauma in 4 patients, sharp-force injury in 6, falling in 10, gunshot injury in 1, traffic accidents in 3, asphyxia in 2, drowning in 2, fire-related death in 1, and intoxication in 4. There were no definite discrepancies between clinical and autopsy diagnoses, except for 5 non-traumatic deaths and 2 unnatural deaths. These results suggest that the role of the emergency department may be crucial in postmortem investigations.

 Key words Death on arrival Emergency room Postmortem examination REFERENCES Tavora F Crowder C Kutys R Discrepancies in initial death certificate diagnoses in sudden unexpected out-of-hospital deaths: the role of cardiovascular autopsy Cardiovasc Pathol 200817 17882 Kang YS Lee KR Park IC Survey of the causes of death on the death certificates of DOA patients J Korean Soc Emerg Med 200112 38592 Lee JH Cheon YJ Park HJ Autopsy results of out-of-hospital cardica arrest Korean J Leg Med 200933 1115 Buschmann CT Gahr P Tsokos M Clinical diagnosis versus autopsy findings in polytrauma fatalities Scand J Trauma Resusc Emerg Med 201018 55 Na JY Min BW Lee YJ The discrepancy of the causes of death between medical death certificates and autopsy reports Korean J Leg Med 200933 108 Ok TG Cho JH Park CW A study of the investigative method of cause of death for making out a death certificate J Korean Soc Emerg Med 200617 24553 Tables

Non-traumatic Deaths

Sex Age Clinical diagnosis Brief history/ Medical history Postmortem examination diagnosis
M 27 ∗AMI∗ Suddenly fell over AMI
M 49 AMI Collapsed at the office IHD†
M 61 AMI Fell down in residence AMI
M 59 AMI Collapsed after acupuncture therapy at the oriental medical clinic AMI
M 51 AMI After coughing and vomiting in the taxi, became pale and apnea AMI
M 62 AMI Collapsed during repairing roof of the truck AMI
M 35 AMI After loading and unloading, complained chest pain and collapsed on the deck IHD
M 34 AMI Came home after drinking, and complained dyspnea during sleeping SCD†
M 53 SCD Collapsed at the office Atherosclerotic heart disease
M 43 Unknown Found dead at home DCMP§
F 0 Unknown Apnea in residence SIDS‖
(7 months)
F 32 Non -traumatic Transferred to the emergency room on account of abdominal pain Myocarditis
M 52 Non -traumatic Collapsed during drinking coffee with his friend AMI
M 56 Non -traumatic During riding in the car, collapsed after getting out of the car AMI
M 71 Non -traumatic Collapsed during sitting on the wall of apartment back gate AMI
F 68 Non -traumatic Transferred to the hospital on account of dyspnea Panperotonitis due to perforation of large intestine
M 51 Non -traumatic After vomiting, collapsed in the taxi SCD
F 28 Unknown After Cesarean section, collapsed during recovery Pulmonary thromboembolism
M 29 Unknown Complained chest pain SCD
M 27 Unknown Collapsed during showing his love DCMP
M 65 Traumatic During driving a motorcycle, fell down to avoid taxi AMI
M 65 IHD Lost his consciousness in the jjimjilbang SCD

AMI: Acute myocardial infarct;

IHD: Ischemic heart disease;

SCD: Sudden cardiac death;

DCMP: Dilated cardiomyopathy;

SIDS: Sudden infant death syndrome

Unnatural Deaths

Sex Age Clinical diagnosis Brief history/ Medical history Postmortem examination diagnosis Classification
M 42 Traumatic Death laid under the griddle while at work MOI∗ Blunt trauma
F 48 Undetermined Collapsed in the home after quarrel Death related with neck injury Blunt trauma
F 86 Traumatic Had been assaulted MOI of the head and arms Blunt trauma
M 49 Traumatic Got stuck between the freight elevator and the iron railing MOI of the neck and thorax Blunt trauma
M 33 Hypovolemic shock Got stabbed three times Stab wound of the heart Sharp force injury
M 28 Stab wound of the neck Got stabbed in the neck with the beer bottle in the saloon Stab wound of the neck Sharp force injury
F 52 Hypovolemic shock Got stabbed by roommate Stab wound of the back Sharp force injury
F 19 Abdominal stab wound Got stabbed in the abdomen during staying in the inn Stab wound of the abdomen Sharp force injury
M 65 Traumatic shock Bleeding due to violence using knife during having a fight with his wife Traumatic shock Sharp force injury
M 48 Hypovolemic shock Got multiple incised wounds of the neck and left wrist Multiple incised wounds of the neck and left wrist Sharp force injury
M 39 Hypovolemic shock Fell down on the cement floor by pushing of the suspect Traumatic cardiac rupture Fall down
M 51 Traumatic Had had past medical history of scalp laceration, and slept after drinking Craniocerebral injury Fall down
F 41 Traumatic brain injury Collapsed on the street MOI of the head and trunk Fall down
M 47 Craniocerebral injury Fell backward after entering the mart Craniocerebral injury Fall down
M 50 Traumatic SAH Collapsed on the street after drinking Craniocerebral injury Fall down
F 42 Traumatic Lost her consciousness after drinking on account of having a fight with her husband Craniocerebral injury Fall down
F 48 Hypovolemic shock Fell down MOI Fall down
F 4 MOI∗ of trunk Fell from the balcony of the apartment onto the flower bed MOI Fall from height
F 53 MOI Fell from 5th floor MOI of the head and trunk Fall from height
M 49 MOI Fell from construction site MOI Fall from height
M 34 Panperitonitis (gastric perforation) Suicidal firing on the neck using air gun Panperitonitis Gunshot wound
M 17 Traumatic Fell down on the road, and impacted by motorcycle MOI TA†
M 66 Hypovolemic shock Ran over by forklift Mutiple lower extremity injury TA
M 57 Hypovolemic shock Impacted by the car during jaywalking MOI TA
M 60 Strangulation Hanging in the detention center Hanging Asphyxia
F 6 Strangulation Found hanging on the doorknob using belt Manual strangulation Asphyxia
M 35 Drowning Found on the sea Drowning Drowning
M 34 Drowning Fell from the bridge Drowning Drowning
M 80 Death due to fire Death due to fire during sleeping in the residence Death due to fire Death due to fire
F 62 Paraquat poisoning Drunken farmer drunk agricultural poison during village track meet Paraquat poisoning Intoxication
M 70 Agricultural poisoning Found lying after drinking herbicide Paraquat poisoning Intoxication
M 87 Agricultural poisoning Drunk herbicide in the yard of residence after visiting his wife in the hospital Paraquat poisoning Intoxication
M 20 Unknown Found dead at home Anionic surfactant poisoning Intoxication

MOI: Multi-organ injury;

TA: Traffic accident