Journal List > Korean J Leg Med > v.37(1) > 1004729

Huh, Kim, Jo, and Lee: Differences in the Determination of Cause and Manner of 127 Natural Death Cases by Postmortem Inspection and Autopsy

Abstract

Medicolegal 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.

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Table 1.
Cause of Death by Postmortem Inspection n
Cause of death No. of cases
Cardiovascular disease 81
Chronic alcoholism and/or chronic liver disease 21
Cerebrovascular disease 10
Upper GI bleeding due to chronic liver disease 4
Complication of diabetes mellitus 3
Sudden manhood death syndrome 2
Upper GI bleeding, unclassified 1
Cardio- and cerebrovascular disease 1
Pneumothorax 1
Pulmonary thromboembolism 1
Asthma 1
Nutritional deficiency 1
Total 127
Table 2.
Discrepant Cases by Manner of Death after Autopsy
Postmortem inspection diagnosis Autopsy diagnosis Manner of death No. of cases
Cardiovascular disease (n=81) Acute alcohol intoxication Unnatural 2
Glyphosate intoxication Unnatural 2
Antidepressant intoxication Unnatural 1
Traumatic basal subarachnoid hemorrhage Unnatural 1
Undetermined Undetermined 2
Chronic alcoholism and/or chronic liver disease (n=21) Acute alcohol intoxication Unnatural 3
Methomyl intoxication Unnatural 1
Traumatic subdural hematoma Unnatural 1
Undetermined Undetermined 3
Complication of diabetes mellitus (n=3) Acute alcohol intoxication Unnatural 1
Total     17
Table 3.
Discrepant Cause of Death among Confirmed Natural Death after Autopsy
Postmortem inspection diagnosis Autopsy diagnosis No. of cases
Cardiovascular disease (n=73) Intracerebral hemorrhage 4
Pneumonia 1
Pulmonary thromboembolism 1
Brain tumor (meningioma) 1
Fatty liver, severe 1
Subarachnoid hemorrhage 1
Chronic alcoholism and/or chronic liver disease (n=13) Ischemic heart disease 4
Hypertrophic cardiomyopathy 1
Pneumonia 1
Intracerebral hemorrhage 1
Cerebrovascular disease (n=10) Ischemic heart disease 4
Pneumonia 1
Upper GI bleeding due to chronic liver disease (n=4) (-) 0
Sudden manhood death syndrome (n=2) Dilated cardiomyopathy 1
Upper GI bleeding, unclassified (n=1) (-) 0
Cardio- and cerebrovascular disease (n=1) Chronic alcoholism 1
Pulmonary thromboembolism (n=1) Dilated cardiomyopathy 1
Pneumothorax (n=1) Ischemic heart disease 1
Asthma (n=1) Ischemic heart disease 1
Nutritional deficiency (n=1) (-) 0
Total (n=107)   26
Table 4.
Positive Predictive Values of 4 Most Common Cause of Death by Postmortem Inspection
Cause of death Fraction %
Cardiovascular disease 64 correct/81 79.0
Chronic alcoholism and/or chronic liver disease 6 correct/21 28.6
Cerebrovascular disease 5 correct/10 50.0
Upper GI bleeding due to chronic liver disease 4 correct/4 100.0
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