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

Gi Yeong Huh; Kwang Hoon Kim; Gam Rae Jo; Sang Yong Lee

doi:10.7580/kjlm.2013.37.1.9

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

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Korean J Leg Med 2013;37(1):9-13.

Published online: 17 January 2013

DOI: https://doi.org/10.7580/kjlm.2013.37.1.9

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

Gi Yeong Huh, Kwang Hoon Kim, Gam Rae Jo, Sang Yong Lee

Institute of Forensic Medicine, Pusan National University School of Medicine, Yangsan, Gyeongsangnam-do, Korea

이 논문은 부산대학교 자유과제 학술연구 비(2년)에 의하여 연구되었음. 책임저자 : 허기영 (626-870) 경상남도 양산시 물금읍 범어 리, 부산대학교 의학전문대학원 법의학연 구소 전화 : +82-51-510-8058 FAX : +82-51-510-8143 E-mail : gyhuh@pusan.ac.kr

Received 23 October 2012 Revised 28 December 2012 Accepted 28 January 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

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.

Keywords: Key words, Cause of death, Manner of death, Postmortem inspection, Autopsy, Forensic pathologists

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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
Cerebrovascular disease (n=10)	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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