Statistical Analysis of Unknown Causes of Deaths Using Postmortem Findings by Medical Examination

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  • 死因不明であった症例の監察所見による統計学的考察

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Abstract

Autopsy of individuals in whom the cause of death was unknown is recommended, but the autopsy rate varies regionally, and it cannot be always performed. No guidelines for its promotion have been complied from the viewpoint of medicine yet. For accurate determination of causes of deaths, establishment of databases using the Utstein style and evaluating by postmortem examination system are performed in Kobe. In this study, we evaluated the findings obtained by medical examination or autopsy of CPA patients, in whom determination of the cause of death was clinically difficult, and attempted to produce a chart for the clinical estimation of causes of deaths in regions in which evaluation by autopsy is difficult. Subjects and methods: Among 2,606 individuals recorded using the Utstein style between January 1, 2001 and December 31, 2003, the subjects were 226 CPA patients who had undergone postmortem examination or autopsy because the cause of death was considered endogenous but uncertain. We evaluated the clinical findings and results of postmortem examination or autopsy. Results: Of the 226 patients, postmortem examination alone was performed in 76, and autopsy in 150, respectively. The confirmed causes of deaths were ischemic cardiac disorders in 31% of the patients, cerebrovascular disorders in 7.1%, cardiac or great vascular disorders in 7.1%, aspiration or asphyxiation in 8.4%, and other cardiac disorders in 11.1%. Prodromes before the occurrence of out-of-hospital CPA were noted only in 20 patients. Discussion: It is difficult to determine causes in individuals who died of certain disorders, such as great vascular disorders, gastrointestinal perforation, chemical poisoning, and dysbolism, by postmortem examination alone, therefore autopsy is often required. Physical findings and postmortem examination are insufficient for identifying the causes of deaths in CPA patients, and results of clinical examinations are often meaningless because they are affected by various factors. Prodromes in out-of-hospital CPA provide important information, but they cannot be generally obtained. We produced a flowchart for the estimation of the cause of death in decreasing order: (1) ischemic cardiac disorders, (2) great vascular disorders, (3) cerebrovascular disorders, and (4) aspiration or asphyxiation, which showed high incidences in this study, so that it can be applied to out-of-hospital CPA in which identifying the cause of death is difficult in regions where autopsy examination is difficult.

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