Autopsies and death certification in deaths due to blunt trauma: what are we missing?
OBJECTIVE
To determine the frequency, body region and severity of injuries missed by the clinical team in patients who die of blunt trauma, and to examine the accuracy of the cause of death as recorded on death certificates.


METHODS
A retrospective review.


METHODS
London Health Sciences Centre, London, Ont.


METHODS
One hundred and eight deaths due to blunt trauma occurring during the period Apr. 1, 1991, to Mar. 31, 1997. Two groups were considered: clinically significant missed injuries were identified by comparing patient charts only (group 1) and more detailed injury lists from the autopsies and charts of the patients (group 2).


METHODS
Chart and autopsy findings.


RESULTS
Of the 108 patients, 78 (72%) were male, and they had a median age of 39 years (range from 2 to 90 years). The most common cause of death was neurologic injury (27%), followed by sepsis (17%) and hemorrhage (15%). There was disagreement between the treating physicians and the causes of death listed on the death certificate in 40% of cases and with the coroner in 7% of cases. Seventy-seven clinically significant injuries were missed in 51 (47%) of the 108 patient deaths. Injuries were missed in 29% of inhospital deaths and 100% of emergency department deaths. Abdominal and head injuries accounted for 43% and 34% of the missed injuries, respectively.


CONCLUSIONS
The information contained on the death certificate can be misleading. Health care planners utilizing this data may draw inaccurate conclusions regarding causes of death, which may have an impact on trauma system development. Missed injuries continue to be a concern in the management of patients with major blunt trauma.
Hodgson
N F
NF
Department of Surgery, University of Western Ontario, London Health Sciences Centre.
Stewart
T C
TC
Girotti
M J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000592:standards*; D015982:Bias; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003334:Coroners and Medical Examiners; D003644:Death Certificates; D005260:Female; D006285:Health Planning; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000401:mortality*