Autopsy practice in forensic pathology - evidence-based or experience-based? a review of autopsies performed on victims of traumatic asphyxia in a mass disaster.
Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case series, we describe the variation observed in autopsy reports by five different pathologists of eight victims who died simultaneously from traumatic asphyxia due to compression during a human stampede. We observed that there was no mention of the availability of medical charts in five of the reports, of potentially confounding resuscitation efforts in three reports, of cardinal signs in seven reports and of associated injuries to a various degree in all reports. Further, there was mention of supplemental histological examination in two reports and of pre-autopsy radiograph in six reports. We inferred that reliance on experience and individual customary practices led to disparities between the autopsy reports as well as omissions of important information such as cardinal signs, and conclude that such reliance increases the potential for error in autopsy practice. We suggest that pre-autopsy data-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy of the report as a legal document as well as rendering it more useful for data-gathering efforts.
Department of Forensic Medicine, Copenhagen University, Denmark. Electronic address: bonnie.colville-ebeling@sund.ku.dk.
Bonnie
B
Colville-Ebeling
Department of Forensic Medicine, Aarhus University, Denmark; Section of Forensic Medicine, Umeå University, Sweden; Department of Public Health & Preventive Medicine, Oregon Health & Science University, USA.
Michael
M
Freeman
Department of Forensic Medicine, Copenhagen University, Denmark.
Jytte
J
Banner
Department of Forensic Medicine, Copenhagen University, Denmark.
Niels
N
Lynnerup
D000293:Adolescent; D000328:Adult; D001237:Asphyxia / Q000401:mortality* / Q000473:pathology*; D001344:Autopsy / Q000706:statistics & numerical data*; D002492:Central Nervous System Depressants / Q000097:blood; D003229:Conjunctival Diseases / Q000473:pathology; D003288:Contusions / Q000473:pathology; D000431:Ethanol / Q000097:blood; D049429:Forensic Pathology / Q000379:methods; D006335:Heart Injuries / Q000473:pathology; D006406:Hematoma / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D055370:Lung Injury / Q000473:pathology; D008297:Male; D054527:Mass Casualty Incidents; D011693:Purpura / Q000473:pathology; D053120:Respiratory Aspiration / Q000473:pathology; D012253:Rib Fractures / Q000473:pathology; D012867:Skin / Q000293:injuries / Q000473:pathology; D035441:Thoracic Wall / Q000293:injuries; D055815:Young Adult
D002492:Central Nervous System Depressants; D000431:Ethanol
Autopsy practices; Check lists; Evidence-based; Traumatic asphyxia