Translated Abstract
Research background
Forensic autopsy is an important means of forensic identification, and the postmortem diagnosis of the cause of death, the manner of death, the time of death, and the inference of the injuring objects, which provide important evidence for the handling of the cases. The accuracy of the postmortem diagnosis of the cause of death is not only important to the qualitative investigation of criminal cases, but also significant to the resolution of civil liability in civil cases. The analysis of the cases of autopsy can summarize the distribution of the cause of death, provide basic data for the identification of forensic cases, and provide a scientific basis for the prevention and control of fatal diseases. It is also important in the role of medical examiners in helping crime scene investigators and the judiciary or the coroner in resolving disputes between relatives of the deceased and medical personnel and medical facilities to reach a common concession about cases considered to be medical tangle.
In this retrospective study of forensic autopsy cases, 104 cases were collected from the achieves of forensic files at Xian Jiaotong University center for forensic medicine. The time line for this study was three years, between 2015 to 2017. Whereby 104 cases were obtained, as the sample size for this scientifically based retrospective study of autopsy certified cases.
Research objective:
1. From the 104 cases obtained as the sample size for this retrospective study of forensic autopsies, we want to find out the leading and main causes of deaths based on the different age groups.
2. According to gender, we want to find out from the 104 cases of forensic autopsies to determined the rates and frequencies of mortality between male and female in relation to the different age groups, the leading causes of deaths and the underlying disease conditions.
3. To correlate the mortality rates and frequencies between the age groups and causes of death to the manner of death.
4. To analyze based on all the demographic data, which are age; gender whether male or female in relation to the manner of deaths, such as natural deaths due to disease; accidental deaths which are traffic or non- traffic accidental deaths; suicidal and homicidal deaths.
5. To stress on the role and importance of forensic pathologist in helping crime scene and law enforcing agencies in the process of investigation of all related cases, that are assumed to accidental, traumatic, natural and medical tangles that including illegal medical practice, medical mal-practice, drug related cases, intoxications and poisoning.
6. To statistically analyze all the 104 cases obtained for this study in terms of the different age groups, gender, as to which age group and gender die of natural deaths that are due to diseases; which age group and gender die of accidents whether traffic or non-traffic accidents; which age group and gender die of suicides and homicides.
Research methodology
All cases were obtained from autopsy files from the archives of Xi’an Jiaotong University, with the postmortem diagnosis and the conclusion of the cause of death. The age groups were classified into seven different groups as follows: Classification criteria:
1.Based on the age groups into: under 35 years; 35-44 years; 45-54 years; 55-64 years; 65-74 years; 75-84 years; 85 years and above, and classification based on gender into male and female.
2.Based on gender into: Male and Female.
3.Based on the Causes of deaths into: Cardiovascular related diseases; Respiratory diseases; Intracranial hemorrhages and brain damage; Asphyxia; Septicemia; Renal diseases and renal failure, Intrauterine Fetal deaths (IUFD), Traumatic shock and Multiple organ failure and others
4.Based on the manner of deaths into: Natural sudden deaths from disease, Accidental deaths (traffic and non-traffic deaths); Homicidal and Suicidal deaths.
All the 104 cases of the data were analyzed by SPSS and Excel, and Univariate analysis was performed, and the cause of death was expressed in terms of frequency and percentage. The data presented an average standard error of means (SEM) for age, gender, cause of death and the manner of deaths. Chi square test (X²) was used to compare the relationship between age and sex and the cause of death. The significant level of P-value was set to be less than or equal to 0.05 (P ≥ 0.05).
Research results:
1. Out of the 104 cases collected for this study, the number of male autopsy certified cases were 71 with a valid percent of 68.3%, and numbers of female autopsy certified cases were 33 with a valid percent of 31.7%.
2. Based on the age group; from the different seven groups the data analysis shows that the number of deaths out of the 104 cases; 38 deaths were under the age of 35 years representing 36.5%; 20 deaths in the age group between 35-44 years with the percentage of 19.2%; in the age group between 45-54 years, 19 cases were reported it represents 18.3%; between 65-74 years there were 11 cases representing 10.6%; between 75-84 years there were 4 cases accounting to 3.8%, and above 85 years only 1 case with a valid 1%.
3. Based on the categorized main leading causes of deaths; cardiovascular diseases accounts for 71 deaths representing 68.3%; Respiratory disease were 11 deaths accounting for 10.6%; Intracranial hemorrhage with brain damage were 15 cases accounting for 14.4%; Asphyxia had only 1 case reported representing 1%; out of the 3 cases of poisoning, it accounts for 2.9%; Renal failure were 2 cases representing 1.9% and traumatic shock was 1 case accounting for 1.0%.
4. Based on the four different manner of deaths obtained from the 104 cases, they are as follows: Natural sudden deaths from disease were 59 deaths accounting for 56.6%; accidental deaths whether traffic or non-traffic accidents were 40 accounting for 38.5%; there were 3 cases of homicide accounting for 2.9%, and suicide were 2 cases with a 1.9%.
Discussion and conclusion:
Out of the 104 retrospective study forensic autopsy cases selected and based on the statistical analysis, on the different age groups, the main leading causes of deaths in relation to the underlying disease conditions and the manner of deaths, the following conclusions were reached
1.Out of the 104 cases collected in this study, cardiovascular related diseases (CVD) remain the high ranking, whereby the total of deaths were 71, out of which 49 were male and 22 were female, hence the number of male frequency is higher than the female because of some modifiable high risk factors such as excessive smoking in the adult population of male, excessive alcoholism and, drug abuse, physical inactivity, obesity, dyslipidemias and unhealthy diets that increases the susceptibility of developing cardiovascular disease; out of which ischemic heart disease heart disease, coronary atherosclerosis and hypertension. This mainly occurs in the age range of late 40’s and above. In the young and middle age group, mainly the cause of deaths from cardio vascular related diseases (CVD) are mainly from congenital heart diseases, cardiomyopathies such as viral myocarditis. Other related diseases are thromboembolisms and pulmonary embolisms. The deaths due to cerebrovascular disease that led to stroke mainly occur in those with long standing hypertension and thromboembolism. All these can lead to circulatory and respiratory failure, cardiac arrhythmia and heart attack. While the non-modifiable factors that contributes to the development of cardiovascular related diseases include; age, gender, family history and environmental factors. Which means the manner of death are natural/sudden deaths due to disease.
2. Out of the 104 cases, 11 deaths were reported, whereby 8 deaths were male and 3 deaths were female, and this reflects deaths mainly in young and adult age groups of under 35 years mainly due to respiratory tract infections such as pneumonia that led to septicemia with respiratory failure, other contributing factors involve carcinomas of the lungs, hence the manner are natural deaths due to disease.
3. From the 104 cases, the proportion of cranio-cerebral or deaths due to intracranial hemorrhages with brain damage were 15 cases, whereby 10 cases were male and 5 cases were female. The factors leading to death mainly were skull fractures with some brain concussions, brain contusions, subdural hematoma and brain damage that led to cardiorespiratory arrest from compression of the cardiac and respiratory centers. In this category, the deaths mainly occur in the adult age groups, and the manner of deaths were accidental deaths due to road traffic accidents, fall from a height, and blunt head trauma during a fight, while some of which were homicidal were mainly due to assault.
4. There was only one reported case of death from asphyxia which was male, and the manner of death was accidental due to drowning.
5.From the 104 cases, 3 cases of poisoning were reported, out of which 2 were male in the elderly age group, from pesticide poisoning hence the manner of death was accidental as they were farm workers, and 1 female case due to chemical ingestion, in the adult age group and the manner was suicide.
6. There were two cases of renal failure 1 male and 1 female, in the elderly ages who have been having long standing chronic pyelonephritis and glomerulonephritis, hence the manner of deaths were natural due to disease.
In conclusion, from all the 104 cases obtained for this retrospective of forensic autopsies analysis, cardiovascular related deaths ranks in the first position, whereby the male mortality is high mainly in the middle and old age groups due to bad habits such as excessive smoking, alcoholism, drug abuse, physical inactivity, obesity, dyslipidemias and unhealthy dietary habits, while the low female mortality were due long standing hypertension. While deaths due to respiratory diseases occur mainly the young and middle age groups mainly due to respiratory tract infections such as pneumonia, while renal failure occur mainly in the elderly from those having chronic kidney disease. The deaths from intracranial hemorrhages with brain injuries mainly occur in the middle age groups, mainly following traffic accidents, fall from a height, blunt head trauma during fighting and assaults, out of which the rate is high in male than female. The rates of suicides are high in female than male mainly due ingestion of poisonous substances. Hence the mortality rates was high due to diseases, followed by accidental and traumatic deaths, while homicidal and suicidal deaths have low frequencies.
Translated Keyword
[case analysis, cause of death, Forensic autopsy, forensic identification, mode of death]
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