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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 181-187

Secondary data analysis of postmortem examination records at a teaching hospital in Northern India


1 Department of Forensic Medicine, Kalpana Chawla Govt. Medical College, Karnal, Haryana, India
2 Department of Forensic Medicine, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India
3 Department of Forensic Medicine, Dr. Radhakrishnan Govt. Medical College, Hamirpur, Himachal Pradesh, India
4 Department of Forensic Medicine, Dr. Baba Saheb Ambedkar Hospital, Rohini, Delhi, India
5 Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India

Date of Submission01-Aug-2019
Date of Decision21-Oct-2019
Date of Acceptance03-Jan-2020
Date of Web Publication9-Apr-2020

Correspondence Address:
Anil Kumar Malik
Department of Forensic Medicine, Maharishi Markandeshwar Medical College and Hospital, Solan . 173 229, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_56_19

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  Abstract 


INTRODUCTION: Mortality data help in identifying the leading cause of death in populations and provide evidence to prioritize of disease prevention efforts. This study aims to describe the age and gender distribution and analyze the causes of fatalities certified after postmortem examinations to facilitate improved and more reliable certification of the cause of death.
MATERIALS AND METHODS: This secondary data analysis is of data recorded from January 01, 2016, to December 31, 2017, in the postmortem registers of the forensic medicine and toxicology department of a medical college in Haryana. Probable time of death, time of conducting the postmortem examination, and the probable cause of death as per the police records are also entered in the register. The data were analyzed for age and gender distribution and cause of death. Diagnoses provided by postmortem examination were categorized.
RESULTS: One thousand nine hundred and sixty-one postmortem examinations were conducted during the study period. About 52% of deceased persons belonged to the age group 21–40 years, 82.96% were male and 60% were from a rural area. Majority of deaths occurred at public places (57%). Deaths at home were more common among females (44%), while majority of deaths at public places occurred among males (59%). Unintentional deaths (74.50%) were more common. Deaths due to accidents were about 42.22%.
CONCLUSION: Conventionally, the emphasis of postmortem examination has been viewed as serving the inquest. However, they now have an important role within public health such as surveillance and causes of death. There is a strong obligation to generate reliable information for formulating effective intervention policies.

Keywords: Autopsy, cause of death, injuries


How to cite this article:
Khanna K, Pal V, Malik AK, Dagar T, Garg V, Verma M. Secondary data analysis of postmortem examination records at a teaching hospital in Northern India. Int J Health Allied Sci 2020;9:181-7

How to cite this URL:
Khanna K, Pal V, Malik AK, Dagar T, Garg V, Verma M. Secondary data analysis of postmortem examination records at a teaching hospital in Northern India. Int J Health Allied Sci [serial online] 2020 [cited 2020 May 30];9:181-7. Available from: http://www.ijhas.in/text.asp?2020/9/2/181/282139




  Introduction Top


Ever since G. B. Morgagni first showed the scientific value of autopsies, many reasons have arisen for carrying out autopsies over the centuries.[1] Besides improving the medical science and extending help in an inquest, mortality data are essential to understand the underlying health of a population.[2],[3] Mortality data can supplement the health administrations to identify the leading causes of deaths in a population. It can also provide evidence to prioritize disease prevention efforts.[4],[5] Such data assist governments in allocating scarce resources for epidemiological research.[6] A postmortem examination (autopsy and necropsy) is a standard, current medical procedure performed in a surgical manner, through which a thorough check of tissues and organs of a human body after death, aiming at determining the cause of death, of mechanisms that lead to that outcome, shortly said tanatogenesis.[7]

Detailed morphological and topographical conditions can be determined only through postmortem examination, allowing correlating clinical and anatomical aspects. Data obtained through postmortem examination are essential because not only it establishes the leading cause of death but also it can clarify associated pathology, treatment response, and disease evolution. Autopsies allow doctors to correct, clarify, and confirm the antemortem clinical diagnosis; this way, physicians may improve their medical knowledge, can train their ability for diagnosis, and apply this knowledge into future practice.[8] Medical education is from far the greatest beneficiary of the postmortem examination, as it is a significant valuable learning tool which helps understand basics of pathology, of aspects regarding uncertainties in clinical practice, of social and psychological issues related to death, and necessity of high-quality standard in medical health care.

Regarding the public health-care policies, a forensic autopsy is performed to prove any causal relationship between the accident and the death, identify the vehicle at fault, and determine the cause of the accident. Besides that, postmortem examination holds great potential for public health surveillance and represents a tool for establishing cost/efficiency report and assessing how adequate resources are distributed. Considering a wide range of diseases, it is imperative that allocating resources should be based on epidemiology studies, on death certificates, and statistic data about life.[9] Causes of death ascertained by postmortem examination are a subset of the total number of deaths registered in an area. This study aims to describe the age and gender distribution and analyze the causes of fatalities certified after postmortem examinations to facilitate improved and more reliable certification of the cause of death.


  Materials and Methods Top


Study setting

This is a secondary data analysis of postmortem registers data that were recorded from January 01, 2016, to December 31, 2017, in the Department of Forensic Medicine and Toxicology, Kalpana Chawla Government Medical College, Karnal, in the state of Haryana in Northern India. The terrain of the district is plain and has a population of about 2.8 lakhs and is situated on one of the busiest highways of North India. The department is currently conducting postmortem examinations of death that have occurred within the district of Karnal. This is also the only functional postmortem examination center in the area.

Data source

The postmortem registers are maintained by the department exclusively for each year. Data are entered by the doctors conducting the postmortem examination. The various columns include sociodemographic characteristics of the deceased person, along with the details of the accompanying person and police officers. Probable time of death, time of conducting the postmortem examination, and probable cause of death as per the police records are also entered in the register. For our study, data were collected using a predesigned format from postmortem registers/records, inquest papers, and postmortem reports maintaining confidentiality.

Operational definitions

For the purpose of maintaining uniformity, standard definitions were used and injuries were classified based on “intentionality.” All the road traffic injuries, poisoning, falls, fire and burn injuries, and drowning were labeled as unintentional, while the intentional injuries included interpersonal violence (homicide, sexual assault, neglect and abandonment, and other maltreatment), suicide, and collective violence (war).[10]

Ethical clearance

Since it was secondary data analysis, ethical approval was waived off by the Institutional Ethics Committee of Kalpana Chawla Government Medical College, Karnal. However, prior permission was sought from the institutional authorities for conducting the study.

Statistical analysis

The data were double entered in Microsoft Excel worksheet and were cross-validated by the primary investigator. Analysis of the data was carried out using Statistical Package for the Social Sciences (SPSS) for Windows version 17.0, released 2008 (SPSS Inc., Chicago, IL, USA). The data were analyzed for age and gender distribution and cause of death. Diagnoses provided by postmortem examination were categorized.


  Results Top


Background characteristics and age-pattern of the deceased

A total of 1961 postmortem examinations were conducted during the study period. Their background characteristics are depicted in [Table 1]. Around 52% (n = 1030) of the deceased persons belonged to the age group of 21–40 years. Around 83% (1627) deceased were male and 60% (n = 1192) belonged from a rural area. Overall, most of the deaths were reported from public places (57%), followed by at home (29%), private health facilities (29%), and government facilities (4%). Deaths among females were more common in urban areas (60%; 202 of 334 deaths among females) and at home (44%). However, in males, more deaths occurred in rural areas (65%; 1064 of 1627deaths among males) and in public places (59%). Majority of the deceased were unemployed, retired, or homemakers. About three-fourth of the deaths (74.50%) were reported to be unintentional, while only 3% had an intentional motive behind them and nearly one-fifth of the deaths (19.47%) were due to self-harm. In about 2.07% of the cases, the intention behind the death was not known or not recorded. Unintentional deaths were more common among males (78%), while deaths due to self-harm were more common among females (36%).
Table 1: Sociodemographic profile of deceased persons bought for postmortem examination in Kalpana Chawla Government Medical college between January 2016 and December 2017

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[Table 2] depicts the age pattern among the deceased received for postmortem examination. There was an increasing peak with a maximum number of deaths observed in 21–30 years age group (29%), after which the proportion of deaths starts declining with increasing age.
Table 2: Age wise distribution of deceased cases received by the Department for Postmortem Examination, in Kalpana Chawla Government Medical College between January 2016 and December 2017

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Cause of death

[Table 3] depicts the gender-wise cause of death among the deceased. Road traffic accidents (RTA) were the most common cause of deaths in both males and females. About 12% of deaths were reported with a natural cause, i.e., age related and were more among males (13.33%) as compared to females (6.88%). Poisoning was a third-most common cause of death (11.98%) and was more common among females (21.25%) compared to males (10.07%). Other causes of deaths included drowning, hanging, railway accidents, and electrocution that were responsible for 7.08%, 7.54%, 4.9%, and 3.62% of deaths, respectively. Less than 1% of deaths were also directly reported due to medical negligence.
Table 3: Distribution of deceased cases received for postmortem examination according to the intentions and cause of death in in Kalpana Chawla Government Medical College between January 2016 and December 2017

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Majority of deaths due to RTA occurred between 21 and 40 years of age. RTA was the major cause of death among all the age groups. It constituted about 41% of total deaths in 21–40 years' age group, followed by 46% in 0–20 years' age group and 44% in >40 years' age group. Drowning (16.96%), poisoning (12.52%), and natural deaths (17.66%) were the second major causes of deaths in 0–20 years', 21–40 years', and >40 years' age groups [Table 4]. Deaths due to self-harm were more common in 21–40 years (21.26%) and >40 years age group (19.27%).
Table 4: Association between cause of death and age groups of deceased bought for postmortem examination in Kalpana Chawla Government Medical College between January 2016 and December 2017

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[Table 5] depicts the distribution of deceased persons bought for postmortem examination in Kalpana Chawla Government Medical College between January 2016 and December 2017 on the basis of the intention behind the death. It was observed that most of the intentional and unintentional deaths occurred between 0 and 20 years of age (4% and 83%). Intentional could not be assessed in around 2.70% of the deceased. This association between age-groups and intention behind death was statistically significant as per the Chi-square test (P < 0.001).
Table 5: Association of Intention behind the death and age groups of deceased bought for postmortem examination in Kalpana Chawla Government Medical College between January 2016 and December 2017

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  Discussion Top


The present prospective study was conducted at the Department of Forensic Medicine and Toxicology, Kalpana Chawla Government Medical College, Karnal. Of the total 1961 postmortem cases, male outnumbered females by a ratio of approximately 5:1. Men's higher unintentional injury, suicide, and homicide mortality rates are observed in all age groups in low-, middle-, and high-income countries, as observed in the previous studies.[11],[12],[13],[14] Gender disparities in unnatural deaths such as injury and RTA are invariable and unrelenting. Men are more likely than women to die of almost every disease and illness and to die earlier. Gender patterns in unnatural death mortality do not follow typical social justice analyses of health, in which men are at greater risk.[15] Males are more exposed to the outside environment and are more susceptible to accidents and violence. They are considered as bread earners and females usually being confined to home doing household work. Majority of the cases were in the age group of 21–40 (52%) years, which is the most productive year in one's life. This is because persons belonging to this age group are active, mobile, and energetic. The young individuals are short tempered and quickly become emotional, which results in violence. These results were also similar to other studies.[11],[16] Younger individuals also have a risk-taking behavior and thus engage in activities which are otherwise dangerous. About 60% of the deceased were from the rural area. Other studies such as the fatal traffic crash research have also indicated that fatality rates in rural areas are higher than in urban areas.[17] This high proportion can also be attributed to a lack of timely care in rural areas.

About 57% of the deaths occurred in public places, while 29% were at home. About 9% and 4% of the deaths occurred at private health and government facilities, respectively. Deaths at home were more common among females, while majority deaths at public places occurred among males. Unintentional deaths (74.50%) were more common than intentional deaths (3.31%) and death due to self-harm (19.47%). Unintentional deaths were more common among males, while deaths due to self-harm were more common among females. Deaths due to self-harm were more common among 21–40 years' age group. Various other studies have reported similar results.[11] However, Jagnoor et al. also reported that unintentional injury constituted nearly 7% of all deaths and the unintentional injury mortality rates were higher among males than females, in rural versus urban areas, and in those aged 70 years or older.[18] This differences may be due to the reluctance of the relatives to go for postmortem examinations in older people.

In our study, RTAs were the leading cause of death and males depicted higher mortality, similar to the pattern depicted by another study.[11] Jagnoor et al. depicted road traffic injuries, falls, and drowning as the three leading causes of unintentional injury mortality, with fire-related injury causing 5% of these deaths.[18] This trend suggests that modernization and rapidity of the various means of transport have accelerated the pace of human life on one hand, while on the other, it has added to the woes of humanity. This situation is versed due to defects in vehicles and lack of observance of traffic rules as highlighted by other studies also.[19],[20]

In our study, majority of deaths due to RTA occurred in >40 years, followed by 21–40 years' age group. However, as per the Office of the Registrar General and Census Commissioner India report, age group of 15–29 years had highest mortality due to vehicle accidents (13.7%) and intentional injuries including suicide (18.0% and 1.5%), while 5–14 years' age group had the highest mortality due to unintentional injuries other than motor vehicle accidents (20.5%).[21]

Besides RTAs, poisoning (11%), hanging (7%), and drowning (7%) were found to be a more common cause of unnatural deaths. Deaths due to poisoning and hanging were more common among females than males and more than 20 years of age. One of the most consistent findings in suicide research is that women make more suicide attempts than men, but men are more likely to die in their attempts than women.[22] A study from Sri Lanka depicted that males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. The interpersonal conflict was a common trigger associated with nonfatal self-poisoning for both males and females.[23] Another study states that males prefer more lethal methods (e.g., hanging), while the methods favored by females tend to be less lethal (e.g., overdose).[24] However, compared to suicides in high-income countries, suicide in India is more prevalent in women (particularly young women), is much more likely to involve ingestion of pesticides, is more closely associated with poverty, and is less closely associated with mental illness.[25] Suicide and deliberate self-harm activities are high priorities of mental health policy in India, as they are throughout the world.[26]

In our study, deaths due to drowning were higher in males in the age group of 0–20 years. Million death studies from India have also reported the highest mortality rates in the youngest age groups (i.e., in children younger than 5 years) in the Eastern and Northeastern regions of India, which are the delta areas for major rivers.[27] These causes of premature mortality are responsible for an annual loss of 74 healthy life-years per 1000 population.[28] Among >40 years of age group, deaths due to natural reasons were the second major cause of death after RTA. Natural deaths that have been subjected to postmortem examinations have been reported in a range between 3% and 21% cases.[29],[30]

The study had a few obvious limitations. Since it was a secondary data analysis of the existing records, some important research questions could not be answered. The reliability of the information provided by the attendants of the deceased is also questionable. Future studies should aim to highlight the main avoidable causes of death.


  Conclusion Top


We understand that the present study highlights the major causes of unintentional injuries in our region. These data provide an impartial, real-world scenario of the modern-day epidemiology, disease burden, and underlying causes of sudden death due to injuries. Postmortem examinations are important sources of improvement of medical sciences including public health, and they provide us with a way to review the aggregate mortality data as defined by death certificates or conventional criteria in the community.

It is recommended to review the cause of death using uniform standards during the reporting of autopsies. This could lead to an improvement in the use of the data acquired through them. Mitigation of the rising burden of injuries and deaths due to avoidable causes should be amongst the urgent public health priorities. For this, it is essential to sensitize the policymakers from time to time, which is still a major challenge for most of the developing countries. There is a strong obligation for different stakeholders to come together and develop a model where medical colleges can play a leading role. This will help us to generate reliable information for formulating effective intervention policies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wittekind C, Gradistanac T. Post-mortem examination as a quality improvement instrument. Dtsch Arztebl Int 2018;115:653-8.  Back to cited text no. 1
    
2.
Choprapawon C, Porapakkham Y, Sablon O, Panjajaru R, Jhantharatat B. Thailand's national death registration reform: Verifying the causes of death between July 1997 and December 1999. Asia Pac J Public Health 2005;17:110-6.  Back to cited text no. 2
    
3.
Swift B, West K. Death certification: An audit of practice entering the 21st century. J Clin Pathol 2002;55:275-9.  Back to cited text no. 3
    
4.
Sibai AM. Mortality certification and cause-of-death reporting in developing countries. Bull World Health Organ 2004;82:83.  Back to cited text no. 4
    
5.
Lakkireddy DR, Gowda MS, Murray CW, Basarakodu KR, Vacek JL. Death certificate completion: How well are physicians trained and are cardiovascular causes overstated? Am J Med 2004;117:492-8.  Back to cited text no. 5
    
6.
Johansson LA, Westerling R. Comparing hospital discharge records with death certificates: Can the differences be explained? J Epidemiol Community Health 2002;56:301-8.  Back to cited text no. 6
    
7.
Morar S, Cristian A, Perju-Dumbrava D. Ethical and legal aspects of the use of the dead human body for teaching and scientific purposes. Rev Rom Bioet 2008;6:65-83.  Back to cited text no. 7
    
8.
Nemetz PN, Ludwig J, Kurland LT. Assessing the autopsy. Am J Pathol 1987;128:362-79.  Back to cited text no. 8
    
9.
Marinescu D, Rogozea L. The role and importance of autopsy-a practical and ethichal approach. Bulletin of the Transilvania University of Brasov. Medical Sciences Series VI 2014;7:85-92.  Back to cited text no. 9
    
10.
World Health Organisation. Injuries. World Health Organization; 2016. Available from: https://www.who.int/ceh/risks/cehinjuries2/en/. [Last accessed on 2019 Nov 18].  Back to cited text no. 10
    
11.
Radhakrishna KV, Makhani CS, Sisodiya N, Chourasia S, Sarala M, Khan RN. Profile of medicolegal autopsies conducted at tertiary medicolegal centre in southwestern India. International J of Healthcare and Biomedical Research 2015;3:70-5.  Back to cited text no. 11
    
12.
Zine KU, Wakde SD, Tandle RM, Varma NM, Jambure MP, Tasgaonker GV. Study of deaths in industrial areas around Aurangabad city. Journal of Indian Academy of Forensic Medicine 2012;34:111-3.  Back to cited text no. 12
    
13.
Sharma B, Singh V, Sharma R, Sumedha. Unnatural deaths in northern India: A profile. J Indian Acad Forensic Med 2004;26:140-6.  Back to cited text no. 13
    
14.
Murthy MS, Dutta BN, Ramalingaswami V. Coronary atherosclerosis in North India (Delhi area). J Pathol Bacteriol 1963;85:93-101.  Back to cited text no. 14
    
15.
Sorenson SB. Gender disparities in injury mortality: Consistent, persistent, and larger than you'd think. Am J Public Health 2011;101 Suppl 1:S353-8.  Back to cited text no. 15
    
16.
Shrivastava P, Som D, Nandy S, Saha I, Pal PB, Ray TG, et al. Profile of postmortem cases conducted at a morgue of a tertiary care hospital in Kolkata. J Indian Med Assoc 2010;108:730-3.  Back to cited text no. 16
    
17.
Zwerling C, Peek-Asa C, Whitten PS, Choi SW, Sprince NL, Jones MP. Fatal motor vehicle crashes in rural and urban areas: Decomposing rates into contributing factors. Inj Prev 2005;11:24-8.  Back to cited text no. 17
    
18.
Jagnoor J, Suraweera W, Keay L, Ivers RQ, Thakur J, Jha P, et al. Unintentional injury mortality in India, 2005: Nationally representative mortality survey of 1.1 million homes. BMC Public Health 2012;12:487.  Back to cited text no. 18
    
19.
Curran WJ. The medicolegal autopsy and medicolegal investigation. Bull N Y Acad Med 1971;47:766-75.  Back to cited text no. 19
    
20.
Lakshmi PV, Tripathy JP, Tripathy N, Singh S, Bhatia D, Jagnoor J, et al. A pilot study of a hospital-based injury surveillance system in a secondary level district hospital in India: Lessons learnt and way ahead. Inj Epidemiol 2016;3:24.  Back to cited text no. 20
    
21.
Office of the Registrar General & Census Commissioner. Census of India Website: Causes of Death Statistics. Office of the Registrar General & Census Commissioner; 2019. Available from: http://www.censusindia.gov.in/vital_statistics/causesofdeath.html. [Last accessed on 2019 Nov 18].  Back to cited text no. 21
    
22.
Vijayakumar L. Suicide in women. Indian J Psychiatry 2015;57:233-8.  Back to cited text no. 22
[PUBMED]  [Full text]  
23.
Rajapakse T, Griffiths KM, Christensen H, Cotton S. A comparison of non-fatal self-poisoning among males and females, in Sri Lanka. BMC Psychiatry 2014;14:221.  Back to cited text no. 23
    
24.
Tsirigotis K, Gruszczynski W, Tsirigotis M. Gender differentiation in methods of suicide attempts. Med Sci Monit 2011;17:PH 65-70.  Back to cited text no. 24
    
25.
Rane A, Nadkarni A. Suicide in India: A systematic review. Shanghai Arch Psychiatry 2014;26:69-80.  Back to cited text no. 25
    
26.
Parkar SR, Dawani V, Weiss MG. Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India. Suicide Life Threat Behav 2006;36:223-38.  Back to cited text no. 26
    
27.
Million Death Study Collaborators, Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, et al. Causes of neonatal and child mortality in India: A nationally representative mortality survey. Lancet 2010;376:1853-60.  Back to cited text no. 27
    
28.
Hyder AA, Wali S, Fishman S, Schenk E. The burden of unintentional injuries among the under-five population in South Asia. Acta Paediatr 2008;97:267-75.  Back to cited text no. 28
    
29.
Afandi D. Profile of medicolegal autopsies in Pekanbaru, Indonesia 2007-2011. Malays J Pathol 2012;34:123-6.  Back to cited text no. 29
    
30.
Patel J, Chandegara P, Patel U, Parkhe S, Govekar G. Profile of autopsy cases at New Civil Hospital, Surat: A retrospective study. Int J Med Sci Public Heal 2016;5:10.  Back to cited text no. 30
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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