Fischtein Danit, Cina Stephen J
Division of Emergency Medicine, University of Toronto, Toronto, Canada.
Am J Forensic Med Pathol. 2011 Jun;32(2):146-8. doi: 10.1097/PAF.0b013e31820c2ee6.
The medical examiner's office in Broward County is responsible for determining the cause and manner of death in cases falling under its jurisdiction and issuing death certificates on these decedents. Amendments are occasionally required to correct misinformation on death certificates or within the autopsy reports. The purpose of this study was to investigate the major causes for the amendments and to develop strategies to avoid future errors. We found 128 cases from 2006 to 2007 that required amendments; 103 contained sufficient data in the file for further analysis. Over this time period, 3790 death certificates were issued over that same period, resulting in a 3.37% amendment rate. In this study, the cohort included both males and females with a ratio of 2:1. Their ages ranged from newborn to 103 years, with a mean age of 49 years. Of the 103 amended cases, amendments were made to the cause (n = 30) and often the manner (n = 21) of death listed on the death certificate; the remaining changes were limited to the autopsy report. The most common reasons for amendments included reception of delayed laboratory findings (35%), acquisition of additional medical history (22.5%), and typographic errors (15.5%). Typographic errors mainly occurred because of inaccuracies in the names originally provided to our office, the use of aliases by decedents, incorrect personal/demographic history, or various misspellings by funeral homes or medical examiner staff. The most significant reclassifications involved changing certified natural deaths to accidental overdoses and vice versa, based on toxicological analysis. Because of delays in specimen turnaround, these amendments often were made months after the original death certificate was issued. STAT urine drug screening has been helpful in reducing the number of amendments made, but certain drugs of significance are missed by rapid screens. Given that our office performed complete toxicological analysis on all cases over this period, it seems likely that we detected several overdoses that would have been missed if natural deaths were not routinely screened for potential toxins.
布劳沃德县的法医办公室负责确定其管辖范围内案件的死因和死亡方式，并为这些死者签发死亡证明。有时需要进行修正，以纠正死亡证明或尸检报告中的错误信息。本研究的目的是调查修正的主要原因，并制定策略以避免未来出现错误。我们发现2006年至2007年有128例需要修正；其中103例档案中有足够的数据用于进一步分析。在此期间，同期共签发了3790份死亡证明，修正率为3.37%。在本研究中，队列包括男性和女性，比例为2:1。他们的年龄从新生儿到103岁不等，平均年龄为49岁。在103例修正病例中，对死亡证明上列出的死因（n = 30）以及通常的死亡方式（n = 21）进行了修正；其余更改仅限于尸检报告。修正的最常见原因包括收到延迟的实验室检查结果（35%）、获取额外的病史（22.5%）和排版错误（15.5%）。排版错误主要是由于最初提供给我们办公室的姓名不准确、死者使用别名、个人/人口统计信息不正确，或殡仪馆或法医工作人员的各种拼写错误。最显著的重新分类涉及根据毒理学分析将经认证的自然死亡改为意外过量用药，反之亦然。由于样本周转延迟，这些修正通常在原始死亡证明签发数月后进行。即时尿液药物筛查有助于减少修正的数量，但快速筛查会遗漏某些重要药物。鉴于我们办公室在此期间对所有病例都进行了完整的毒理学分析，如果不对自然死亡病例进行潜在毒素的常规筛查，似乎很可能会漏检几例过量用药病例。
