O'Sullivan J P
Department of Histopathology, St Richard's Hospital, Chichester, West Sussex.
J Clin Pathol. 1996 Sep;49(9):737-40. doi: 10.1136/jcp.49.9.737.
To determine the number of unsuspected disease processes found in a series of cases of sudden unexpected death occurring outside hospital and to enumerate how many of these were not recorded on the death certificate.
In a series of 1000 routine coroners' necropsies for sudden unexpected death, major findings that had not been known about in life were recorded. Macroscopic findings were confirmed histologically as appropriate. The deaths occurred either outside hospital or in the Accident and Emergency department before the patient could be examined. Cot deaths and decomposed bodies were excluded.
There were 575 major findings in 532 (53.2%) subjects that had been clinically silent in life. Of these 575 findings, 277 (48.2%) were not the cause of death and so did not appear on the death certificate. Eighty per cent of the major alimentary system findings and all of the genitourinary findings were of this type. In addition, however, 30% of the major cardiovascular and 34% of the major respiratory findings were not recorded on the death certificate for this reason.
A large amount of important epidemiological data is being lost in the operation of the coronial system. Some of this information is irrecoverable as the function of the death certificate is to provide a cause of death only. In addition, information may be being lost because the necropsy is not being performed adequately and is not subject to audit.
确定在一系列院外突发意外死亡病例中发现的未被怀疑的疾病过程数量，并列举其中有多少未记录在死亡证明上。
在一系列1000例常规死因裁判尸检中，记录生前未知的主要发现。宏观发现视情况进行组织学确认。死亡发生在院外或患者接受检查前的急诊科。婴儿猝死综合征和尸体已腐烂的情况被排除。
532名（53.2%）受试者有575项主要发现，这些发现在生前临床上未表现出来。在这575项发现中，277项（48.2%）不是死亡原因，因此未出现在死亡证明上。主要消化系统发现的80%和所有泌尿生殖系统发现均属此类。然而，此外，主要心血管系统发现的30%和主要呼吸系统发现的34%也因此未记录在死亡证明上。
死因裁判系统的运作正在丢失大量重要的流行病学数据。其中一些信息无法恢复，因为死亡证明的作用仅为提供死亡原因。此外，由于尸检执行不充分且不受审核，信息可能正在丢失。
