Role of Histopathology in Determining the Cause of Death in Medicolegal Autopsies

TL;DR

This study examines how histopathology helps determine the cause of death in medicolegal autopsies, especially when the cause is unclear from a gross autopsy.

Contribution

The study highlights the critical role of histopathological examination in resolving ambiguous causes of death in medicolegal autopsies.

Findings

Histopathology significantly contributes to determining the cause of death when it is unclear from gross examination.

In 95.7% of cases with a provisional cause of death, histopathology did not confirm the final cause.

When the cause of death was pending, histopathology confirmed the cause in 91.3% of cases.

Abstract

Background

A medicolegal or forensic autopsy is performed on the instructions of the legal authority responsible for the investigation of sudden, suspicious, obscure, unnatural, litigious, or criminal deaths. Although the purpose and procedure of a medicolegal autopsy differ from those of a pathological autopsy, at times, they overlap. Usually, histopathological examination (HPE) is required in sudden deaths, where the cause of the death is not known or not apparent at gross autopsy.

Purpose

This research has been conducted for a tenure of one and a half years, from October 2022 to April 2024, analyzing 87 autopsy cases in a tertiary care center in Northeast India to determine the role of histopathological examination in medicolegal autopsies.

Method

Data collection involved detailed histopathological examinations and a structured pro forma to ensure comprehensive documentation of the findings. The study's independent variables include age, sex, and time since death, while outcome variables focus on histopathological findings and the determined cause of death. Data was analyzed using IBM SPSS Statistics for Windows, Version 28.0.1.1 (Released 2022; IBM Corp., Armonk, New York, United States). A p-value of less than 0.05 at a 95% confidence interval (CI) was considered statistically significant.

Results

An analysis of the provisional cause of death determined through gross autopsy and the final opinion on the cause of death established by histopathology revealed a statistically significant association between the two. However, there is less than a chance of agreement among them, as indicated by a Kappa statistic of -0.497. Among the 47 cases where a provisional cause of death was determined through gross autopsy, the final cause of death was not concluded based on histopathological examination (HPE) in 45 cases (95.7%). Additionally, in the 23 cases where the provisional cause of death was pending until the HPE report was received, the final opinion on the cause of death was determined based on HPE in 21 cases (91.30%). Analyzing the final opinion on the cause of death and the opinions based on HPE, it was found that their relationship is statistically significant as the p-value was calculated to be <0.05.

Conclusion

In medicolegal autopsies, histopathology is essential for determining the cause of death when there are no visible external injuries or when the cause of death is unclear at the time of the gross autopsy. When the preliminary cause of death is known at the time of the gross autopsy, such as in cases of fatal injuries, the role of histopathological examination is restricted.