Level of agreement between opinions of medical examiner investigators and forensic pathologist medical examiners regarding the manner of death

To evaluate the level of agreement between medical examiner investigators' opinion of the manner of death and what the manner of death was as certifie d by forensic pathologist medical examiners (MEs), we reviewed the case rec ords stored in a database of all deaths reported to the office of the medic al examiner in Fulton County, Georgia. Of 15,771 deaths reported to the off ice during a 10-year period, a difference exists in 1908 cases. In 900 natu ral deaths, the investigators recorded 135 accident, 10 homicide, 10 suicid e, and 745 undetermined manners of death. In 755 accidental deaths, the inv estigators recorded 16 natural, 8 homicide, 13 suicide, and 718 undetermine d manners of death. In 107 homicides, the investigators recorded 12 natural , 8 accident, 0 suicide, and 87 undetermined manners of death. In 70 suicid es, the investigators recorded 9 natural, 9 accident, 3 homicide, and 49 un determined manners of death. In 61 deaths classified as undetermined, the i nvestigators recorded 25 natural, 13 accident, 17 homicide, and 6 suicide m anners of death. In 15 deaths, the discrepancy exists due to an apparent er ror in the database information. This study confirms a high concordance bet ween investigator and ME opinion regarding manner of death but also documen ts the need for case review and autopsies by forensic pathologists to confi rm the investigators' opinion of the manner of death, determine the manner of death when the investigator selects undetermined, and on occasion, refut e the investigators' opinion regarding the manner of death.