Autopsies and death certification in deaths due to blunt trauma: What are we missing?

OBJECTIVES: TO determine the frequency, body region and severity of injurie s missed by the clinical team in patients who die of blunt trauma, and to e xamine the accuracy of the cause of death as recorded on death certificates . DESIGN: A retrospective review. SETTING: London Health Sciences Centre, London, Ont. PATIENTS: One hundred and eight deaths due to blunt trauma occurring during the period Apr. 1, 1991, to Mar. 31, 1997. Two groups were considered: cli nically significant missed injuries were identified by comparing patient ch arts only (group1) and more detailed injury lists From the autopsies and ch arts of the patients (group 2). OUTCOME MEASURES: Chart and autopsy findings. RESULTS: Of the 108 patients, 78 (72%) were male, and they had a median age of 39 years (range from 2 to 90 years). The most common cause of death was neurologic injury (27%), followed by sepsis (17%) and hemorrhage (15%). Th ere sas disagreement between the treating physicians and the causes of deat h listed on the death certificate in 40% of cases and with the coroner in 7 % of cases. Seventy-seven clinically significant injuries were missed in 51 (47%) of the 108 patient deaths. Injuries were missed in 29% of inhospital deaths and 100% of emergency department deaths. Abdominal and head injurie s accounted for 43% and 34% of the missed injuries, respectively. CONCLUSIONS: The information contained on the death certificate sim be misl eading. Health care planners utilizing this data may draw inaccurate conclu sions regarding causes of death, which may have an impact on trauma system development. Missed injuries continue to be a concern in the management of patients on trauma system with major blunt trauma.