[The accuracy of the causes of death with judicial intervention in Catalonia in the period 2015-2020. Effect of declaration through IML-Web application]

OBJECTIVE

On January first, 2020, the Institutes of Legal Medicine and Forensic Sciences (IMLCF) began to inform the causes of death directly to the National Statistics Institute (INE) through a web application (IML-Web). The objective of this study was to evaluate the impact of the implementation of this application on the quality of the data collected.

METHODS

A descriptive study using deaths data with judicial intervention that occurred in Catalonia was carried out. The data of the period 2015-2018 and 2019 was compared with 2020. The percentages, with confidence intervals, of the causes of death that were not specific, according to different classifications, were calculated on the total of cases by period and territory.

RESULTS

The total percentage of non-specific deaths had decreased, not significantly, by 1.6 points between the period 2015-2018 and 2020. The same indicator between 2019 and 2020 had decreased by 13.4 points. The percentage of non-specific deaths from external causes showed significant drops between both periods and 2020. In general, the indicators displayed territorial differences.

CONCLUSIONS

The roll-out of the IML-Web implies, compared to 2019, an improvement in the quality of the data. On the other hand, compared to the period 2015-2018, the data show a similar level of quality. Generally, it is assessed that the information provided by IMLCF of Catalonia through the IML-Web is accurate, but still has room for improvement.

[Descriptive study of a series of deaths due to accidental falls in the elderly.]

OBJECTIVE

Accidental falls are a growing public health problem. The objective was to describe the characteristics of deaths due to accidental falls in people over 65 from the forensic source.

METHODS

Descriptive observational study of deceased at over 65 undergoing judicial autopsy in Tarragona between the years 2013-2017 whose basic cause of death was coded as accidental fall (W00-W19 of the International Classification of Diseases - 10th edition).

RESULTS

89 cases were identified (42.7% women). The mean age of the deceased females (82.9 years) was significantly higher than that of the males (77.6 years). The cause of death was a head injury in 77.5% of cases. 78.7% had previously been assisted in a hospital center. Falls from one level to another were significantly more lethal (60% vs 40%), and were associated with those corpses not coming from hospital. 82% had prescribed at least one drug (57.5% more than 5). 85.4% had a pathological history. Comorbidity was significantly higher in females and in corpses from hospital and lower in falls from one level to another.

CONCLUSIONS

The data, based on forensic sources, show the presence of risk factors associated with the fatality of accidental falls in ≥65 years of age. More studies are needed to understand its role in these injuries.

[Validation of the underlying cause of death in medicolegal deaths]

BACKGROUND

Deaths due to external causes require additional medical tests in order to determine the cause of death. If these results are not incorporated into the death register these causes may be misclassified. The objective of this study is to validate the underlying cause of death of the Mortality Register with information obtained from forensic sources in Barcelona between 2004 and 2006.

METHODS

Cross-sectional design. The study population consisted of deceased residents in Barcelona with a medicolegal intervention between 2004 and 2006. The sources of information are the Mortality Registry and the forensic pathology file filled in by Institute of Legal Medicine of Catalonia (ILMC) (gold standard). The study variables are the cause of death, sex and age. Sensitivity and percentage of confirmation (PC) with 95% confidence intervals (95% CI) are calculated.

RESULTS

The sensitivity of external causes is 59.7% (95% CI:56.5-62.9) and PC is 96.7% (95% CI:94.8-98.0). Traffic injuries, poisonings and suicides are under-reported in the Mortality Register with a sensitivity lower than 45% and a PC higher than 80%. Symptoms, signs and ill-defined conditions are over-reported with a sensitivity of 89.2% (95% CI:83.4-93.4) and a PC of 28.0% (95% CI:24.2-32.1). There are no differences by sex and age.

CONCLUSIONS

The validity of the external causes in the Mortality Register is low due to under-reporting and the high proportion of symptoms signs and ill-defined causes. According to the results, incorporating information from forensic sources to the Mortality Register increases the quality of mortality statistics.