The medicolegal postmortem external examination project in Frankfurt/Main-First postmortem external examination vs. autopsy results

Background. In Frankfurt am Main (similar to 750,000 inhabitants) first postmortem external examinations are carried out by two institutions at the request of the police. During daytime the medical team of the Institute of Forensic Medicine performs first postmortem external examinations, whereas during nights and weekends, the examinations are carried out by physicians of the medical emergency service (aBD). Material and methods. For the year 2019 both examiner groups were evaluated with respect to the certification of the manner of death during the first postmortem external examination. Evaluation results were then compared with those of a subsequent autopsy. For the aBD group 461 examinations resulting in 76 autopsies were included in this study, whereas for the forensic medicine group 364 examinations were included, which resulted in 78 autopsies. Results. In 57 cases of the aBD the manner of death had to be changed based on the autopsy findings (49 cases in the forensic medicine group). This fraction of cases mainly consisted of a change from an undetermined to a natural manner of death. In 19 cases of the aBD and 8 cases of the forensic medicine group the manner of death was changed from undetermined to unnatural death. In one case of the forensic medicine group the manner of death had to be changed from natural to unnatural, 1 case from the aBD changed from unnatural to natural. Discussion. The necessity for changing manners of death after performing a medicolegal autopsy in a relatively high percentage of examinations in both subgroups stresses the need for an increase of the autopsy rate. Furthermore, the data showed that even with a professionalized approach using forensic experts for first postmortem external examinations, special case constellations pose great challenges on the medical examiner.

Automated summary

In Frankfurt, the necessity of changing the manner of death based on autopsy findings highlights the need to increase the autopsy rate. Even with forensic experts performing the first postmortem external examinations, special case constellations pose challenges for medical examiners.