Original Article MEDICOLEGAL PROFILE OF BROUGHT DEAD CASES RECEIVED AT MORTUARY - PDF document

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 \n\n\r   Original Article MEDICOLEGAL PROFILE OF BROUGHT DEAD CASES RECEIVED AT MORTUARY Dr. B. Tirpude, Dr. N. Nagrale, Dr. P. Murkey, Dr. P. Zopate, Dr. S. Patond Authors Dr. Bipinchandra Tirpude Professor & Head, Dept. of Forensic Medicine, Mahatma Gandhi Institute of Medical sciences, Sewagram Dr. Ninad Nagrale Postgraduate student, Dept. of Forensic Medicine, Mahatma Gandhi Institute of Medical sciences, Sewagram Dr. Pankaj Murkey Professor, Dept. of Forensic Medicine, Mahatma Gandhi Institute of Medical sciences, Sewagram Dr. Pravin Zopate Assistant Professor, Dept. of Forensic Medicine, Mahatma Gandhi Institute of Medical sciences, Sewagram Dr. Swapnil Patond Postgraduate student, Dept. of Forensic Medicine, Mahatma Gandhi Institute of Medical sciences, Sewagram Number of pages: 8 Number of tables: 9 Number of photographs: 0 Corresponding author: Dr. B.H. Tirpude Professor & Head, Dept. of Forensic Medicine, Mahatma Gandhi Institute of Medical sciences, Sewagram, 442102 Email- tirpudeb@yahoo.com
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 \n\n\r   Original Article MEDICOLEGAL PROFILE OF BROUGHT DEAD CASES RECEIVED AT MORTUARY Dr. B. Tirpude, Dr. N. Nagrale, Dr. P. Murkey, Dr. P. Zopate, Dr. S. Patond Abstract Literally, “brought dead” (also known as dead on arrival) denotes those deaths happened before reaching at emergency. In those cases, as per law, doctor can’t issue the death certificate without knowing the actual cause of death. That is the reason for which post-mortem examination of those brought dead cases is essential & mandatory for establishment of actual cause of death. In the present work 200 brought dead cases were studied in different parameters at Forensic Medicine Department, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha from May 2010 to April 2012 (two years study). Keywords: brought dead, natural deaths, unnatural deaths. Introduction It is a well known fact that in most unnatural deaths by means of criminal activity there always is an attempt on the part of the offender to hide the crime. But many times they fail in their attempt and the dead body is brought to emergency by law enforcing authority. These cases should be dealt with precaution, so that actual cause of death is revealed & the offender, who tried to conceal the offense, can be identified. The common mistake done by doctor is inability to differentiate the apparent death (death trance or suspended animation) from actual death. This point should be emphasized to avoid massive public agitation, as well as to avoid legal complication in terms of professional negligence on behalf of doctors. This study on brought dead cases may be helpful to furnish our knowledge to some extent in this regard. As we know that all brought dead cases are not always emergency conditions. Many times we observe that the patient was suffering from chronic illness for a long duration but the relatives & legal guardians were not so careful to attend at hospital in proper time. This carelessness has many reasons like ignorance, poverty, lack of sympathy etc. Besides this situation, one important factor is inappropriate referral system of critical patients from distant or peripheral health centres or hospitals to district or tertiary centre where better treatment facilities are available. For this reason many times the acute emergency patients have lost their lives on the way & they are declared as brought dead when they reach the emergency department. In addition to this faulty referral system, infrastructural deficit also enhances the above problem to some extent (1, 5). In few cases it is not evident to the party that death has already occurred & they bring the patient to confirm the death. These cases are also declared as brought dead. The aim of this study also includes the scenario of sudden death cases with respect to cause, time, sex-ratio etc. This study may point out the necessity to start an early management of critical patients. Also, it emphasizes the need to detect the actual cause of death that is not evident only on clinical examination. Though it is not commonly done by the relatives to bring the unnatural death cases at emergency department; still few cases are brought to disprove their criminal activity related to particular death cases with an intention to eyewash the society. The present study also proposes to prove or disprove the previous information related to ‘brought dead’ cases if any.
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 \n\n\r   Objectives 1.To find out the different natural causes of brought dead cases. 2.To point out the delay of initiation of treatment where ever applicable. 3.To find out the ratio of natural & unnatural causes of brought dead cases. 4.To compare between provisional diagnosis & actual cause of death after post mortem examination in those cases where definite disease process was present from history of relatives / inquest report. 5.To specify & enhance the importance of autopsy of the cases where cause of death is not known definitely. Materials and Methods In the present study, we assessed the brought dead cases (declared dead) at the casualty of Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha & then post-mortem examination was then carried out in the morgue by Department of Forensic Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha from May 2010 to April 2012 (two year study). a.Criteria for case selection – 1.Both male & female victims are taken into consideration. 2.All age groups are included in this study. 3.All types (according to apparent cause of death) are taken into consideration excluding death by gross and obvious railway injury. b.Collection of data- 1.From inquest report – address, religion, place, date & time of first incidence. 2.Previous history of the case. 3.Medical document – time & date of declaration of death at emergency department. 4.During autopsy – Whether the findings corroborated with the apparent cause of death or not? External & internal findings are considered. Results: In the present work 200 brought dead cases were studied in different parameters. Table 1: Age wise distribution of cases Serial no. Age (years) Total no. of cases Percentage 1 10 2 1% 2 10 – 20 18 9% 3 21 – 30 35 17.5% 4 31 – 40 37 18.5% 5 41 – 50 55 27.5% 6 51 – 60 29 14.5% 7 61 – 70 16 8% 8 71 – 80 7 3.5% 9 �80 1 0.5% Total 200 The above table shows that maximum victims 55 (27.5%) were within 41 – 50 years
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 \n\n\r   Table 2: Sex wise distribution of casesSerial no. Sex Total no. Percentage 1 Male 154 77.00% 2 Female 46 23.00% Total 200 The above table shows only 23.00% of the victims were female. Table 3: Place of occurrence of incidence Serial no. Place of occurrence Total no. Percentage 1 Residence 90 45.00% 2 Road / footpath 87 43.50% 3 Place of work 5 2.50% 4 Others 18 9.00% Total 200 The above table shows almost same no. of cases has occurred at residence & Road/footpath. Table 4: Time of occurrence of incidence Serial no. Time of occurrence Total no. Percentage 1 6 am – 1pm 85 42.50% 2 1 pm – 5 pm 35 17.50% 3 5 pm – 11pm 45 22.50% 4 11 pm – 6 am 35 17.50% Total 200 In this table, it is observed that most cases 85(42.50%) occurred during 6 am to before 1 pm. Table 5: Distribution of cases according to cause of death – whether natural or unnatural Serial No. Cause of death No. of cases Percentage 1 Natural 71 35.50% 2 Unnatural 129 64.50% Total 200 This table shows deaths are attributable to unnatural causes 64.50%, where the rest are natural death. Table 6: Cause of death in male and femaleCause of death Male Female Total Natural 60 (38.96%) 11(23.9%) 71 Unnatural 94 (61.03%) 35 (76.1%) 129 Total 154 46 200 The above table shows that the death of 38.96% of male and 23.9% of female were due to some natural disease process.
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 \n\n\r   Table 7: Cause of death in different age groups Age group Cause of death Total Natural Unnatural 10 years 0 (0%) 2 (1.55%) 2 10 – 20 years 0 (0%) 18 (13.95%) 18 21 – 30 years 3 (4.23%) 32 (24.80%) 35 31 – 40 years 12 (16.92%) 25 (19.37%) 37 41 – 50 years 26 (36.66%) 29 (22.48%) 55 51 – 60 years 15 (21.15%) 14 (10.85%) 29 61 – 70 years 10 (14.1%) 6 (4.65%) 16 71 – 80 years 5 (7.05%) 2 (1.55%) 7 �80 years 0 (0%) 1 (0.78%) 1 Total 71 129 200 The above table shows that maximum no. of natural deaths occurs in the age group of 41- 50 years and maximum no. of unnatural death occurs in the age group of 21 – 30 years. Table 8: Distribution of Sex of victims according to age Age group Male Female Total 10 years 2 (1.29%) 0 (0%) 2 10 –20 years 12 (7.79%) 6 (13.02%) 18 21 – 30 years 23 (14.93%) 12 (26.04%) 35 31 – 40 years 33 (20.46%) 4 (8.68%) 37 41 – 50 years 43 (21.42%) 12 (26.04%) 55 51 – 60 years 20 (12.98%) 9 (19.53%) 29 61 – 70 years 14 (9.09%) 2 (4.34%) 16 71 – 80 years 6 (3.89%) 1 (2.17%) 7 �80 years 1 (0.65%) 0 (0%) 1 Total 154 46 200 The above table shows maximum no. of male victims fall in the age group 41 – 50 years. and maximum no. of female victims fall in the age group 21 – 30 years and 41 – 50 years. Table 9: Different causes of deathSl. No. Cause of death No. of cases Percentage 1 Hanging 27 13.50 2 Smothering 2 1.00 3 Strangulation 1 0.50 4 Injury / Head injury 60 30.00 5 Poisoning 18 9.00 6 Drowning 11 5.50 7 Electrocution 5 2.50 8 Snake bite 1 0.50 9 Burn 4 2.00 10 AMI 23 11.50 11 Pulmonary Tuberculosis 39 19.50
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 \n\n\r   12 Pneumonia 2 1.00 13 Cirrhosis 5 2.5 14 Intra cerebral haemorrhage 2 1.00 Total 200 The results of observation has been analysed in the tabular form and the different aspects are taken in to consideration. Discussion and analysis In table no. 1 of age wise distribution of cases, it is seen that cases with age 10 years was only 2 (1%). In age group 10 – 20 years total number was 18 (9%); between 21 – 30 years of age, number was 35 (17.5%), in 31 – 40 years age group no. of cases was 37 (18.5%), between 41 – 50 years, maximum 55 (27.5%) was found. In the age group 51 – 60 and 61 – 70 the no. of cases were 29 (14.5%) and 16 (8%) respectively. Only 8 cases (4%) fall under the &#x-10.;䙩70 years group. So it is seen that no. of cases are very few in the extremes of age. The age wise distribution is similar to the age wise distribution of whole population of our country (1, 3, 8, 13). In the table 2 which is on sex wise distribution of cases, it was found that more than th of all victim (154 – 77%) were male whereas less than 1/4th cases (46 – 23%) were female. In the place of occurrence wise distribution of incidence (Table no. 3), it is found that almost equal no. of incidence have occurred at residence and on road / pavement – 90 (45%) and 87 (43.5%) respectively, In residence, deaths were mainly due to natural causes and suicides. On road or footpath most common cause is road traffic accidents, some are the dead bodies of persons without any identity –mostly vagabond. There are only five cases (2.5%) that have occurred at the place of work. The category ‘other’ constitutes mostly bodies found besides railway track or in some water bodies like pond or river. Table no. 4 describes time of occurrence wise distribution of cases which actually some time denotes the time of discovery of the victims dead specially for the bodies recovered from footpath, pond or in bed in the morning. Maximum 85 (42.5%) cases happened between 6 a.m. to 1 p.m. 45 cases (22.5%) were found within 5 p.m. to 11 p.m. Equal number of cases happened within 1 p.m. to 5 p.m. and 11 p.m. to 6 a.m. as 35 (17.5%) and 35 (17.5%) in number respectively. Table 5 shows distribution of victims according to cause of death – whether natural or unnatural. 71 (35.5%) deaths are attributable to different types of natural deaths due to various disease condition, while the rest 129 (64.5%) of cases are unnatural deaths of multiple reasons. Table 6 considers cause of death and sex wise distribution of victims simultaneously. It shows 60 (38.96%) and 94 (61.03%) no. of male were died due to some natural and unnatural causes respectively among a total of 154 male. Whereas among 46 female, 11 (23.9%) had natural death and 35 (76.1%) had unnatural death. So it can be concluded that there is no such significant difference in cause of death in male and female. Proportion of unnatural death is only slightly higher in a female (76.1%) which is 61.03% in case of male. And the reverse situation is found in case of natural death (3, 8). Table 7 describes causes of death – whether natural or unnatural in different age group. It shows maximum no. of unnatural death occurred in the age group of 21 – 30 years. (24.8%), next in decreasing order of frequency 41 – 50 years (22.48%), 31 – 40 years (19.37%) 10 – 20 years (13.95%), 51 – 60 years (10.85%). Rest falls in the both extremes of life constituting a very few in number. The reason behind if may be increase tendency of self-
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 \n\n\r   destruction in adolescent and middle age group people than in extreme of life. Accidents are also more common in the adolescent and middle age people as they are students / working people spending much of time out side home that is road (1, 5). But highest proportion of victim having natural death fall in the age group 41 – 50 years (36.66%), next comes 51 – 60 years (21.15%), 31 –40 years (16.92%) and 61 – 70 years (14.1%). The cause behind these clustering of cases may be excess stress in life, style of living – all those predispose to different disease condition (1). Table 8 considers male – female distribution in different age group among the brought death victims. It is found that maximum no. of male victims fall in the age group 41 – 50 years (21.42% of all male victims). But in case of female, highest no. are found in 21 –30 years and 41 – 50 years of age group (Almost 26% of all female victims in each of those 2 age groups). Different causes of death are described in the table no. 11. Different major causes of unnatural death include Hanging (13.5%), injury / head injury (30%), poisoning (9%) drowning (5.5%). Some categories with minor contribution are smothering, strangulation, electrocution, snake bite, burn. Different diseases with major contribution are ischemic heart disease (11.5%) and pulmonary tuberculosis (19.5%). Other causes are pneumonia, cirrhosis, and pathological intracerebral haemorrhage (1, 3, 8, 13). Conclusion The present study was done on 200 subjects in the Department of Forensic Medicine, MGIMS, Sewagram. The cases which were under the jurisdiction of MGIMS, Sewagram are only considered including the referred cases from different areas of Central India. 1.It was observed that 154 (77 %) cases are male while only 46 (23%) victims are female. 2.In the present study most (27.5%) of the cases were within the age group of 41 – 50. Numbers are very few in the extremes of ages. ‘ 3.In this study it is also found that approximately equal no. of incidences took place at residence and on road / pavement. 4.Most of the incidences occurred in day time between 6 am to 1 pm. (42.5%). 5.In this study 129 (64.5%) deaths are unnatural, whereas 71 (35.5%) deaths are caused by some disease process. 6.In this study it is found that maximum no. of natural death occurs in the age group of 41 – 50 years and that of unnatural death in the age group of 21 – 30 years. 7.This study also shows that maximum numbers of male victims are in 41 – 50 years where as maximum no. of female victims fall in the age group 21 – 30 years and 41 – 50 years. 8.Regarding specific cause of death, injury to different parts including head leading to haemorrhage due to road traffic accident or fall from height maximum no. of unnatural death (30%). 9.Diseases of Respiratory system (19.5 %) and cardiovascular system (11.5%) attribute to most cases of natural deaths. References 1.A Text book of Preventive and Social Medicine. Park K. 20th edition 2010: 354. 2.Forensic Medicine & Toxicology Mukherjee JB 3rd edition 2008: 253, 425, 427. 3.Forensic Medicine and Toxicology Karmakar R N 3rd edition 2007: 57, 59, 319 – 325. 4.Forensic Medicine: Clinical and pathological Aspect, JP James 2003: 133- 147, 169 – 179, 337 – 339 5.Forensic Pathology Bernard knight – 2nd 1996:171 – 230, 243 – 260, 333 – 345. 6.Fundamentals of Forensic Medicine & Toxicology Basu R. 2005: 117 – 119, 129 –130, 136. 7.Handbook of Forensic Pathology Vincent J. M. Di Maio. 2001: 36 – 55, 137 – 142, 175 –180. 8.Principals of Forensic Medicine Nandy A. 2nd edition: 286 – 294, 295 – 309.
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 \n\n\r   9.Robbins Basic Pathology. Cotran RS, Kumar V, Collins T. 9th edition. 2007: 53, 54, 364 – 368, 612 – 615. 10.Taylor’s Principles and Practice of Medical Jurisprudence A. Keith. 7th edition: 210 11.Textbook of Forensic Medicine & Toxicology – Principles and practice sudden and unexpected death. Krishan Vij 4th edition 2008. 12.Text book of Medical Jurisprudence and Toxicology, Parikh CK 6th edition, 1999: 3.35 – 3.70, 4.39 –4.41, 4.86 –4.91. 13.The Essentials of Forensic Medicine & Toxicology Reddy KSN 26th edition :129 – 130, 296 – 297.