When is a peri-procedural death iatrogenic in nature?
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ORIGINAL ARTICLE
When is a peri-procedural death iatrogenic in nature? Marian Wang • Gilbert Lau
Accepted: 23 May 2011 / Published online: 11 June 2011 Ó Springer Science+Business Media, LLC 2011
Abstract In almost any instance of suspected iatrogenic fatality, the attending forensic pathologist faces the challenging and often daunting task in ascertaining the cause of death, determining if an iatrogenic injury had indeed occurred and if so, its contribution to the causation of death. The Forensic Medicine Division of the Health Sciences Authority in Singapore embarked on a 6 year study of such deaths to identify pertinent factors that may facilitate the assessment of iatrogenic injuries and their contribution to mortality. A total of 106 iatrogenic deaths, arising from 613 coroner’s peri-procedural autopsies conducted during the period of 2005–2010 were reviewed with particular reference to the following parameters: (1) clinico-pathological correlation; (2) the length of survival; (3) the number of interventional procedures. A comprehensive analysis of these cases indicated that they could be classified into the following 3 categories, in relation to the role of clinico-pathological correlation in the ascertainment of the causes of death: (A) advantageous but not essential; (B) essential; (C) critical. A large proportion of the cases (76.5%) were assigned categories B and C. Only the minority of cases (23.6%) were assigned category A. Also, as the number of days of survival between injury and death, and the number of interventional procedures after injury increases, the greater the need for detailed clinical documentation to ascertain the cause of death. Keywords Iatrogenic Peri-procedural Clinico-pathological correlation
M. Wang (&) G. Lau Forensic Medicine Division, Health Sciences Authority, 11 Outram Road, Singapore 169078, Singapore e-mail: [email protected]
Introduction From the perspective of forensic pathology, iatrogenesis may be thought of as injury attributable, in part or in whole, to the adverse effects of or mishaps arising from medical treatment, including various diagnostic and invasive procedures to which a patient has been subjected at any time, and which may result in serious morbidity or death. Fatal iatrogenesis has to be considered to be well within the ambit of forensic pathology and that, accordingly, the detailed investigation of actual or suspected iatrogenic deaths constitutes a substantial forensic contribution to injury prevention, medical audit, continuing improvement in health care, as well as the elucidation and resolution of the attendant clinico-pathological and medicolegal issues that almost inevitably arise in their wake. The authors recognize that as medical therapeutic and diagnostic technology and knowledge advances at a rapid pace, diseases as well as complications arising from interventional procedures are being diagnosed earlier and treated accordingly. While this is good news indeed for the general population, it somewhat complicates the task at hand for the
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