Multifactorial Clinical and Anatomical Analysis of Lethal Outcome
Aim. To establish signifi cant factors infl uencing the discrepancy of lifetime and postmortem diagnoses and to offer a technique of comparison of diagnoses when carrying out the clinical and anatomical analysis of a lethal outcome.Material and methods. The material for the study was 1420 acts of forensic examination of corpses recorded at the Bureau of forensic medical examination of the Moscow region during the 2014-2018 period. We studied the cases of deaths in hospitals of medical organisations with fi nal clinical diagnoses of the initial causes of death from diseases of the circulatory system (1085), respiratory diseases (157), digestive system (178). An analytical comparison of nosological forms of diseases in all headings of the fi nal clinical and forensic diagnoses was carried out. The frequency of occurrence of objective and subjective causes of discrepancy of diagnoses was determined. The most signifi cant factors of erroneous formulation of the fi nal clinical diagnosis, which create risks in the formation of divergence of diagnoses, were established. The causes of divergence of diagnoses relevant to the choice of inadequate treatment and the onset of death were established. Absolute (abs) values were calculated for qualitative variables and relative (%) frequencies. The frequency comparison was carried out using Fisher’s two-way exact criterion. Risk ratios with 95 % bilateral confi dence intervals for risk ratios were calculated to identify the factors causing the highest level of divergence. Statistically signifi cant differences were considered when the probability of error of the fi rst kind was less than 5 % (p < 0.05). Data processing was carried out using the Excel 2016 (Microsoft, USA) and IBM SPSS Statistics 25 (IBM, USA) software.Results. The study found that the discrepancy between the lifetime diagnosis criteria of reliability, etiopathogenetic and timeliness are the most signifi cant factors affecting the discrepancy of diagnoses under the heading “underlying disease”. The causes of divergence of diagnoses, which are of the greatest importance for the choice of inadequate treatment and the formation of a lethal outcome, were revealed. On the basis of the obtained data, a method for comparing the in vivo and postmortem diagnoses during the clinical and anatomical analysis of the lethal outcome was developed.Conclusion. Incorrect clinical diagnosis is important in the onset of death only if the erroneous diagnosis is due to insuffi cient examination of the patient, the lack of clinical data, the severity of the condition and the short duration of stay, which does not allow the underlying disease and fatal complication to be determined and adequate medical measures to be carried out. The proposed method for comparing the in vivo and postmortem diagnoses allows a correct, reliable and convincing clinical and anatomical analysis of the case of death in the hospital to be performed.