Post-mortem examination of corpses prior to cremation

The external post-mortem examination of a corpse is an important task and errors can have serious medical, statistical and legal implications. In Germany death certificates issued on completion of such investigations form the source of population-based mortality statistics. In a retrospective study 2,365 death certificates over a 6-month period were analyzed after an obligatory second external post-mortem examination of the corpse had been performed prior to cremation at the city of Essen crematorium. All these deaths were analyzed to ascertain the correctness and plausibility of the death certificates. The content of the death certificate was evaluated with respect to the findings of the second external examination. In 20.6% of cases unclear information had been given or severe errors made relating to the first external examination. In 4.5% of cases death was certified although no certain signs of death were recorded as being present. The term brain death was applied confusingly in 1.3% of cases. In a total of 277 cases (11.71%) the examining physicians stated that they had not investigated the corpses as thoroughly as legally required and in 1.1% of cases either no cause of death or insufficient information was given. In 26 cases the manner of death had been wrongly classified as"natural", however, no previously unidentified murder cases were found. The autopsy rate was not surprisingly also very low (1.2%). The quality of external post-mortem examinations of corpses in the Ruhr area around Essen needs to be improved as is known to be the case for Germany as a whole. The findings of this study demonstrate that in approximately 20% of all deaths severe errors occurred both while conducting the post-mortem examination and in filling out the death certificate. The best way to improve the mortality statistics and the quality of the first post-mortem examination of corpses in Germany is to significantly increase the frequency of autopsies.