Quality of external post-mortem examination and death certificates at the University Hospital in Hamburg, Germany

PurposeThe quality of external post-mortem examinations and medical death certificates has long been criticized and autopsy rates are on the decline. To identify potential errors in external post-mortem examinations and hospital death certificates, this study examined the quality of information provided regarding both aspects at the University Medical Center Hamburg-Eppendorf (UKE).MethodsAmong the 630 patients who died at the UKE during aperiod of 5months in 2017, the post-mortem findings and death certificates of 511 were re-examined. Furthermore, for 419 deceased patients where a forensic autopsy was carried out at the UKE from 2008 to 2016, the clinical data were compared with the autopsy results.ResultsFor 77 (15%) of the decedents, the second external post-mortem examination produced relevant findings that had not been previously reported on the death certificates. This included information regarding relevant medical interventions (9%), significant disorders (5%), and trauma (2%). Formal errors were rarely found on the death certificates. In 62% the cause of death and underlying disorders stated in the death certificates were in full agreement with the diagnoses identified at autopsy. Nonconformities were identified in 10%.ConclusionThe quality of external post-mortem examinations and medical death certificates should be improved. It is evident that autopsies are indispensable for verifying the cause of death.