Postmortem changes mistaken for traumatic lesions: a highly prevalent reason for coroner's autopsy request

Postmortem changes are well known for their possible misinterpretation as traumatic lesions which can mislead to suspicion of violent death and therefore to a forensic autopsy request. As far as we know, a systematic review of the prevalence of such a reason for coroner's autopsy request has not been done yet. A retrospective study of 230 forensic autopsies requested by the Coroner's office from 2002 to 2004 in the province of Quebec, Canada, was conducted by the authors. Of the 230 reviewed cases, postmortem artifacts mistaken for traumatic lesions were found in 18 cases. These misinterpretation were based on 5 categories of portmortem changes: purge fluid drainage in 12 cases (66.7%), bluish discoloration by lividity in 5 cases (27.8%), parchment-like drying of the skin in 4 cases (22.2%), bloating from gas formation in 4 cases (22.2%), and skin slippage in 1 case (5.56%). Therefore, postmortem artifacts misinterpretation occurred in 7.83% (95% confidence interval 0.05-0.12) of all requested forensic autopsies and in 35.29% (95% confidence interval 0.23-0.50) of decomposed autopsy cases. This study clearly establishes the high prevalence of postmortem artifacts as main reason for forensic autopsy request. Hence, in a context of forensic pathologist shortage, the improvement of coroner continuous training may reduce the workload.