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Area of Science:

  • Forensic Pathology
  • Microbiology
  • Public Health

Background:

  • Autopsies, including complete diagnostic autopsy (CDA) and minimally invasive autopsy (MIA), are time-sensitive due to tissue degradation.
  • A 24-hour postmortem interval (PMI) is often considered a limit for optimal tissue quality.
  • This study investigates the feasibility and diagnostic performance of autopsies performed beyond 24 hours.

Purpose of the Study:

  • To compare the diagnostic performance of CDA and MIA when performed within versus after 24 hours postmortem.
  • To assess the impact of increasing PMIs on microbiological test results.
  • To evaluate the reliability of autopsies conducted later than 24 hours after death.

Main Methods:

  • A retrospective analysis of 282 coupled MIA/CDA procedures at Maputo Central Hospital (2013-2015).
  • Procedures were categorized as early (≤24 hours PMI) or late (>24 hours PMI).
  • Diagnostic outcomes and microbiological findings were compared between early and late autopsy groups.

Main Results:

  • No significant difference in non-conclusive diagnoses for CDA (1% vs 1%) or MIA (13% vs 7%) between early and late autopsies.
  • Increasing PMIs were significantly associated with a higher number of identified bacteria (rate: 1.014 per hour).
  • Enterobacteriaceae and Pseudomonas spp. showed increased detection with longer PMIs.

Conclusions:

  • Both MIA and CDA can provide reliable diagnostic results for non-infectious and many infectious conditions even when performed more than 24 hours postmortem.
  • Extended PMIs may lead to overestimation of Enterobacteriaceae and Pseudomonas spp. as causes of death.
  • Autopsy procedures can be performed later than 24 hours, but microbiological interpretations require careful consideration of PMI.