Defining, exploring the sources and expressing post-mortem diagnostic uncertainty.

Area of Science:

• Forensic Pathology
• Medical Diagnostics
• Autopsy Science

Background:

• Diagnostic uncertainty is a recognized challenge in clinical practice.
• Post-mortem diagnostics (PMD) inherently involves uncertainty due to complex, multidisciplinary autopsies.

Purpose of the Study:

• To explore diagnostic uncertainty in post-mortem diagnostics.
• To identify factors contributing to PMD uncertainty.
• To develop a tool for assessing certainty in cause-of-death determinations.

Main Methods:

• Conducted a comprehensive literature review on PMD uncertainty.
• Convened an expert panel to evaluate sources of uncertainty.
• Developed the Post-Mortem Diagnostic Certainty Scale (PMDCS).

Main Results:

• Literature on PMD uncertainty is sparse but present.
• Defined PMD uncertainty as the inability to determine exact cause of death or significance of findings.
• Identified six objective factors contributing to PMD uncertainty.
• Introduced the eight-category PMDCS for cause-of-death certainty.

Conclusions:

• Understanding PMD uncertainty improves interpretation of autopsy findings.
• Standardizing investigations and using the PMDCS can reduce and clarify PMD uncertainty.
• Eliminating PMD uncertainty is not fully achievable, but mitigation is possible.