Coronial autopsy in a rural setting

ObjectivesTo determine the precise nature of the non-homicide coronial autopsy.Design and settingRetrospective analysis of coronial autopsies between 2005 and 2011 in a rural setting on the Mid North Coast of New South Wales.ResultsA total of 1446 autopsies were performed during the 7 year study period. There were 1428 (98.75%) coronial and 18 (1.25%) hospital autopsies. Death in the coronial cases was attributed to natural causes in 829 (58%) of the cases, accidental causes in 321 (22.5%) of the cases, suicide in 244 (17%) of the cases and no apparent cause (indeterminate) in 34 (2.5%) of the cases. Acute myocardial ischaemia constituted 66.7% of the natural causes. Road traffic and other motorised vehicle-related accidents were responsible for 60.7% of deaths in the accidental group. The 2 main types of death in the suicide group were hanging (36.5%) and drug overdose (31.5%). In 34 deaths, the cause remained unclear, however, because of lack of suspicious circumstances and negative histology and toxicology, they were presumed to be due to natural causes.ConclusionsThe hospital autopsy has almost completely disappeared. On the other hand, coronial autopsies are on the rise. General Practitioners appear reluctant to issue death certificates in certain situations where there are no suspicious circumstances and the Coroners feel obliged to ask for autopsies. Currently, there is a severe shortage of pathologist and the additional coronial works adds to the burden on those pathologists who engage in such work. The coronial system needs to think about the role of the autopsy in these circumstances. Furthermore, additional resources from the various stakeholders are required for the increasing educational role of the coronial autopsy in undergraduate and postgraduate teaching.