A Pathologist’s Point of View: Establishing Cause of Death Susan E. Crawford, MD Northwestern Univ. Medical School

Terminology n Primary or Underlying Cause of Death u The disease or condition that initiated the chain of events leading directly to the death of the patient n Contributing Conditions/Complications u Most important events that contributed to death but not considered the immediate cause of death; “intermediate causes” n Other Significant Conditions u Other conditions that contributed to death; not as important as those listed above; did not result in death

Primary or Underlying Cause of Death n Disease or injury that initiated the events leading directly to death n Antecedent to all other causes and without this underlying cause, death would not have occurred n Information used for epidemiological purposes and public health planning

Primary or Underlying Cause of Death Examples: Acute Vascular Thrombosis Placental Abruption Metabolic Diseases Congenital Heart Disease

Primary or Underlying Cause of Death n Intrauterine Fetal Demise u Thrombosis (Primary) and Maternal Disease (Contributing Factor) u Importance of fetal circulation and congenital heart disease n Postnatal Death u Transitional circulation and closure of ductus arteriosus and foramen ovale u Pulmonary Hypoplasia, Infection, NEC, Prematurity

Primary or Underlying Cause of Death n Mechanistic terminal events lack etiologic specificity and should not be used as causes of death u Examples: F Asystole F Respiratory Arrest F Cardiopulmonary Arrest

Contributing Conditions/Complications n Important events that contributed to the primary cause of death u Maternal Diseases – Cervical Incompetence, Thrombophilia, Oligohydramnios u Prematurity u Respiratory Insufficiency u Congestive Heart Failure

Manner of Death n Forensic Pathology u Natural u Accidental u Homicide u Suicide u Undetermined

Determining the Cause of Death Discuss case with clinical services prior to starting the autopsy examination; keep them informed of preliminary findings & results of final report u Most important information is in the gross examination u Placental examination should be included in the autopsy examination u Microscopic examination; genetics; cultures u Clinico-pathological correlation