'White autopsies': an overview of cases with inconclusive results of post-mortem examinations in the Department of Forensic Medicine of the Jagiellonian University Medical College in Kraków, Poland.

Abstract

The aim of the study: The aim of the study was to accurately determine the incidence of white autopsies and to identify possible conditions responsible for such autopsies by means of analyzing confirmed causes of death in the same age group.

Material and methods: We searched autopsy reports from the Department of Forensic Medicine (Jagiellonian University, Medical College) from years 2009-2022 for cases of sudden death in the age group 2-40 years old. Exclusion criteria involved: death caused by trauma or other external factors, subject at an advanced stage of decomposition, in-hospital death.

Results: A review of 900 included cases yielded a total of 97 cases in which the post-mortem examinations did not disclose the cause of death, although only in 20 of those cases all diagnostic measures, including toxicology examination, were used. The average annual incidence of these cases is ca. 7 p.a. We also analyzed the reported causes of death to identify such conditions which both occur relatively often and might not provide any morphological alterations in autopsy; such as: non-ethanol poisonings (143), death due to epileptic seizure, not caused by seizure-connected trauma or aspiration of gastric contents into the respiratory tract (38), myocarditis (37).

Conclusions: The incidence of white autopsies at our center appears to be higher than previously estimated, partly due to the fact that negative autopsies are often not supplemented with additional examinations (toxicology and histopathology). An analysis of confirmed causes of sudden death in the same age group allowed us to identify at least 3 fatal conditions which might leave no trace in autopsy and thus be responsible for at least some of the white autopsy cases. It seems recommendable to include targeted investigations designed to better detect those conditions (non-ethanol poisoning, sudden death in epilepsy, myocarditis) in an algorithm for proceeding in cases of autopsy failure.