array:25 [ "pii" => "S238702061630119X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.04.054" "estado" => "S300" "fechaPublicacion" => "2016-02-19" "aid" => "3389" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2016;146:185-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S002577531500487X" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.07.016" "estado" => "S300" "fechaPublicacion" => "2016-02-19" "aid" => "3389" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2016;146:185-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 23 "formatos" => array:2 [ "HTML" => 15 "PDF" => 8 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Autopsia judicial y autopsia clínica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "185" "paginaFinal" => "186" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Forensic autopsy and clinical autopsy" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1333 "Ancho" => 1618 "Tamanyo" => 126435 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Número anual de autopsias clínicas (AC) o judiciales (AJ) en Cataluña entre 2009 y 2013. Las AC registradas son aquellas en las que el ítem «¿Se practicó autopsia?» del certificado de defunción se cumplimentó con el valor «sí». Para determinar las AC estimadas, en primer lugar se calculó la proporción de AC registradas en relación con las defunciones sin intervención judicial con el ítem «¿Se practicó autopsia?» cumplimentado («sí» o «no»); en segundo lugar, se aplicó esta proporción al número de defunciones sin intervención judicial con el ítem «¿Se practicó autopsia?» no cumplimentado; y finalmente, se sumó el resultado obtenido al número de AC registradas. El porcentaje de defunciones sin intervención judicial con el ítem «¿Se practicó autopsia?» no cumplimentado fue 54,3% en 2009, 31,7% en 2010, 30,5% en 2011, 29,7% en 2012 y 27,1% en 2013. El elevado porcentaje de no cumplimentación en 2009 se debió al todavía frecuente empleo del antiguo boletín estadístico de defunción, que alcanzó el 38,1% del total de defunciones sin intervención judicial en ese año, cifra que descendió al 2,4% en 2010, al 0,5% en 2011, al 0,3% en 2012 y al 0,2% en 2013.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fuentes de información: Institut de Medicina Legal de Catalunya para las AJ; Registre de Mortalitat de Catalunya (Servei d’Informació i Estudis, Departament de Salut, Generalitat de Catalunya) para las AC.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alexandre Xifró, Eneko Barbería, Anna Puigdefàbregas, Adriana Freitas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Alexandre" "apellidos" => "Xifró" ] 1 => array:2 [ "nombre" => "Eneko" "apellidos" => "Barbería" ] 2 => array:2 [ "nombre" => "Anna" "apellidos" => "Puigdefàbregas" ] 3 => array:2 [ "nombre" => "Adriana" "apellidos" => "Freitas" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S238702061630119X" "doi" => "10.1016/j.medcle.2016.04.054" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061630119X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577531500487X?idApp=UINPBA00004N" "url" => "/00257753/0000014600000004/v2_201604080826/S002577531500487X/v2_201604080826/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020616301188" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.04.053" "estado" => "S300" "fechaPublicacion" => "2016-02-19" "aid" => "3384" "copyright" => "Elsevier España, S.L.U." 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Parox: paroxysmal; Persist: persistent; Recur: recurrences; RS: sinus rhythm.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jesús Perea-Egido, Rodolfo Romero-Pareja, Javier García-Ruiz, Francisco G. Cosío" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Jesús" "apellidos" => "Perea-Egido" ] 1 => array:2 [ "nombre" => "Rodolfo" "apellidos" => "Romero-Pareja" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "García-Ruiz" ] 3 => array:2 [ "nombre" => "Francisco G." 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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2016;146:186-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "186" "paginaFinal" => "187" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José-Fernando Val-Bernal" "autores" => array:1 [ 0 => array:2 [ "nombre" => "José-Fernando" "apellidos" => "Val-Bernal" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315004820" "doi" => "10.1016/j.medcli.2015.09.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315004820?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616301188?idApp=UINPBA00004N" "url" => "/23870206/0000014600000004/v1_201606140021/S2387020616301188/v1_201606140021/en/main.assets" ] ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Forensic autopsy and clinical autopsy" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "185" "paginaFinal" => "186" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alexandre Xifró, Eneko Barbería, Anna Puigdefàbregas, Adriana Freitas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Alexandre" "apellidos" => "Xifró" "email" => array:1 [ 0 => "alexandre.xifro@xij.gencat.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Eneko" "apellidos" => "Barbería" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "Anna" "apellidos" => "Puigdefàbregas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 3 => array:3 [ "nombre" => "Adriana" "apellidos" => "Freitas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Institut de Medicina Legal de Catalunya, Departament de Justícia, Generalitat de Catalunya, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departament de Salut Pública, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Institut de Medicina Legal de Catalunya, Departament de Justícia, Generalitat de Catalunya, Tarragona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departament de Ciències Mèdiques Bàsiques, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Tarragona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servei d’Informació i Estudis, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Autopsia judicial y autopsia clínica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1330 "Ancho" => 1616 "Tamanyo" => 93294 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Annual number of clinical (CA) or forensic (FA) autopsies in Catalonia between 2009 and 2013. The CA registered are those in which the question “was an autopsy was performed?” on the death certificate was completed with the “yes” option. To determine the estimated CA, first the proportion of CA registered in connection with deaths without legal intervention was calculated using the question: “was an autopsy performed?” that was completed (“yes” or “no”); second, this ratio was applied to the number of deaths without legal intervention using the question “was an autopsy performed?” that was not completed; and finally, the result of the number of registered CAs. The percentage of deaths without legal intervention with the question “was an autopsy performed?” was not completed in 54.3% in 2009, 31.7% in 2010, 30.5% in 2011, 29.7% in 2012 and 27.1% in 2013. The high percentage of non-completion in 2009 was due to the still frequent use of the former statistical death bulletin, which saw 38.1% of total deaths without legal intervention in that year, a figure which fell to 2.4% in 2010, 0.5% in 2011, 0.3% in 2012 and 0.2% in 2013. <span class="elsevierStyleItalic">Information sources</span>: For FA the Institute of Legal Medicine of Catalonia; For CA The Mortality Register of Catalonia (Servei d’Informació i Estudis, Departament de Salut, Generalitat de Catalunya).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the astute, special article by Val-Bernal<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> published in Medicina Clínica.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The author exposed the validity of the clinical autopsy (CA) as a fundamental procedure in medicine. Our objective is to complement their contribution with some considerations about forensic autopsy (FA) as well as exposing the figures for CA and FA in Catalonia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The benefits of CA established by Val-Bernal are generally also applicable to FA. The medicolegal death investigation system is a monitoring system for deaths of unknown origin, so it is a source of knowledge of new pathological entities or their symptoms.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> FA contributes to patient safety, particularly in regard to the control of new diagnostic and therapeutic modalities, when unexpected inauspicious results that can lead to court cases occur.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> The contributions of FA are significant as a source of epidemiological information of various causes of death<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> (especially, deaths from external causes) or as material for research (for example, through biobanks).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> However, perhaps the most relevant and recognised contribution of FA is the study of sudden death – often occurring out of hospitals and investigated through FA, either because of a suspected crime or merely because of the absence of a death certification.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To these qualitative aspects the quantitative aspects should be added. While CA has experienced a decrease in how often they are performed, FA remains stable except for a decrease over the last decade due mainly to the reduction of mortality from traffic injuries (by 65.6% in Catalonia).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> As an approximation to the actual numbers of both types of autopsy, we studied the data concerning our region. For this, we used the statistics of the Institute of Legal Medicine of Catalonia for FA, while for CA, information was obtained from the Mortality Registry of Catalonia (RMC). The latter was possible because the Medical Death Certificate/Death Statistics Bulletin (CMD/BED) in force in Spain since 2009 includes the question “was an autopsy performed?” (referring to CA) with the option of answering “yes” or “no”; previous models did not include this information.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the results for the years 2009–2013 (the last year available in the RMC at the time of this study in June 2015).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">During the period under study, 18,232 FA were performed (6.0% of all deaths) and 3162 CA were registered (1.1% of all deaths without legal intervention). The latter percentage would be approximately twice that of hospital deaths without legal intervention if we assume that in Spain around 50% of deaths occur in hospitals.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Another thing to mention is that the RMC data do not include foetal CA and that we do not know whether the CMD/BED register partial CA. Of course, while the true number of CAs conducted cannot be lower than the number registered, it may be higher than estimated. In any case, according to the methodology used in Catalonia, the frequency of FA tends to be 3500 per year and is more than 3 times higher than that of CA, which remains at about 1000 per year.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, the health relevance of FA extends further than its expert scope and its frequency in Catalonia appears to be clearly superior to that of the CA. In our opinion, it would be significant if these regional data were completed with those from other parts of the country using a comparable methodology.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Xifró A, Barbería E, Puigdefàbregas A, Freitas A. Autopsia judicial y autopsia clínica. Med Clin (Barc). 2016;146:185–186.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1330 "Ancho" => 1616 "Tamanyo" => 93294 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Annual number of clinical (CA) or forensic (FA) autopsies in Catalonia between 2009 and 2013. The CA registered are those in which the question “was an autopsy was performed?” on the death certificate was completed with the “yes” option. To determine the estimated CA, first the proportion of CA registered in connection with deaths without legal intervention was calculated using the question: “was an autopsy performed?” that was completed (“yes” or “no”); second, this ratio was applied to the number of deaths without legal intervention using the question “was an autopsy performed?” that was not completed; and finally, the result of the number of registered CAs. The percentage of deaths without legal intervention with the question “was an autopsy performed?” was not completed in 54.3% in 2009, 31.7% in 2010, 30.5% in 2011, 29.7% in 2012 and 27.1% in 2013. The high percentage of non-completion in 2009 was due to the still frequent use of the former statistical death bulletin, which saw 38.1% of total deaths without legal intervention in that year, a figure which fell to 2.4% in 2010, 0.5% in 2011, 0.3% in 2012 and 0.2% in 2013. <span class="elsevierStyleItalic">Information sources</span>: For FA the Institute of Legal Medicine of Catalonia; For CA The Mortality Register of Catalonia (Servei d’Informació i Estudis, Departament de Salut, Generalitat de Catalunya).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El papel de la autopsia en la práctica clínica actual" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.F. 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Journal Information
Vol. 146. Issue 4.
Pages 185-186 (February 2016)
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Vol. 146. Issue 4.
Pages 185-186 (February 2016)
Letter to the Editor
Forensic autopsy and clinical autopsy
Autopsia judicial y autopsia clínica
Visits
1
Alexandre Xifróa,b,
, Eneko Barberíac,d, Anna Puigdefàbregase, Adriana Freitase
Corresponding author
a Institut de Medicina Legal de Catalunya, Departament de Justícia, Generalitat de Catalunya, Barcelona, Spain
b Departament de Salut Pública, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
c Institut de Medicina Legal de Catalunya, Departament de Justícia, Generalitat de Catalunya, Tarragona, Spain
d Departament de Ciències Mèdiques Bàsiques, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Tarragona, Spain
e Servei d’Informació i Estudis, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
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José-Fernando Val-Bernal
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