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Letter to the Editor
Forensic autopsy and clinical autopsy
Autopsia judicial y autopsia clínica
Alexandre Xifróa,b,
Corresponding author
alexandre.xifro@xij.gencat.cat

Corresponding author.
, Eneko Barberíac,d, Anna Puigdefàbregase, Adriana Freitase
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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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Annual number of clinical &#40;CA&#41; or forensic &#40;FA&#41; autopsies in Catalonia between 2009 and 2013&#46; The CA registered are those in which the question &#8220;was an autopsy was performed&#63;&#8221; on the death certificate was completed with the &#8220;yes&#8221; option&#46; To determine the estimated CA&#44; first the proportion of CA registered in connection with deaths without legal intervention was calculated using the question&#58; &#8220;was an autopsy performed&#63;&#8221; that was completed &#40;&#8220;yes&#8221; or &#8220;no&#8221;&#41;&#59; second&#44; this ratio was applied to the number of deaths without legal intervention using the question &#8220;was an autopsy performed&#63;&#8221; that was not completed&#59; and finally&#44; the result of the number of registered CAs&#46; The percentage of deaths without legal intervention with the question &#8220;was an autopsy performed&#63;&#8221; was not completed in 54&#46;3&#37; in 2009&#44; 31&#46;7&#37; in 2010&#44; 30&#46;5&#37; in 2011&#44; 29&#46;7&#37; in 2012 and 27&#46;1&#37; in 2013&#46; The high percentage of non-completion in 2009 was due to the still frequent use of the former statistical death bulletin&#44; which saw 38&#46;1&#37; of total deaths without legal intervention in that year&#44; a figure which fell to 2&#46;4&#37; in 2010&#44; 0&#46;5&#37; in 2011&#44; 0&#46;3&#37; in 2012 and 0&#46;2&#37; in 2013&#46; <span class="elsevierStyleItalic">Information sources</span>&#58; For FA the Institute of Legal Medicine of Catalonia&#59; For CA The Mortality Register of Catalonia &#40;Servei d&#8217;Informaci&#243; i Estudis&#44; Departament de Salut&#44; Generalitat de Catalunya&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the astute&#44; special article by Val-Bernal<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> published in Medicina Cl&#237;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The author exposed the validity of the clinical autopsy &#40;CA&#41; as a fundamental procedure in medicine&#46; Our objective is to complement their contribution with some considerations about forensic autopsy &#40;FA&#41; as well as exposing the figures for CA and FA in Catalonia&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The benefits of CA established by Val-Bernal are generally also applicable to FA&#46; The medicolegal death investigation system is a monitoring system for deaths of unknown origin&#44; so it is a source of knowledge of new pathological entities or their symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> FA contributes to patient safety&#44; particularly in regard to the control of new diagnostic and therapeutic modalities&#44; when unexpected inauspicious results that can lead to court cases occur&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;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> &#40;especially&#44; deaths from external causes&#41; or as material for research &#40;for example&#44; through biobanks&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> However&#44; perhaps the most relevant and recognised contribution of FA is the study of sudden death &#8211; often occurring out of hospitals and investigated through FA&#44; either because of a suspected crime or merely because of the absence of a death certification&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To these qualitative aspects the quantitative aspects should be added&#46; While CA has experienced a decrease in how often they are performed&#44; FA remains stable except for a decrease over the last decade due mainly to the reduction of mortality from traffic injuries &#40;by 65&#46;6&#37; in Catalonia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> As an approximation to the actual numbers of both types of autopsy&#44; we studied the data concerning our region&#46; For this&#44; we used the statistics of the Institute of Legal Medicine of Catalonia for FA&#44; while for CA&#44; information was obtained from the Mortality Registry of Catalonia &#40;RMC&#41;&#46; The latter was possible because the Medical Death Certificate&#47;Death Statistics Bulletin &#40;CMD&#47;BED&#41; in force in Spain since 2009 includes the question &#8220;was an autopsy performed&#63;&#8221; &#40;referring to CA&#41; with the option of answering &#8220;yes&#8221; or &#8220;no&#8221;&#59; previous models did not include this information&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the results for the years 2009&#8211;2013 &#40;the last year available in the RMC at the time of this study in June 2015&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">During the period under study&#44; 18&#44;232 FA were performed &#40;6&#46;0&#37; of all deaths&#41; and 3162 CA were registered &#40;1&#46;1&#37; of all deaths without legal intervention&#41;&#46; The latter percentage would be approximately twice that of hospital deaths without legal intervention if we assume that in Spain around 50&#37; of deaths occur in hospitals&#46;<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&#47;BED register partial CA&#46; Of course&#44; while the true number of CAs conducted cannot be lower than the number registered&#44; it may be higher than estimated&#46; In any case&#44; according to the methodology used in Catalonia&#44; the frequency of FA tends to be 3500 per year and is more than 3 times higher than that of CA&#44; which remains at about 1000 per year&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; 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&#46; In our opinion&#44; it would be significant if these regional data were completed with those from other parts of the country using a comparable methodology&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Annual number of clinical &#40;CA&#41; or forensic &#40;FA&#41; autopsies in Catalonia between 2009 and 2013&#46; The CA registered are those in which the question &#8220;was an autopsy was performed&#63;&#8221; on the death certificate was completed with the &#8220;yes&#8221; option&#46; To determine the estimated CA&#44; first the proportion of CA registered in connection with deaths without legal intervention was calculated using the question&#58; &#8220;was an autopsy performed&#63;&#8221; that was completed &#40;&#8220;yes&#8221; or &#8220;no&#8221;&#41;&#59; second&#44; this ratio was applied to the number of deaths without legal intervention using the question &#8220;was an autopsy performed&#63;&#8221; that was not completed&#59; and finally&#44; the result of the number of registered CAs&#46; The percentage of deaths without legal intervention with the question &#8220;was an autopsy performed&#63;&#8221; was not completed in 54&#46;3&#37; in 2009&#44; 31&#46;7&#37; in 2010&#44; 30&#46;5&#37; in 2011&#44; 29&#46;7&#37; in 2012 and 27&#46;1&#37; in 2013&#46; The high percentage of non-completion in 2009 was due to the still frequent use of the former statistical death bulletin&#44; which saw 38&#46;1&#37; of total deaths without legal intervention in that year&#44; a figure which fell to 2&#46;4&#37; in 2010&#44; 0&#46;5&#37; in 2011&#44; 0&#46;3&#37; in 2012 and 0&#46;2&#37; in 2013&#46; <span class="elsevierStyleItalic">Information sources</span>&#58; For FA the Institute of Legal Medicine of Catalonia&#59; For CA The Mortality Register of Catalonia &#40;Servei d&#8217;Informaci&#243; i Estudis&#44; Departament de Salut&#44; Generalitat de Catalunya&#41;&#46;</p>"
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