Clinical and autopsy parameters of acute medical deaths in an emergency facility in South-west Nigeria

Background: Acute medical deaths are usually consequences of acute critical diseases, or acute exacerbations of chronic diseases. Thus, autopsy - confirmed characteristics would provide support for future management strategies. Objectives: To examine clinical and autopsy parameters including causes of death (COD) and mechanisms of death (MOD) among acute medical deaths. Methods: A 5-year (2005-2009) retrospective analysis was undertaken of Emergency Department (ED) related medical deaths occurring <24 hours after presentation. Case-notes provided clinical details while autopsy records supplied the COD and MOD respectively. Results: Decedents were 250 males (58.5%) and 177 females (41.5%), (male: female ratio=1.4: 1), predominantly (78%) young; with mean age of 43.7±16.6 years. In 22.8%, symptom duration was <1 day but >4 days in 42.8%. Coma -36%, and dyspnoea -10% prompted early presentation; but late presentation (>4days) characterised cough (4%), fever (10%), and body swelling (19%). Of the total, 23% presented after 10 pm, 16% were "dead on arrival" (DOA), and 40% died within six hours of arrival. Three commonest CODs were circulatory-cardiovascular disease [CVD](36%), infections/septicaemia (18%), and malignancies (8.4%). CVD subset was older (52 years), with significant male preponderance (62.5% vs 37.5%; p<0.05); but comparable mean age in both sexes. Common MODs were cerebral dysfunction (29%) - including sub-types of intra-cerebral haemorrhage (51.8%) and tonsillar herniation (33.3%), heart failure (19%), and septicaemia (15%). Conclusion: The highlights were late presentation, early demise from communicable and noncommunicable diseases; and common "exit" mechanisms of septicaemia, heart failure and cerebral dysfunction. These data will guide management and preventive strategies