• Philipp Eckstein, Christian Schyma, and Burkhard Madea.
• Institut für Rechtsmedizin der Universität Bonn.
• Arch Kriminol. 2010 May 1; 225 (5-6): 145-58.

AbstractThe paper presents a retrospective analysis of 16,541 external post-mortem examinations carried out before cremation by the Institute of Forensic Medicine of the University of Bonn between 1998 and 2008 with regard to different variables (age, sex, place of death, cause of death etc.). In more than 50 % of cases, the individuals had died in a hospital followed by their apartment or a nursing home. The first post-mortem examination was mainly performed by hospital doctors followed by emergency doctors and office practitioners. As to the age distribution, the 6th to 8th decade of life was prevalent. In 99.8 %, a natural death was certified in the first external post-mortem and only in 0.2 % the manner of death was determined to be non-natural or unclear. In more than half of the cases, the non-natural deaths were determined by emergency doctors. Deaths wrongly classified in the first external post-mortem were mostly accidents and deaths associated with medical procedures. Although the second external examination before cremation is very useful in detecting previously overlooked signs of homicide, it is only of limited value in homicides with few external traces or for detecting underlying diseases and causes of death. In this respect, the second external examination before cremation can only check the plausibility of the cause of death given by the attending physician. The gold standard for a reliable certification of the manner and cause of death remains the autopsy.

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