Impact of Post-mortem PCR Testing on Lead Time of the Medico-legal Death Investigation. A Retrospective Study During the COVID-19 Pandemic in a Tertiary Care Hospital in Sri Lanka

Introduction: The lead time is defined as the time between the beginning of a process or project and the appearance of its results. A post-mortem nasopharyngeal swab is the preferred specimen and Real-time reverse transcriptase-polymerase chain reaction-based assays remain the “gold standard” for the detection of severe acute respiratory syndrome coronavirus 2. Although the RT-PCR provides a relatively rapid result (average 6 hours) the process of post-mortem specimen collection, transportation, and real-time polymerase chain reaction testing lead to the increased time duration of releasing the deceased to the next of kin. This study aims to assess the effectiveness of the institutional policies governing autopsies adopted during the COVID-19 pandemic at the medico-legal unit of Matale in decreasing the lead time of medico-legal death notification.Methods: This study was conducted at the medico-legal unit of District General Hospital Matale, Sri Lanka. All data was collected from the post-mortem reports and records maintained at MLU of Matale from May 2021 to December 2021. All the post-mortems conducted by the author (442 autopsies) were included.Results: The study population comprised of 283 (64%) males. The majority (30%, n=134) of the decedents were more than 80 years. The mean age of the deceased was 69.20 years and the standard deviation was 17.881. The majority (66%, n=291) of the descendants were Sinhala. The majority of inquests (n= 423, 96%) were conducted by inquire into deaths. In the months of August and October number of autopsies performed had increased 4 times and 3 times respectively to that of the same period in previous years and the following year. Out of the autopsies, 23% (n= 101) of the lead time of autopsy was on the same day of death. In the majority (64 %, 85) of the deaths lead time of autopsy was the next day of the death.Conclusion: During the COVID-19 pandemic, excess mortality was detected, lead time of autopsy was reduced due to the policies adopted by the medico-legal unit. Lessons learned during the pandemic may help improve resource utilization without negatively influencing outcomes in a low-resource setting.