Burden and temporal patterns of brought-in-dead cases and surveillance readiness of a mortuary register: A 12-year retrospective audit (2009 – 2020)

Abstract

Objectives: Brought-in-dead (BID) cases are a major mortuary burden in resource-limited settings and a pragmatic marker of gaps in prehospital care and death registration, but mortuary registers are typically maintained for administrative/cost-recovery purposes rather than surveillance. We quantified BID burden and temporal patterns in a tertiary hospital mortuary (2009–2020) and assessed register surveillance readiness using completeness and an internal consistency metric. Material and Methods: A retrospective register audit of all mortuary admissions (January 2009–December 2020) was performed, defining BID using the register’s deposition classification. Temporal patterns were assessed using annual and monthly distributions, logistic regression for yearly trend, and a likelihood-ratio test for seasonality, while surveillance readiness was evaluated using variable completeness and pre-specified internal consistency checks. Results: A total of 3,747 mortuary admissions were analyzed; 1,237 (33.0%) were BID. Annual BID proportions ranged from 23.5% (2017) to 40.9% (2010), with a statistically significant overall decline over time (odds ratio (OR) per year 0.964, 95% confidence interval (CI) 0.947–0.982, p =0.000084). Monthly BID proportions ranged from 27.8% (June) to 40.4% (August), with evidence of seasonality (LR χ 2 (11) =20.80, p =0.035). Sex was recorded in 99.5% of entries, whereas usable numeric age was available in 71.3% (non-numeric “adult [age-not-given]” 24.0%, missing 4.75%). Source documentation was limited by a high proportion of “Unspecified Ward” (36.9%). BID-source concordance was complete (0 discordant records), but the deposition “diagnosis” field was non-informative for cause-of-death surveillance. Conclusion: BID constituted one-third of admissions with significant temporal variation; however, missingness and limited source detail constrain surveillance utility, supporting targeted upgrades to a minimal standardized dataset.