This study sought to map the evidence on data management and practice systems in Forensic Medicine. The results show that several data management and practice systems exist. However, most of the existing systems were from high-income countries with few in LMICs based on this study’s eligibility criteria. This review was informed by the need to collect systematic evidence on the data management and practice systems being used in forensic medicine and the possible lessons and applicability to LMIC contexts where paper reporting is still being used. The lack of information on data management and practice systems is visible in that only two of the articles included for review reported on studies from the LMIC context. Half the publications (50%) were published during and after 2017. This trend may be due to the greater access, use, and reporting of electronic data reporting systems. The inclusion of Forensic Pathology reports on databases also captures information that is not routinely captured in vital registration statistics. The existing data management systems in forensic medicine reported in the included articles have several benefits. Nonetheless, the included articles also reported several challenges about those existing data management systems (see Fig. 2).
To the best of our knowledge, this scoping review is the first present evidence on data management and practice systems in Forensic Medicine. Therefore, we cannot compare our findings. Nonetheless, the literature shows that electronic data reporting systems are relevant and were developed from the recognition of coronial data as not only a part of the death investigation but as a contributor to preventable death research and public health initiatives. For instance, in an article by Bruce Levy which discussed the United States of America systems currently in place to support Forensic Pathology and death investigation, the CDC implemented the National Violent death Reporting System in response to a report describing the need for a national fatal intentional injury surveillance system. Initially, the system started in six states but later was expanded to 18 states as stated in the publication (Fowler et al. 2018). According to the CDC website, and an article published in 2019 regarding its future directions, the program has now expanded to all 50 states and is constantly being updated and improved for data sharing (Blair et al. 2016; CDC, 2012). Other systems developed in the USA included a state-wide comprehensive multisource drug overdose fatality surveillance system in Kentucky (developed in response to drug overdoses cited as a public health crisis) and a database related to infant and child abuse (Soto Martinez et al. 2019; Hargrove et al. 2018). The burden of sudden infant death syndrome and the large number of cases that remain unexplained led to the passing of legislation in Italy (2006) that fetuses and infants, from 25 weeks of gestation to one postnatal year, who died suddenly and unexpectantly should be sent to the University of Milan, Italy, for a postmortem with parental consent (Ottaviani et al. 2017). An Italian research center developed a web portal for a national bank registry which has been set up to centralize records retrieved from regions across Italy which hopes to contribute data for epidemiology and study into risk factors for sudden unexpected death in infants. Canada instituted a National Coroner and Medical Examiner database to detect emerging trends and hazards for the prevention of avoidable deaths (Canada 2012). Tokyo is recognized as a technology hub, and the latest inclusion of a Legal Medicine Information System for forensic systems is discussed in an included article (Kiuchi et al. 2013). Using the information system, Forensic Pathologists and other staff can register and search for institutional autopsy information, print death certificates, and extract data for research and analysis. Switzerland created a tool called the Virtopsy-a centralized database in Forensic Medicine for analysis and comparison of radiological and autopsy findings (Aghayev et al. 2008). It is a database currently created but not in routine use as it has not been validated. The database compares autopsy and radiological data with photograph storage. In the Nigerian study, recognition of the poorly representative mortality injury surveillance system prompted the authors to institute an electronic injury surveillance system (Kipsaina et al. 2015). The system included features based on a South African initiative namely the National Injury Mortality Surveillance System (NIMSS) which due to logistical reasons and lack of funding was deemed unfeasible and discontinued (Prinsloo 2019). Articles related to NIMSS did not meet the inclusion criteria of the current study. Although the tools that were utilized were already existing making the system feasible and sustainable, but an appropriate infrastructure needs to be in place to maintain the system (Prinsloo 2019).
The recognition and understanding of violent deaths require the collection of accurate, timely, and comprehensive surveillance data to implement preventative measures (du Toit-Prinsloo and Saayman 2012; Prinsloo 2019; Saar et al. 2017; Blair et al. 2016; Pearse 2012). The wealth of information collected by Forensic Pathologists can be effectively used in public health and safety initiatives, policies, and legislation (Dunstan 2019; Fowler et al. 2018; Blair et al. 2016). The databases have been credited as an evidence base for awareness-raising and death prevention initiatives informing research, policy development, and coronial investigation (Dunstan 2019; Blair et al. 2016). It encourages information exchange, standardization, and implementation of investigation protocols, and research. It has contributed to the publication of more than a hundred articles in a broad range of journals (Blair et al. 2016; Lyndal et al. 2016). Access, tracking, and centralization of data can result in the improvement of scientific and investigative processes with the implementation of international standards and best practices (Fowler et al. 2018; Saar et al. 2017; Blair et al. 2016; Kiuchi et al. 2013). The implementation of the system improved the quality of the surveillance data and the standardization of data. Furthermore, using and linking multiple sources of data-enabled valuable information to be extracted and translated for the identification of vulnerable populations at risk and provided evidence to implement a new legislature (Fowler et al. 2018; Levy 2015). It can be cost-effective and impact public health to reduce waste of resources and improve public initiatives. This data can further be used to develop diagnostic models to better inform clinical decision-making (Soto Martinez et al. 2019). It was recognized that the tool used must be comprehensive and adaptable as data management systems are indispensable as part of forensic investigations (Hofmeister et al. 2017; Levy 2015). It can be remodeled to an online platform that simplified system operations and management, improved timeliness of reporting, and increased adaptability which creates an opportunity for expansion to multiple sites.
There were several limitations discussed which primarily involved feasibility of the system, accuracy, availability, and completeness of data, involvement of relevant stakeholders, and the absence of morbidity data (Lyndal et al. 2016). Collaboration may address challenges of sharing and merging and analyzing of data. Developing policies regarding storage, quality review, and access of the data for analysis may address privacy challenges. Important issues discussed included the protection of data privacy which can be overcome by anonymization of data on the central server and the case sensitive information can be stored on the local server (Kiuchi et al. 2013; Aghayev et al. 2008). The use of the Internet can be a cost-effective solution whereas more sophisticated databases require time and resources and a necessary framework that involves policies, staff, training, quality control, and support. The issues relating to the systems are the limited resources for death investigations (both human factors and technology). The involvement of various stakeholders to support data-sharing programs in Forensic Pathology can relieve the financial strain (Dunstan 2019; Fowler et al. 2018; Hargrove et al. 2018; Dennis et al. 2018; Saar et al. 2017; Hofmeister et al. 2017; Ottaviani et al. 2017; Levy 2015). The Forensic Medicine Departments can utilize simple and available tools that can advance standardization of data collection, storage, and reporting because of the central role they play in reporting provincial/national data (Kipsaina et al. 2015). The reviewed articles included a great variety of systems that could lend themselves to use in LMIC contexts. Apart from its limitations, the autopsy/coronial data reporting systems are recognized as an essential tool for monitoring the prevalence and incidence of violence related to fatal injuries.
Strengths and limitations
This study is the first scoping review that systematically mapped literature relating to data practices in Forensic Medicine globally. A major strength of our study method is that it permits the inclusion of all study designs and the development of a protocol that ensures reproducibility. Moreover, we conducted a thorough search using a comprehensive search strategy which enabled us to capture the most relevant articles to answer the review question. However, the articles selected were limited to Forensic Medicine, keywords, and its data collection methods of autopsy records; therefore, articles that entail electronic methods for the data collection in other medical departments were excluded. The limitation was due to the focus of the study being on the value of these systems to preventative programs rather than treatment. The keywords to be used in the search strategy are broad and may not identify specialized studies in data management. Only articles in English will be used. Nonetheless, the finding produced by this study is useful to inform further research, particularly LMICs.
Recommendations
The general consensus from the articles is that a data management and practice system containing coronial/medical examiner/Forensic Pathology data is beneficial for research, policymaking, prevention strategies, and information exchange for education. Due to resource limitations in some low- to middle-income countries, the database can be done by using available resources to create a limited database (Kipsaina et al. 2015). Although if multiple stakeholders can be involved to formulate and fund a nationally representative information system, this can be wholly beneficial, not only to the community and government but may also impact on private companies with regard to product development and reformation due to its comprehensive coverage of preventable deaths (Dunstan 2019; Hargrove et al. 2018; Saar et al. 2017; Blair et al. 2016; Lyndal et al. 2016).