Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce. To distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts. 84.1% (n = 618) were classified as COVID-19 deaths, 6.4% (n = 47) as non-COVID-19 deaths, 9.5% (n = 70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n = 283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n = 187). Thromboses were found in 39.2% (n = 62/158 cases), pulmonary embolism in 22.1% (n = 56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n = 618) represented COVID-19 deaths. Our study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

In several countries, general practitioners conduct post-mortem external examination (PMEE) and certify death in out-of-hospital cases. A possible lack of accuracy has been repeatedly criticised, although data on everyday practice of PMEE on outpatients are scarce. To evaluate medical practitioner's competence, education and accuracy regarding PMEE, we conducted a fax-survey among 1343 medical doctors in the metropolitan area of Hamburg, Germany. The results indicate considerable shortcomings in up to 63% regarding the inspection of body orifices and hidden areas, palpation of osseous structures, ectropionisation of the eyelids and use of aids. More than 5% of respondents reported to fill in a death certificate without performing a complete PMEE in the majority of cases. While theoretical teaching on PMEE was reported quite frequently (up to 78%), a considerably smaller group received practical training (32% during undergraduate and 13% during postgraduate education). To estimate the effects of training on PMEE, an individual "accuracy score" was calculated (range 1-5). Mean score was 3.63 (SD 0.81), and results differed significantly (p < 0.001) among groups of medical practitioners with or without education on PMEE and was highest among doctors who received practical training (p < 0.005). The results indicate that there are major shortcomings in a relevant portion of PMEE performed on out-of-hospital deaths that might lead to misdiagnosis of non-natural causes of deaths and homicides. Practical pre- and postgraduate education appears to positively impact accuracy and therefore quality of the procedure. Consequently, corresponding practical training should be mandatory during academic studies and ongoing education programs.

Only few studies have reported on males as victims of intimate partner violence (IPV) so far. The aim of the present study is to analyse frequency and case characteristics of physical violence against male IPV victims examined in a clinical-forensic medical examination centre for victims of violence in Germany over an 11-year period, contributing to a better understanding of IPV in men. Male victims represented 6.2% of IPV cases (n = 167) with a median age of 40 years. Cases were reported to the police in 78.4% before medicolegal examination. In 60.5% of the cases, the perpetrator was the current partner, and 82% occurred in a domestic environment with a predominance of female offenders. In more than half of the cases (57.5%), the victims consulted the examination centre without prior healthcare utilisation. About one-third of the victims reported previous IPV (31.7%). The findings point to the relevance of men as victims of IPV, case group–specific risk factors, injury-dependent behaviour related to healthcare utilisation, the need to establish or strengthen specialised support services for affected men and underscore the importance of clinical-forensic services in documenting and assessing violence-related injuries.