The 48-Hour Protocol on Deaths Following Traumatic Events at the Hospital of Novara in Eastern Piedmont, Italy: A Review of the Effectiveness of Reporting to the Judicial Authority

In the past decades, the autopsy rate has been declining worldwide, including in Italy, especially of judicial autopsies, partially losing sight of the pivotal importance of autopsy in detecting the cause and the manner of death.1-4 Indeed, discrepancies between clinical diagnosis and hospital autopsy are quite high.5,6 This study aims to review the effectiveness of the “48-hours protocol” in operation at the hospital “Maggiore della Carità” of Novara. This protocol states that after the death of a patient with a traumatic event in their past medical history, a notification of death must be sent to the Judicial Authority, which must be made aware that, after a time of 48-hours, a non-judicial autopsy is planned, giving the time to decide if the autopsy should be changed into a judicial one or not. The review was made on all cases in which the “48h protocol” came into effect, in the years 2017, 2020, and 2023. Out of the 127 medical death records, 116 were correctly reported as 48-hour protocols. A total of 107 autopsies were carried out, among which 103 were hospital ones, and only 4 were judicial ones. The most documented traumatic events were falls at home, followed by road traffic accidents. Over 46% of the autopsy results totally or partially differed from clinical diagnosis made in the hospital. The interpretation of the results of this study suggests three conclusions: first, the autopsy is pivotal to correctly detect the cause of death in traumatic deaths; second, the Judicial Authority does not make enough and proper use of the “48-hours protocol,” underestimating the role of judicial autopsies; and third, that the protocol might be too superficially used. Therefore, some changes to the protocol should be made in order to have a better communication to the Public Prosecutor’s Office, maybe adding more specific information to the reports sent to hopefully increase the authorities’ interest. Once these details have been refined, and the usefulness of this protocol validated, it would also be desirable to disseminate it to other prosecutors’ offices to raise awareness of the issue throughout Italy.