Core body temperatures during final stages of life-an evaluation of data from in-hospital decedents

Abstract

Temperature-based methods are widely accepted as the gold standard for death time estimation. In the absence of any other information, the nomogram method generally assumes that a person died with a core body temperature of approximately 37.2 °C. Nevertheless, several external and internal factors may alter the body temperature during agony. A retrospective medical record analysis was carried out on in-hospital death cases from two consecutive years of surgical intensive care units to determine the effects of factors influencing the core body temperature at the point of death. Data from 103 case files were included in the statistical data evaluation. The body temperature fluctuated between and within individuals over time. No clear correlation to certain death groups was observed. Even primary cardiac deaths showed broad intervals of temperatures at the point of death. Men seem to die with higher body temperatures than women. The presented data highlight potential biases for death time estimations when generally assuming a core body temperature of 37.2 °C. In conclusion, the estimation of the time of death should include various methods, including a non-temperature-dependent method. Any uncertainties regarding the body temperature at point of death need to be resolved (e.g. by identifying fever constellations) and elucidated if elimination is not possible.

Keywords: Agony; Death time; Estimation; Influence factors; Nomogram; Temperature.

Fig. 1

Age distribution (years) of the included deceased persons. Box contains 50% of the tested persons, the line inside the box indicates the respective median, and the satellites and individual outliers indicate 25% of the tested persons. Outliers are presented as dots. Total n = 103

Fig. 2

Death groups (x-axis), numbers of assigned deceased individuals (without external heating or cooling), and the final measured body temperature within 2 h ante mortem (°C, y-axis). Numbers are presented below each column. Total n = 103

Fig. 3

Death categories by age groups (number; x-axis). Red: 4–20 years, blue: 21–40 years, green: 41–60 years, pink: 61–80 years, and brown: 81–98 years

Fig. 4

Intraindividual fluctuation of the body temperature (°C) during the last 24 h ante mortem. Total n = 149

Fig. 5

Number of persons in distinctive death groups with fluctuation of the body temperature of more than 1.5 °C in the last 24 h ante mortem

Fig. 6

Fluctuation of the body temperature (°C; y-axis) during the last 24 h of life (hours ante mortem; x-axis). The red dots indicate average values. Total n = 103

Fig. 7

Fluctuation of the systolic blood pressure (mmHg; y-axis) during the last 24 h of life (hours ante mortem; x-axis). Total n = 103

Fig. 8

Fluctuation of the pulse (bpm; y-axis) during the last 24 h of life (hours ante mortem; x-axis). Total n = 103

Fig. 9

Correlation of vital signs, hemoglobin, and intravenously administered fluids (x-axis) with temperature in subjects who had at least 10 contemporaneous responses of temperature and the corresponding variable (n = 284). Data according to Pearson’s correlation coefficient (y-axis). The numbers of observations are presented below each column

Fig. 10

Fluctuation of the body temperature (°C; y-axis) during the last 24 h of life (hours ante mortem; x-axis). Total n = 36

Fig. 11

Fluctuation of the body temperature (°C; y-axis) during the last 24 h of life (hours ante mortem; x-axis). Total n = 25