Comparison of Stanford and DeBakey Classification Distributions Between Hospital-Diagnosed and Forensic Autopsy-Diagnosed Aortic Dissection Cases.

Background: This study compared demographic characteristics and Stanford and DeBakey classification distributions between aortic dissection cases diagnosed in a tertiary hospital and those diagnosed at forensic autopsy. Methods: This retrospective comparative study included 58 cases diagnosed between 31 December 2019, and 1 January 2024. Hospital-diagnosed cases (n = 31) were identified from electronic medical records, whereas cases diagnosed at autopsy (n = 27) were retrieved from medico-legal autopsy reports. Demographic characteristics and classification distributions were compared. Results: Mean age was higher among hospital-diagnosed cases than among forensic autopsy-diagnosed cases (52.84 ± 17.59 vs. 43.93 ± 17.26 years; mean difference: 8.91 years; 95% CI: -0.27 to 18.10; p = 0.057). Stanford type A was more frequent among forensic autopsy-diagnosed cases (92.6% vs. 67.7%), with an absolute difference of 24.9 percentage points (95% CI: 3.8 to 43.2; Fisher's exact p = 0.025). The overall DeBakey distribution also differed between the groups (Fisher-Freeman-Halton exact p = 0.044), with type III being 24.9 percentage points less frequent among forensic autopsy-diagnosed cases (95% CI: 3.8 to 43.2). Sex was not significantly associated with either classification. Conclusions: Stanford type A and DeBakey types I-II predominated among cases diagnosed at autopsy. These findings demonstrate classification differences according to diagnostic setting and emphasize the contribution of forensic autopsy to identifying fatal aortic dissections.