Can computed tomography replace or supplement autopsy?

Postmortem computed tomography (PMCT) has been integrated into the practice of many forensic pathologists. To evaluate the utility of PMCT in supplementing and/or supplanting medicolegal autopsy, we conducted a prospective double-blind comparison of abnormal findings reported by the autopsy pathologist with those reported by a radiologist reviewing the PMCT. We reviewed 890 cases: 167 with blunt force injury (BFI), 63 with pediatric trauma (under 5 years), 203 firearm injuries, and 457 drug poisoning deaths. Autopsy and radiology reports were coded using the Abbreviated Injury Scale and abnormal findings and cause of death (COD) were compared for congruence in consensus conferences with novel pathologists and radiologists. Overall sensitivity for recognizing abnormal findings was 71% for PMCT and 74.6% for autopsy. Sensitivities for PMCT/autopsy were 74%/73.1% for BFI, 61.5%/71.4% for pediatric trauma, 84.9%/83.7% for firearm injuries, and 56.5%/66.4% for drug poisoning deaths. COD assigned by reviewing PMCT/autopsy was correct in 88%/95.8% of BFI cases, 99%/99.5% of firearm fatalities, 82.5%/98.5% of pediatric trauma deaths, and 84%/100% of drug poisoning deaths of individuals younger than 50. Both autopsy and PMCT were imperfect in recognizing injuries. However, both methods identified the most important findings and are sufficient to establish COD in cases of BFI, pediatric trauma, firearm injuries and drug poisoning in individuals younger than 50. Ideally, all forensic pathologists would have access to a CT scanner and a consulting radiologist. This would allow a flexible approach that meets the diagnostic needs of each case and best serves decedents' families and other stakeholders.     

指甲伤的类型与形成机制研究

目的探讨人体体表指甲伤的分型与形成机制。方法收集法医实际检案资料51例指甲伤434处,借助放大镜对各处伤进行形态特征观察、归类整理。结果指甲伤可分为条状抓擦伤、片状压擦伤和弧状压挫伤/创3种基本类型,分别有168处、153处和113处,其形态特征改变主要与成伤指甲的结构,作用力的大小、方向、作用时间,伤处皮肤的松驰度、Langer线走向,伤后经过时间等因素有关。结论指甲伤的类型和成份机制判断对加害人意图的分析和案件定性有重要作用。     

156例道路交通事故活体损伤分析

１５６例道路交通事故活体损伤分析陈新山（武汉同济医科大学法医病理学教研室；武汉４３００３０）ＡＮＡＬＹＳＩＳＯＦ１５６ＣＡＳＥＳＯＦＮＯＮ－ＦＡＴＡＬＩＮＪＵＲＹＩＮＲＯＡＤＴＲＡＦＦＩＣＡＣＣＩＤＥＮＴ￥ＣｈｅｎＸｉｎｓｈａｎ（Ｄｅｐａｒｔｍｅｎｔ...     

Examination results and autopsy findings in assaults on elderly people

As the percentage of elderly people in the population grows, violence against persons of advanced age constitutes an increasing social problem. The findings of the clinical forensic examinations (CE group) and autopsies performed on elderly violence victims (> or = 60 years) between 1999 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In all, the study material comprised 55 victims of the CE group (35 females and 20 males, median age 73.5 years) and 55 autopsies (33 females and 22 males, median age 72.7 years). In most of the autopsy cases, the suspect was a family member or partner. In contrast, the alleged perpetrator was a stranger in most cases of the CE group. Blunt force injuries were most often found in the CE group victims (63.6%). Altogether, 38.2% (CE group) and 20.0% (autopsy cases) of the violent assaults were associated with robbery. In the majority of the CE cases, the victims suffered potentially or acute life-threatening injuries. In summary, the analysis shows that elderly people frequently become victims of robbery and blunt force injury. In most homicides of old people, the perpetrator is familiar to the victim. In surviving elderly violence victims, the assault is more likely to be reported to the police if the suspect is a stranger.     

Criteria for differentiating self- or other-inflicted injuries of alleged or real victims

A synoptic study of six cases of self-inflicted sharp force injuries is presented, where young, mostly female people had simulated assaults to gain sympathy or other personal advantage. The morphological distinctives of simulated assault wounds from such of real assault are worked out and the common situative and motivative background is cleared up.     

臂丛神经主要分支损伤法医学鉴定66例分析

目的探讨臂丛神经主要分支损伤的法医学鉴定。方法取自本室2003年1月至2005年12月共66例84条臂丛神经主要分支损伤的案例进行统计分析。结果被鉴定人中男性青壮年占较大比例;锐器伤引起神经损伤居多达94%;神经损伤伴有骨折的占34%,其中50%尺神经损伤伴尺骨骨折;曾行肌电图检查的为34条神经,占40%,其中有15条临床未确诊为神经损伤。结论臂丛神经主要分支损伤的法医学鉴定,关键看影响肢体运动功能的后果,鉴定时机宜术后20天 L(神经断端远侧的长度)/R(生长速度) 90天。     

Bimodal distribution of violent assaults

The aim of the present study was to investigate the relationship between the number of injuries inflicted on victim during violent assault and other variables, characterizing the offender and the assault. The study is based on all the cases that were processed at the City Court of Tallinn, Estonia in 1986 and 1996. The number of assault-related injuries caused to the victim in Tallinn, Estonia, for 1986 and 1996 revealed bimodal distribution. About 2/3 of the assaults resulted in 1-5 injuries, in 1/3 of the cases the number of inflicted injuries was 10 or higher, with only a relatively small number of injuries in between. This distribution pattern was stable over the 10-year interval between the observations and was invariant to alcohol intoxication, consequences, and reasons for the assault. Comparison of the offenders' criminal record during the 15-year follow-up period showed that recidivism was more common among those who had committed a multi-injury assault as their first offence. The evident distribution of assaults into few- and multi-injury groups and the fact that the number of injuries caused during the first offence is a more reliable criterion for predicting the further criminal record of the offender than the consequences of the assault suggest that there are two discrete types of behaviour determined by a set of variables characteristic of the offender's psychology.     

Stranger and acquaintance sexual assault of adult males

This study examined victim and assault characteristics and the nature and extent of coercion, violence, and physical injuries among adult male victims of sexual assaults. Client records of three groups presenting to a sexual assault care center were included: males assaulted by a stranger (n = 64), males assaulted by an acquaintance (n = 81), and females assaulted by an acquaintance (n = 106). Study results revealed that male victims of sexual assault tended to be young, single men who reported high rates of vulnerabilities such as homelessness and physical, psychiatric, and cognitive disabilities. Male stranger assailant victims were more likely to experience assaults involving weapons and physical violence. Injuries sustained by victims and services delivered at the sexual assault care center were similar for both male and female clients. The results of this study reveal new information about violence in male sexual assaults and the vulnerability of the male victims.     

Breaking point? An analysis of fatal stab wounds to the torso in Ireland between 2011 and 2018, examining the extent of rib fractures

This study examines the pattern of rib injuries occurring in cases of fatal torso stab wounds in Ireland between 2011 and 2018. It has been suggested by previous studies that rib fractures are not commonly sustained in stab wounds to the torso. We wanted to ascertain whether this was the case, as our data suggested that rib fractures were frequent, and where a rib is fractured there is a higher chance of organ injury and death, making this an important area of study. One hundred and forty seven cases of fatal stab wounds from an eight-year period were retrospectively reviewed. Fatal stab wounds to other body areas, were excluded; leaving a total of 104 cases with stab wounds to the torso. We found that 69.2% of cases had rib injuries, a figure significantly higher than previously reported. Our data suggests that stab wounds to the torso often fracture ribs, putting the underlying organs at increased risk of injury and perhaps contributing to fatality. The amount of force needed to cause a rib fracture can be difficult to quantify and indeed from the high percentage of rib fractures sustained in our data it appears that the ribs may be fractured regardless of the amount of force used; this is borne out by the finding that self-inflicted injuries also caused rib fractures. Our study shows that other factors, such as anatomical positioning and wound depth may have a greater bearing than force in terms of whether a rib fracture is sustained.     

道路交通事故颅脑损伤的法医学鉴定

目的　研究道路交通事故中颅脑损伤的类型、特点、主要并发症及其受伤人员的伤残评定。方法　 862例道路交通事故颅脑损伤的案例资料 ,按伤者受伤的不同部位、有无并发症、并发症的类型及伤残程度进行统计分析。结果　复合性颅脑损伤 2 76例 ,脑挫伤 192例 ,颅骨骨折 79例 ,颅内出血 91例 ,头皮外伤 2 2 4例 ;主要并发症为脑积水 ( 19例 ,2 2 0 % )、癫痫 ( 16例 ,1 86% )、偏瘫 ( 14例 ,1 62 % )、植物人状态 ( 12例 ,1 3 9% )。结论　道路交通事故中颅脑损伤 ,以头部复合性损伤最多见 ,严重的脑挫伤为最常见的损伤类型 ,并发症的诊断应掌握诊断标准 ,并注意与相关疾病鉴别。     

Sharp Force Homicide in Denmark 1992–2016

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992–2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.     

Patterns of Trauma Induced by Motorboat and Ferry Propellers as Illustrated by Three Known Cases from Rhode Island*

Abstract: Understanding patterns of trauma is important to determining cause and manner of death. A thorough evaluation of taphonomy, trauma, and bone fracture mechanisms is necessary to reconstruct the circumstances of the death. This study examines the skeletal trauma caused by boat propeller strikes in terms of wound characteristics and location based on three cases from Rhode Island. These case studies review the traumatic characteristics caused by propeller injuries and highlight the anatomic regions most likely to sustain skeletal trauma. With this information, investigators may be able to identify propeller trauma even in severely decomposed remains. The discussion of boat propeller trauma also raises issues regarding how forensic anthropologists and forensic pathologists classify trauma (specifically blunt force vs. sharp) and highlights semantic issues arising in trauma classification. The study also discusses why these propeller cases should be classified as blunt trauma rather than sharp or chop/hack trauma. Ultimately, the authors urge consistency and communication between pathologist and forensic anthropologists performing trauma analyses.     

Disentangling the Effects of Self-Protective Behaviors on the Risk of Injury in Assaults Against Women

Using data from the National Crime Victimization Survey, this paper attempts to disentangle the effects of self-protective behaviors on the risk of injury in assaults against women. Unlike previous research, in this study we address simultaneously three important conceptual and methodological issues: (1) type of self-protective behavior, (2) temporal sequencing of self-protective behavior in relation to injury, and (3) the victim/offender relationship. Results indicate that even after controlling for other contextual characteristics of an assault, the probability of a woman being injured was lowest when she employed non-physical resistance strategies such as arguing or reasoning with the offender. This was true for all types of offenders. However, for assaults involving intimates, the probability of injury was increased for women who physically resisted their attackers.     

Clinical forensic examination findings in assault cases among adolescents

Child and youth criminality has risen markedly over the past 25 years and causes increasing concern to the general public. The clinical forensic examination cases of youth violence victims examined at the Institute of Legal Medicine of the Hanover Medical School and its Oldenburg Branch between 1999 and 2008 were retrospectively analyzed. In all, 55 adolescents (37 females, 18 males; median age 15.5 years) were examined. In most cases the suspect was a close (40.0%) or passing (23.6%) acquaintance. 16 assaults were committed by two or more adolescents jointly. Most of the juveniles were victims of sexual assaults (56.4%). In 15 victims of sexual offences (51.7%) diagnostic findings were obtained on the basis of anogenital injuries and/or the presence of sperm. In summary, the analysis shows that adolescents frequently become victims of sexual assault. In addition, youth violence is often committed in a group.     

Workplace Sexual Harassment in Policing: Perceived Psychological Injuries by Source and Severity

Relatively little is known about employee perceptions of workplace psychological injuries following sexual and nonsexual harassment. In quasi-military occupational organizations, such as policing, the rate of sexual harassment to workplace injuries from other sources is comparatively high. In an exploratory 5?×?2 between-subjects factorial experimental projection study, 220 New South Wales Police Force officers responded to one of ten experimental vignettes in which sources of psychological injury and the gender of the injured worker were systematically varied. Results revealed an unexpected effect of experience. Employees aged 30 years and older were significantly more likely to anticipate psychological consequences and clinically diagnosable symptoms than their younger counterparts. As hypothesized, a main effect of injury source, but not gender of the target, emerged for the severity of psychological consequences: a physical injury was perceived to produce significantly more severe psychological injuries than sexual harassment in the form of coercion and unwanted sexual attention. Contrary to the hypothesis, participants rated gender-based hostility higher than other types of sexual harassment as a source of severe psychological harm. Participants believed that gender-based hostility requires more professional intervention and predicted more negative workplace consequences than other psychological injuries caused by other workplace events. As hypothesized, women employees were generally viewed as significantly more vulnerable to negative workplace outcomes than men. The police officers who participated in this study considered women as more likely to experience workplace problems following sexual coercion than other types of workplace injury. Physical injuries, gender-based hostility, and sexual coercion were distinguished from nonsexual harassment and unwanted sexual attention as significantly more likely to produce clinically diagnosable injuries, irrespective of target gender. Implications of these findings for research, practice, and legal policy are discussed.     

Suicidal or Homicidal Sharp Force Injuries? A Review and Critical Analysis of the Heterogeneity in the Forensic Literature

The differential diagnosis between self-inflicted and nonself-inflicted, suicidal and homicidal, injuries is difficult or impossible in many cases and, above all, cannot be made on the basis of information obtained solely from the autopsy or the medicolegal clinical examination. The purpose of this study is to analyze the literature on suicidal and homicidal sharp force injuries and identify the relevant parameters that may help differentiate between suicidal and homicidal deaths. To achieve this goal, a review of 595 potentially relevant articles was performed. After excluding the nonrelevant papers by screening the titles, all abstracts were reviewed, and articles meeting the inclusion criteria underwent a full-text review. The following parameters were compiled into a table: number of cases, localization of the injuries, and number of injuries. The data were statistically analyzed and compared with those available in the forensic literature. On the basis of the heterogeneity of data revealed by the present review, a simple and short checklist of the parameters that should be included when reporting suicides and homicides by sharp force has been proposed.     

90例行人撞击伤案例分析

目的 探讨行人交通事故和致伤车辆类型的关系,总结其规律.方法 回顾90例行人交通事故案例,分析致伤车辆、损伤部位、损伤特点、严重程度之间的关系. 结果 不同类型致伤车辆所致的撞击伤好发部位取决于受撞击时人体的姿势和车头突出部位的高度,其损伤特点与作用力大小、方向和接触面光滑程度相关. 结论 通过对行人撞击伤的损伤部位、损伤特点、严重程度的分析,可以推断致伤车辆类型.     

几种眼外伤鉴定时机的研究

目的分析几种眼外伤的伤后视力稳定时间,研究最早且合适的鉴定时机。方法将145件案例160个伤眼按损伤类型分成5组,研究几种眼外伤后视力水平、眼外伤类型与视力稳定时间的关系。结果不同的眼外伤,其视力稳定时间有较大差异,且视力水平的高低与视力稳定时间也有明显的相关性。结论眼外伤最早的合适鉴定时机既与眼外伤的类型有关,也与伤后视力水平有关;应灵活掌握鉴定时机,以适应司法机关的需要。     

骑跨伤在机动车碰撞自行车事故中的特征及生物力学分析

目的以真实案例为基础,研究自行车与机动车碰撞交通事故中,不同机动车型、交通方式等因子造成自行车骑车人下肢内侧骑跨伤的特征,分析其生物力学机制。方法选取上海地区发生的自行车与机动车碰撞交通事故案例140例,全面收集现场、自行车、机动车、人体、交通方向等信息,运用回顾性研究方法分析,同时,选取其中典型案例,通过计算机仿真技术模拟事故发生过程,提取人体各受伤部位的动力学响应数值,如加速度、力和力矩等,与案例研究结果对比。结果全部事故中出现骑跨伤与无骑跨伤案例频数相等;侧面撞击与前后方向撞击骑跨伤的发生情况无显著性差别;大型车辆撞击事故中出现骑跨伤频率较低;骑跨伤的发生频率随车速加大而增高;就骑跨伤的分布来说,撞击侧下肢骑跨伤位置低(链条、脚蹬管等损伤),而对侧骑跨伤位置高(鞍座损伤),在小型车辆撞击时该特点更明显。结论分析自行车骑车人的骑跨伤特征和生物力学机制有望对道路交通行为方式鉴定提供新依据。     

Spatial and temporal dimensions of assaults against children in Dallas,Texas, 1980–81

The role of environmental factors in incidents of violence has been relatively neglected in recent decades. Complementing recent research in social psychology and social geography, the present study tested two hypotheses: (1) general environmental conditions-day of the week, season of the y ear, and thermal stress-are significant predictors of the daily incidence of assaults on children, and (2) victim characteristics, sites of incidents, and types of assaults on children vary with levels of neighborhood socioeconomic status. Some 1614 incidents involving persons aged 18 and under were abstracted from a data base of 9994 aggravated assaults drawn from the files of the Dallas, Texas, Police Department, covering a 20-month period from March 1980, through October 1981. Analysis indicated that general environmental indicators are significantly related to daily frequencies of assaults on children. Further, neighborhood socioeconomic status was significantly associated with children's race, sites of assaults on children, and types of assault. Overall, only 11% of the assaults studied were classified as “abuse.” The dominant modes of assault involved firearms (28%) and knives (23%). The analysis revealed how assaults on children varied quantitatively and qualitatively as a function of victim characteristics, temporal and spatial context, and thermal stress.