Reasons for Lack of Consensus in Forensic Pathologist Interpretation of Photographs of Patterns of Injury of the Skin,

In a previous study, a survey‐based analysis of pathologist diagnoses of patterned injury in which participants were asked makes diagnoses from photographs in the absence of history or context. The level of consensus was low. A follow‐up survey was created to ask those who responded to the first survey why they answered as they did or why they were unsure of their answers. The most common reason for lack of consensus was that the lesion was nonspecific. Responses invoking ambiguity were more common than those that indicated a confident difference in diagnosis. There were differences between demographic groups, with age and experience being most prominent. These findings suggest that differences in image interpretation do not generally reflect firm differences in diagnosis as much as differing ways of dealing with ambiguity in the absence of history and context. A third survey will study the effect of the addition of contextual information.     

Forensic Pathologist Consensus in the Interpretation of Photographs of Patterned Injuries of the Skin

Forensic pathologists are commonly asked to evaluate injuries on the basis of photographs. Members of the National Association of Medical Examiners were asked to participate in an online survey in which they were presented with 68 patterned injuries of the skin and asked to make a diagnosis ranging from very general (e.g., “blunt” vs. “sharp”) to specific (e.g., “baton blow”). This was not the case. Consensus for general diagnosis averaged 0.77 and 0.72 for specific diagnosis. While there was a strong correlation between consensus and confidence in aggregate, individual correlations were poor. Consensus diagnosis was inversely correlated with age, and positively correlated with jurisdictional size, medical degree, and whether or not the respondent was actively performing autopsies as a job function. A subsequent survey is exploring possible reasons for lack of consensus in low‐consensus questions. The high correlation between confidence and consensus at the aggregate level and low correlation at the individual level may have implications for quality assurance protocols.     

The Reliability of Pattern Classification in Bloodstain Pattern Analysis,Part 1: Bloodstain Patterns on Rigid Non‐absorbent Surfaces

This study was designed to produce the first baseline measure of reliability in bloodstain pattern classification. A panel of experienced bloodstain pattern analysts examined over 400 spatter patterns on three rigid non‐absorbent surfaces. The patterns varied in spatter type and extent. A case summary accompanied each pattern that either contained neutral information, information to suggest the correct pattern (i.e., was positively biasing), or information to suggest an incorrect pattern (i.e., was negatively biasing). Across the variables under examination, 13% of classifications were erroneous. Generally speaking, where the pattern was more difficult to recognize (e.g., limited staining extent or a patterned substrate), analysts became more conservative in their judgment, opting to be inconclusive. Incorrect classifications increased as a function of the negatively biasing contextual information. The implications of the findings for practice are discussed.     

The Power of Contextual Effects in Forensic Anthropology: A Study of Biasability in the Visual Interpretations of Trauma Analysis on Skeletal Remains

The potential for contextual information to bias assessments in the forensic sciences has been demonstrated, in several forensic disiplines. In this paper, biasability potential within forensic anthropology was examined by analyzing the effects of external manipulations on judgments and decision‐making in visual trauma assessment. Three separate websites were created containing fourteen identical images. Participants were randomly assigned to one website. Each website provided different contextual information, to assess variation of interpretation of the same images between contexts. The results indicated a higher scoring of trauma identification responses for the Mass grave context. Furthermore, a significant biasing effect was detected in the interpretation of four images. Less experienced participants were more likely to indicate presence of trauma. This research demonstrates bias impact in forensic anthropological trauma assessments and highlights the importance of recognizing and limiting cognitive vulnerabilities that forensic anthropologists might bring to the analysis.     

Testing for Potential Contextual Bias Effects During the Verification Stage of the ACE‐V Methodology when Conducting Fingerprint Comparisons*

Abstract: This study was conducted to assess if fingerprint specialists could be influenced by extraneous contextual information during a verification process. Participants were separated into three groups: a control group (no contextual information was given), a low bias group (minimal contextual information was given in the form of a report prompting conclusions), and a high bias group (an internationally recognized fingerprint expert provided conclusions and case information to deceive this group into believing that it was his case and conclusions). A similar experiment was later conducted with laypersons. The results showed that fingerprint experts were influenced by contextual information during fingerprint comparisons, but not towards making errors. Instead, fingerprint experts under the biasing conditions provided significantly fewer definitive and erroneous conclusions than the control group. In contrast, the novice participants were more influenced by the bias conditions and did tend to make incorrect judgments, especially when prompted towards an incorrect response by the bias prompt.     

How Cross‐Examination on Subjectivity and Bias Affects Jurors’ Evaluations of Forensic Science Evidence

Contextual bias has been widely discussed as a possible problem in forensic science. The trial simulation experiment reported here examined reactions of jurors at a county courthouse to cross‐examination and arguments about contextual bias in a hypothetical case. We varied whether the key prosecution witness (a forensic odontologist) was cross‐examined about the subjectivity of his interpretations and about his exposure to potentially biasing task‐irrelevant information. Jurors found the expert less credible and were less likely to convict when the expert admitted that his interpretation rested on subjective judgment, and when he admitted having been exposed to potentially biasing task‐irrelevant contextual information (relative to when these issues were not raised by the lawyers). The findings suggest, however, that forensic scientists can immunize themselves against such challenges and maximize the weight jurors give their evidence by adopting context management procedures that blind them to task‐irrelevant information.     

Signs of Fungal Infection in Dead Mimic the Chronic Torture

The cases of battered woman syndrome (BWS) are very common in India. The majority of the women suffer battering by their family members especially in‐laws. The injuries occurring each time indicate their being battered, but on being questioned about these happenings, a mismatched history being given by them is the major indication of BWS. In many of the cases, the injuries present over the body either in healing stages or in association with skin diseases may mislead the forensic pathologists and investigating agencies. One such rare autopsy was conducted where the healing lesions of the chronic fungal infections were mistaken as the injuries of chronic torture. The case is presented here to remind to the forensic pathologist about the possibility of the signs of chronic fungal infections in dead, which can mimic the torture, and to discuss its medicolegal implications.     

Hyperthermia,Thermal Injuries,and Death from a Forced Convection Heat Source: A Case Report and Experimental Model

Heat‐related deaths of children are most often encountered in the context of enclosed vehicles in summer months. Deviating from this, a 16‐month‐old boy was found unresponsive in a stroller that was placed adjacent to a space heater during mid‐winter. The cause of death was hyperthermia and thermal injuries. Manner of death determination was difficult due to alleged surrounding circumstances. To understand the time‐course of this child's injuries, a child death scene investigation was performed; the stroller and space heater were recovered. In a re‐enactment of the events, a slaughtered pig approximating the child's size was warmed using a water bath and placed in the stroller beside the space heater. Cutaneous temperature measurements showed rapid initial temperature rise with subsequent steady increases. Tanning of the skin was seen on periodic direct observations. Internal temperature monitoring illustrated steady increases. This experiment was essential in classifying the manner of death as homicide.     

Fatal Injury Caused by a Ram (Ovis Aries) Attack

Animal‐inflicted injuries to humans are a major public health problem around the world resulting in great morbidity, money loss, and mortality. They are related to wild and domestic animals alike. Animals can cause injuries by various mechanisms—biting, stinging, crushing, goring, stomping, butting, kicking, pecking, etc. We present a case of a ram's attack with fatal consequences. A 4‐year‐old, 120 kg jezersko‐sol?ava breed ram with prior history of aggressive behavior inflicted multiple injuries to his 83‐year‐old owner, who died in the hospital a few hours later due to severe blunt force injuries sustained in the attack. The autopsy revealed the cause of death to be multiple injuries of the thorax and the head. Sheep, even though they are not considered aggressive or large farm animals such as cattle and horses, can inflict serious injuries with devastating results.     

Forensic Performance Analysis of Load‐Limiting Devices in Automotive Seat Belt Retractors

The introduction of frontal airbags and seatbelt pretensioners for front seat occupants provided an opportunity to address injuries caused by seatbelt loading by introducing load‐limiters, which were intended to reduce belt loading while maintaining proper restraint. Investigation and forensic analysis of real‐world crashes identified that the implementation of these devices, in some circumstances, increased the potential of injury. This paper focuses on the trade‐offs of load‐limiters, that is, the reduction loading to the occupant versus the corresponding increase in seatbelt webbing and occupant movement. If the additional webbing introduced is not controlled, the risk of injury to the occupant is increased and could result in more frequent and severe injuries rather than a reduction. This paper quantifies the webbing introduced by load‐limiter activation through forensic analysis of the seatbelt involved in real‐world crashes and testing and assesses its effect on the injuries sustained by the occupant.     

n‐Ethyl Pentylone‐Related Deaths in Alabama

n‐Ethyl pentylone (NEP) is a chemical substance derived from cathinone. Synthetic cathinones are an evolving group of drugs with stimulating, mind‐altering effects sometimes referred to as novel or new psychoactive substances (NPS). There is scarce information in the medical literature regarding forensic cases in which NEP is detected in toxicological testing. We present four fatalities involving NEP from Alabama in 2017. Deaths were attributed to NEP toxicity in two cases (peripheral blood concentrations of 0.121 and 0.953 mg/L) and injuries caused by gunshot wounds in two cases (peripheral blood concentrations of 0.045 and 0.031 mg/L). One case involving NEP described an individual who exhibited classic CNS‐stimulant induced erratic behavior before being found dead. These cases enhance the forensic literature regarding specific NPS like NEP and provide contextual reference for professionals considering the significance of NEP in toxicological interpretation.     

Fatal Child Abuse Presenting with Multiple Vertebral and Vascular Trauma

This case study involves the unexplained death of a previously healthy 30‐month‐old child. Reportedly, she was found unresponsive by her foster father following a 2‐hour nap. She was transported to the hospital and died in the emergency room of unknown causes. Blood drawn in the ER showed hemoglobin of 4.3 mg/dL. Postmortem skeletal survey, magnetic resonance imaging (MRI) of the brain, and retinal examinations were negative. The medical examiner assumed jurisdiction of the body. The autopsy showed massive retroperitoneal hemorrhage, transections of the abdominal aorta, and inferior vena cava, and complete tears of the anterior longitudinal ligament of the spine at C5/C6 and L1/L2 with diastases of the vertebral bodies at the corresponding intervertebral disk spaces. The case is believed to be extraordinary due to both the extent of injury that does not match the reported history and the mechanism of vertebral and vascular injuries.     

The Reliability of Pattern Classification in Bloodstain Pattern Analysis—PART 2: Bloodstain Patterns on Fabric Surfaces,

This study was designed to produce the first baseline measure of the reliability of bloodstain pattern classifications on fabric surfaces. Experienced bloodstain pattern analysts classified bloodstain patterns on pairs of trousers that represented three fabric substrates. Patterns also varied in type (impact, cast‐off, expiration, satellite stains from dripped blood, and transfer) and extent. In addition, case summaries that accompanied each pattern contained contextual cues that either supported the correct answer (i.e., positive bias), were misleading toward an incorrect answer (i.e., negative bias), or contained no directional information (i.e., neutral). Overall, 23% percent of the resulting classifications were erroneous. The majority (51%) of errors resulted from analysts misclassifying satellite stains from dripped blood. Relative to the neutral information, the positive‐bias information increased correct classifications and decreased erroneous classifications, and the negative‐bias information decreased correct classifications and increased erroneous classifications. The implications of these findings for BPA are discussed.     

Preclinical Assessment of Safety and Efficacy of Fluorescent Dye for Detecting Dermal Injuries (the injuries were both abrasions and incision) in a Murine Model

Objective documentation of tears and abrasions to the external genitalia after sexual assault is an important part of the forensic examination. A 1% aqueous solution of toluidine blue (TB) dye is often used to highlight injury, but the dye can be difficult to see on dark skin. We evaluated a fluorescent dye for detecting injuries on all skin colors in a relevant preclinical murine model. We compared the ability of trained, blinded observers to detect unstained wounds and wounds stained with 1% fluorescein sodium (FL) and with TB. We also evaluated the cutaneous wound healing response after application of both dyes. The no‐dye group had significantly fewer (p < 0.05) true‐positive identifications compared to all the dye groups. No differences in effectiveness were detected between dye treatments. All groups exhibited statistically similar healing rates. These findings support the evaluation of fluorescein sodium in a future clinical study with human subjects.     

Complete Cardiac Rupture Associated with Closed Chest Cardiac Massage: Case Report and Review of the Literature

Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35‐year‐old workman who collapsed and underwent ECM by his co‐workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre‐existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic–abdominal trauma, or medical history, is unclear.     

Retrospective Analysis of Hanging Deaths in Ontario

Hanging deaths from investigation standpoint are rarely problematic. Unusual circumstances can on occasion raise suspicion of foul play. Associated neck injuries are reported in the literature with variable frequency (from 0% to 76.8%). This study retrospectively analyzed 755 hanging deaths in Ontario (Canada) to evaluate the demographic features and circumstances of hanging fatalities, and the frequency of hanging‐related neck injuries. A number of cases showed unusual/special circumstances (e.g., complex, double suicides, restraints). Among 632 cases with complete autopsies, hyoid and larynx fractures were present in 46 cases (7.3%) with the most common being isolated hyoid fractures. The incidence of cricoid fractures was 0.5% and cervical spine injuries, 1.1%. A higher incidence of neck injuries occurred among males, long drop hangings, and in cases with complete suspension. There was a tendency for the number of fractures to increase with increasing age and weight of the deceased.     

Experimental Study of Bite Mark Injuries by Digital Analysis

Abstract: This study was based on a morphometric analysis of bite marks starting from the quantitative definition of the anterior teeth by the geometric acquisition of the “injuries,” using bite marks impressed on pig skin and plastic. Each mark was photographed and acquired. A dedicated program automatically supplied the values of the shape factors and the areas of the pattern geometric figures. The values obtained for the homologous samples were compared to the heterologous values. Statistical comparison was made of the sets by linear regression, determining the correlation coefficient and the determination coefficient for each value. Results showed only 4.8% and 2% of overlap between homologous and heterologous values. This study was carried out in attempting to quantitatively define the anterior teeth of the human dentition and the procedure described and the results obtained support the advantage of morphometric studies and computer‐aided programs in this study of bite marks.     

Child Abuse-Related Homicides in New Mexico: A 6-year Retrospective Review

Abstract:  We retrospectively reviewed autopsy records at a statewide medical examiner's office in order to identify and characterize deaths due to child abuse. In a 6-year period in New Mexico, the medical examiner investigated 45 deaths determined to be child abuse-related. Decedents were predominantly male (68.9%), Hispanic White (53.3%), and all were 5 years of age or younger, with a median age of 1 year. Head injuries were the most common cause of death (44.4%), followed by battered baby syndrome (15.6%). Relatives were involved as alleged perpetrators in 80% of the cases, with the father most often implicated (36.1% of cases), and 88.9% of child abuse injuries resulting in death occurred in the family's residence. Toxicology was positive in 26.7% of cases, but only two cases had substances of abuse present. Information on risk factors such as prematurity, parental age, and history of abuse was also collected.     

Expert Interpretation of Bitemark Injuries—A Contemporary Qualitative Study

This study attempts to characterize the nature of disagreement among odontologists in determining the fundamental properties of suspected bitemark injuries. Fifteen odontologists were asked to freely comment on six images of supposed bitemarks. Qualitative analysis using a grounded theory approach revealed that practitioner agreement was at best fair, with wide‐ranging opinions on the origin, circumstance, and characteristics of the wound given for all six images. More experienced practitioners (>10 years) tended to agree with each other less than those who had 10 years or less experience in forensic odontology. The differences in opinions can be at least partly accounted for by the inconsistent nature of approaches used by different practitioners in assessing bitemark evidence. The results of this study indicate that more definitive guidelines as to the assessment of bitemarks as patterned injuries should be developed to ensure the highest possible level of practitioner agreement.     

Systemic Dissemination of Injected Foreign Material

A 32‐year‐old woman collapsed following an intravenous injection of material that included crushed pharmaceutical tablets. Resuscitation was attempted but was unsuccessful. She had an extensive past medical history of complications resulting from intravenous drug use. Death was due to mixed drug toxicity. The major findings at autopsy included a 10 mm deep skin sinus over the right femoral vein that was used as an injection site. Polarizable foreign material was present at the injection site and also within the lungs with a granulomatous reaction. Of note, a probe‐patent foramen ovale had permitted paradoxical embolization of this material into the systemic circulation with lodgement within the liver, portal lymph nodes, myocardium, spleen, kidneys, and pancreas. This case highlights the importance of checking for any intracardiac shunts, which may be quite small, and systemic dissemination of foreign material to multiple organs in intravenous drug users who present for medicolegal assessment.