Analysis of fatal injuries to motorcyclists by helmet type

To clarify the characteristics of injuries of motorcyclists dying in accidents in relation to helmet type, we retrospectively analyzed forensic autopsies of 36 helmeted motorcycle riders. The presence of major injuries and injury severity were evaluated with the injury severity score and the 1990 revision of the Abbreviated Injury Scale. Persons with open-face helmets (19 cases) were significantly more likely to have sustained severe head and neck injuries, especially brain contusions, than were persons with full-face helmets (17 cases). Furthermore, major injuries of the chest or abdomen, rib fractures, lung injuries, and liver injuries were each present in more than one quarter of all cases (26.3% to 70.6%), but their prevalences did not differ significantly between riders with different types of helmet. Because many types of head and neck injuries cannot be prevented and fatal chest and abdominal injuries occur despite the use of full-face helmets, more effective helmets and devices for protecting the chest and abdomen are needed to decrease deaths from motorcycle accidents.     

Driver and front seat passenger fatalities associated with air bag deployment. Part 1: A Canadian study

Real world motor vehicle collision research of injuries due to deployment of "first-generation" air bags has been conducted by Transport Canada since 1993. Fifty-three fatal crashes (36 frontal impacts; 17 side collisions) involving 48 drivers and 10 right front passengers were reviewed. In the Canadian data, air bag deployment in five of nine low severity frontal crashes (delta-V (deltaV) < 25 km/h or 15 mph) was linked to five deaths, four of whom were autopsied (four adults with craniocervical (basal skull and C2 fracture with brainstem avulsion; "closed head injury"--no autopsy) or chest trauma (aortic or pulmonary artery tears); one child with atlanto-occipital dislocation). An occupant who is close ("out-of-position") to the air bag at the time of deployment is at risk for injury. In 27 high severity frontal impacts, unusual (e.g., pulmonary "blast" hemorrhage in one autopsied case) or isolated potentially survivable injuries (e.g., clinically documented ruptured right atrium; probable flail chest observed during the autopsy on a decomposed body) localized to the head, neck or chest in three possibly out-of-position drivers pointed to the deployed air bag as a source of injury. In one of 17 side collisions an out-of-position driver sustained a radiographically confirmed C1-C2 dislocation in a minimally intruded vehicle.     

Pathologic features of childhood pedestrian fatalities

A retrospective analysis of 68 cases of fatal childhood pedestrian accidents in South Australia that occurred over a 20-year period from January 1977 to December 1996 was undertaken. The age range was 12 months to 16 years (average, 7.6 years), with a male to female ratio of 41:27. The most common site of significant injury was the head (91.2%), followed by the abdomen (50%), chest (47.1%), and neck (38.2%). The most frequently encountered significant injury combinations involved the head, chest, and abdomen (14.7%); the head and chest (11.8%); and the head, neck, and abdomen (11.8%). Injuries were severe, consisting of extensive compound and comminuted skull fractures, neck fractures, and massive intraparenchymal brain and internal organ damage with avulsions and fragmentation. Non-life-threatening limb injuries occurred in 88% of cases. A distinct subgroup involved infants and younger children playing in driveways at home who were hit by reversing vehicles. The injuries were often of such a severe nature that death was instantaneous and with no possibility of successful medical intervention. More deaths occurred during the winter than summer months.     

Comparison of injuries sustained by drivers and pillion passengers in fatal head-on motorcycle collision accidents

This study aimed to compare injuries sustained by motorcycle drivers with those sustained by pillion passengers in fatal head-on motorcycle collision accidents. We examined 84 cases of fatal head-on motorcycle collision accidents, causing 79 deaths of drivers and 19 deaths of pillion passengers, using medical and medico-legal examination records. The distribution of superficial injuries, characteristic injuries, injury severity as well as fatal causes was evaluated and compared using χ(2) tests. The results revealed a significant difference in the distribution of superficial injuries between drivers and passengers. The proportions of injuries in the hand and perineum regions were significantly higher in drivers than passengers. Some characteristic superficial injuries on the palms, chest, abdomen as well as the perineum areas were observed in drivers, while none of these characteristic injuries were observed in pillion passengers. Drivers were found to have suffered more severe chest and abdomen injuries than passengers. In addition, there was a higher incidence of fatalities involving run-over injuries for drivers compared with pillion passengers. The proportion of fatal injuries related to tumbling was higher for passengers than for drivers. Overall, our results revealed a difference in injury severity, superficial injury distribution and characteristic injuries between drivers and passengers. Few characteristic injuries were found in pillion passengers. These findings could help to guide medico-legal examinations, particularly in identifying drivers among victims involved in traffic accidents.     

Artifactual injuries of the larynx produced by resuscitative intubation

Over a period of 9 months we examined a series of 50 deaths due to natural and unnatural causes in which there had been endotracheal intubation and chest compression during resuscitation at the scene or in the emergency department shortly before death. In 37 of 50 cases (74%) there were airway injuries directly resulting from the intubation procedure which we documented using a standardized protocol and photography. Specific airway injuries, ranging from petechiae to contusions, included oral injury (28%), posterior pharyngeal injury (16%), epiglottic injury (22%), piriform recess injury (12%), laryngeal and tracheal mucosa injury (64%), strap muscle hemorrhage (14%), and cutaneous injury of the neck (4%). In addition, we recorded the presence of facial (6%) and conjunctival petechiae (21%) and attributed these changes to resuscitative chest compression. No cases had associated fractures of the hyoid or thyroid cartilage. Based on our findings, we conclude that resuscitative intubation can cause artifactual injury that may mimic inflicted injuries caused by neck compression, including strangulation and neck holds.     

车外人员撞击伤特点分析

目的以真实案例为基础,研究汽车碰撞事故中,不同机动车车型、不同交通方式等因素造成车外人员撞击伤的特征。方法选取上海地区发生的汽车与车外人员碰撞事故案例200例,通过对事故中的人、车等检验对比,分析车外人员撞击伤的特点。结果车外人员撞击伤主要出现在下肢,其次为胸部和头部;行人（含推车人）撞击伤出现频次与骑车人（含自行车或摩托车后座乘员）无明显差异;小轿车和小客车事故中撞击伤多见于下肢,大客车多见于胸部;车外人员被撞击后发生抛甩频率随车速的加大而增高,且通过车体痕迹检验,人体与车辆挡风玻璃发生（二次）撞击伤匹配程度最高。结论分析汽车与车外人员碰撞事故人体撞击伤特点,对于交通伤法医学鉴定及深化交通伤机制研究具有参考价值。     

Mountaineering fatalities on Mount Rainier, Washington, 1977-1997: autopsy and investigative findings.

Mountain climbing is a popular recreational activity with a growing number of participants and associated fatalities. To define the characteristics of these fatal incidents and the typical autopsy findings in the victims, we reviewed the autopsy and investigative findings of all fatalities that occurred on Mount Rainier from 1977 through 1997. A total of 50 deaths occurred in 29 separate incidents. Fifty-eight percent of accident victims died as the result of a fall; another 34% died as a result of an avalanche. The incidents leading to death occurred at an average altitude of 3652 m (11,977 feet); range, 2073 to 4389 m (6800-14,400 feet). The average age of the victims was 31.2 years (range, 17-55 years), and 47 of the 50 were men (94%). Bodies were not recovered in 13 cases (26%). Autopsies were performed in 30 of the remaining 37 cases. At autopsy, the cause of death was ascribed to multiple injuries in 12 cases (40%), isolated head and neck injuries in 7 cases (23%), and chest injuries in 1 case (3%). Asphyxia and hypothermia were the cause of death in 8 cases (27%) and 2 cases (7%), respectively. The frequency of specific injuries is presented by anatomic region. The unique autopsy and investigative features of mountaineering deaths are discussed.     

交通意外事故尸体剖验37例

本文作者报告陆上交通意外尸体剖验37例。事故类型分路人车撞、汽车相撞、汽车撞静物及摩托车事故四种。路人被车撞致死者,损伤分布广,种类多,有5种不同的损伤。摩托车事故死亡者胸腹部损伤多,突出的是胸主动脉横裂。汽车驾驶员的损伤以胸腹部为多。其中因车撞车驾驶员死亡者,头部损伤常不严重。各种不同的损伤各有一定的特征。作者强调了要注意酒精与车祸的关系。     

Esophageal injury in fatal rear-impact collisions

Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma.     

The sensitivity and specificity of control surface injuries in aircraft accident fatalities

Among the important determinations that aircraft crash investigators try to make is which occupant of an aircraft was attempting to control the aircraft at the time of the crash. The presence or absence of certain injuries of the extremities is used to help make this determination. These "control surface injuries" reportedly occur when crash forces are applied to a pilot's hands and feet through the aircraft's controls. We sought to clarify the significance of these injuries and the frequency with which their presence indicates that the decedent was the person that might have been trying to control the aircraft, questions that are frequently asked of the examining pathologist. We studied sequential fatalities of airplane and helicopter crashes in which autopsies were performed by the Office of the Armed Forces Medical Examiner, excluding those that were known to have been incapacitated before the crash and those that were known to have attempted to escape from the aircraft, collecting 100 "qualified" crash decedents. The incidence of control surface injuries was determined for both pilots and passengers. The sensitivity and specificity of control surface injuries were calculated by classifying the decedents into a 4-cell diagnostic matrix. The positive and negative predictive values for control surface injuries were also calculated. Injuries that met the published definitions of control surface injuries had high incidences in passengers, as well as pilots, giving the term control surface injury a diagnostically unacceptable sensitivity and specificity for indicating "a pilot attempting to control an aircraft." We offer caveats and refinements to the definition of these injuries that help to increase the sensitivity and specificity of this term.     

Sharp injury fatalities in New York City

We reviewed the case records of all fatalities due to sharp injuries in New York City in 1999. The epidemiological profile, circumstances, toxicology results, location, and injuries were examined. There were 120 deaths: 101 homicides, 17 suicides, and 2 accidents. The causes of death included: 112 due to stab(s) with or without incised wounds and 8 pure incised wound fatalities of which 5 were suicides. The detection of ethanol and/or illicit drugs was 61% in the homicide and 12% in the suicide groups. "Defense wounds" were reported in 49% of the homicides and "hesitation" wounds were found in 65% of the suicides. There were no self-inflicted sharp injuries of the face. Deaths due to a single stab wound occurred in 34% (34/101) of the homicides and 24% (4/17) of the suicides. Of these 38 deaths, 58% were of the anterior thorax (chest) and 71% injured the heart and/or great vessels. The remaining deaths with single stab wounds involved the femoral artery, abdominal organs, or head. There were no sharp injury suicides by Hispanics, Asians, or anyone under the age of 18 years. Over half of the suicides at home occurred in the bathroom and 78% of these occurred in the bathtub. Suicide notes were found in 24% of suicides, and an additional 24% verbally expressed a plan to commit suicide.     

A Forensic and Medical Evaluation of Dog Bites in a Province of Western Turkey

The aim was to evaluate the demographic data of dog‐bite cases organized from criminal and forensic reports. This study evaluated 328 cases admitted to the Director of Forensic Medicine, Eskisehir, as a result of dog bites between January 1, 2006 and December 31, 2010. It was found that those in the age‐group of 0–18 were most frequently exposed to dog bites (48.5%). Injuries to the lower extremity, upper extremity, and chest/abdomen/back were more frequent in men (72.6%, 76.4%, and 66.1%, respectively), while injuries to the head/neck/face were more frequent in women (52.3%) (p < 0.01). While most of those wounded in the upper extremity, the head/neck/face, and the chest/abdomen/back were in the child age‐group, most of those wounded in the lower extremity were in the adult age‐group (p < 0.001). Teaching children, in particular, how to behave around dogs would be useful in reducing the incidence of bite.     

Fatal positional asphyxia associated with rollover crashes

Motor vehicle rollover crashes result in complex occupant kinematics with the potential for severe injury. Five cases of fatal asphyxia in occupants suspended from their safety belt upside down after a rollover crash are presented. These fatalities accounted for 13.5% of all motor vehicle related asphyxia deaths in San Diego County over a 10-year period. This study supports previous research noting that incapacitation due to other injuries, alcohol, or obesity may be associated with fatal positional asphyxia due to inversion during rollovers. Safety belts are proven to prevent serious injury in motor vehicle crashes and should always be worn. However, redesign of the buckle could be considered to permit easier release by an occupant. We also suggest that pre-existing heart disease may contribute to the possibility of a fatal asphyxia outcome. Although this is a rare cause of motor vehicle related death, our results suggest that these are potentially preventable deaths.     

Serious head and neck injury as a predictor of occupant position in fatal rollover crashes

Serious head and neck injuries are a common finding in fatalities associated with rollover crashes. In some fatal rollover crashes, particularly when ejection occurs, the determination of which occupant was driving at the time of the crash may be uncertain. In the present investigation, we describe the analysis of rollover crash data from the National Automotive Sampling System-Crashworthiness Data System for the years 1997 through 2007 in which we examined the relationship between a serious head and neck injury in an occupant and a specified degree of roof deformation at the occupant's seating position. We found 960 occupants who qualified for the analysis, with 142 deaths among the subjects. Using a ranked composite head and neck injury score (the HNISS) we found a strong relationship between HNISS and the degree of roof crush. As a result of the analysis, we arrived at a predictive model, in which each additional unit increase in HNISS equated to an increased odds of roof crush as follows: for ≥8cm of roof crush compared with <8cm by 4%, for ≥15cm of roof crush compared to <8cm by 6% and for ≥30cm of roof crush compared to <8cm by 11%. We describe two hypothetical scenarios in which the model could be applied to the real world investigation of occupant position in a rollover crash-related fatality.     

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.     

Profiling of volatile impurities in tetramethylenedisulfotetramine (TETS) for synthetic-route determination

In recent years, alcohol consumption has been considered an important public health problem. Ethanol, the alcohol used in beverages, is a drug that affects the central nervous system (CNS) and impairs driving skills and co-ordination, increasing risk of deaths and injuries derived from crashes and road accidents. Consumption of alcoholic beverages is implicated with premature deaths, injuries and damages caused by motor vehicle crashes, which result in high costs to government and society. Considering that alcohol consumption is the main responsible factor for deaths and disabilities in young people, the aim of this work was to evaluate the prevalence of blood alcohol in offenders and/or fatal and non-fatal victims of traffic occurrences in the region of Ribeir?o Preto, S?o Paulo State, from 2005 to 2007. The results revealed that in 2134 cases investigated, blood alcohol positivity was generally found in young adults, 25-45 years old and male. The study showed the high risk of drinking and driving and the importance in establishing actions of prevention and intervention to promote the reduction in the number of traffic occurrences related to consumption of alcoholic beverages.     

The pathological features and circumstances of death of lethal crush/traumatic asphyxia in adults--a 25-year study

A 25-year retrospective study of cases of crush/traumatic asphyxia autopsied at Forensic Science SA, Adelaide, Australia from 1980 to 2004 was undertaken. A total of 79 cases of crush asphyxia was found consisting of 63 males (80%) and 16 females (20%). The age range of the males was 19-86 years (mean=41.8 years) and of the females was 19-75 years (mean=38.6 years). In 18 cases the exact circumstances of death were unclear, leaving 61 cases in which details of the fatal episode were available. Major categories included vehicle crashes (N=37), industrial accidents (N=9), farm accidents (N=6) and entrapment beneath vehicles (N=5). Forty of the 79 victims (51%) had only very minor bruises and abrasions; 28 (35%) had evidence of chest compression with rib and sternal fractures and large areas of soft tissue bruising of the chest; 7 cases (9%) had other significant injuries or findings that had contributed to death. All of these victims had signs of crush asphyxia in the form of intense purple congestion and swelling of the face and neck, and/or petechial hemorrhages of the skin of the face and/or conjunctivae. The pattern of pathological findings of crush asphyxia was not influenced by the presence or absence of concomitant serious or lethal injuries. In 4 cases (5%) where the circumstances of the lethal episode were those of crush asphyxia there were no characteristic pathological findings. This study has shown that a high percentage of crush asphyxias may be caused by vehicle accidents. It has also demonstrated that on occasion fatal crush asphyxia may have to be a diagnosis of exclusion, made only when there are characteristic death scene findings, and no evidence of lethal natural diseases or injuries at autopsy, with negative toxicological screening.     

Symmetrical "mirror-image" injuries and the "chessboard" pattern: useful markers of self-mutilation

The evaluation of injuries due to self-mutilation may be complicated by atypical lesions and fabricated histories of the causative events. Four cases are described where one of the most striking findings was the presence of "mirror-image" injuries and/or a "chessboard" pattern of intersecting parallel lines from self-inflicted incised wounds. Case 1: A 32-year-old man was dead in his burnt-out car, with symmetrical, "mirror-image", circular burns from the car cigarette lighter over his forehead, cheeks, ears, upper and lower arms, the dorsal and palmar aspects of the hands, the anterior chest wall including the nipples, the anterior abdomen, thighs, lower legs, and the back of his neck. The deceased had a history of psychotic depression and had died of burns and inhalation of products of combustion. Case 2: A 19-year-old woman who fabricated a history of assault demonstrated multiple, superficial, "mirror-image" injuries of her thighs and forearms. Case 3: A 32-year-old man who exsanguinated from cut wrists showed multiple, superficial, and "mirror-image" incised wounds of the wrists, with a "chessboard" pattern. Case 4: A 26-year-old man died after jumping from a building. He had multiple superficial, "mirror-image" incised wounds of his anterior chest and thighs, with a typical "chessboard" pattern. Given the difficulties that sometimes arise in determining whether injuries have been self-inflicted or not, the finding of symmetrical "mirror-image" injuries, and/or a "chessboard" pattern formed by 2 groups of regular, parallel, superficial incised wounds running at right angles to each other provides compelling evidence of self-mutilation, unless a plausible alternative explanation is available.     

TV tip-over morbidity and mortality in children

Twenty-eight non-fatal cases of TV related injuries were noted in San Diego in the 2 years prior to September 2008. We reviewed the scene, witness reports, past history, and autopsy findings from three fatal cases and distinguished them from abusive head trauma. The recent literature was also reviewed. Our fatal cases resulted from TVs falling on small children and causing severe head injury. The literature review showed increasing injuries and deaths relating to TV tip-over, TV stands and dressers. Most of the fatalities were head injuries in small children. The reporting methods may not be complete or accurate. Some authors in the literature review suggested preventive measures so as to decrease these injuries. Forensic scientists should become familiar with these injuries and measures so that they may communicate effectively with their communities.