创伤的AIS评分与损伤程度评定对比分析的研究

ＡＩＳ评分法是国际医学临床上公认的创伤严重度评价方法之一。作者收集了本室５４６例伤害案件，分别给予损伤程度评定及ＡＩＳ评分，设为损伤程度组和ＡＩＳ组。两组比较，经Ｘ２检验，Ｐ＜０．００１；经Ｓｐｅａｒｍａｎ等级相关检验ｒｓ＝０，９４０，Ｐ＜０．００１，均有高度显著性，反映两组之间有密切关系而且损伤程度组的程度变化与ＡＩＳ组分级变化有关系。提示：轻伤、重伤可以参照ＡＩＳ严重度分级、编码，由此为轻、重伤分级、标准的计算机化及国际间的交流提供新方法。     

Some medicolegally important aspects of symphyseal injuries due to trauma

A total of 58 cases of fatal trauma (forensic autopsies) were investigated for lesions of the pelvic girdle, the pubic symphysis, and for injuries distant from the pelvis. Traumata of the pubic symphysis were present in 30% (n = 17) of the cases. The symphyses were examined by x-ray and macroscopically related to the main violence (Abbreviated Injury Scale [AIS]). A correlation between the latter and the severity of the resulting injuries could be deducted. Characteristic patterns of symphyseal injuries included small hemorrhages, partial and complete ruptures, and also ruptures of the ligamentary insertions, which have not yet been described. The kind and severity of these lesions related to the intensity/direction of the violence are demonstrated and discussed.     

The Infant Injury Database: A Tool for the Study of Injury Patterns in Medicolegal Investigations of Child Abuse

In 2012, the Harris County Institute of Forensic Sciences began prospectively collecting injury data from pediatric autopsies. These data and associated case information from 635 pediatric cases are archived in the Infant Injury Database (IID). This paper introduces the IID to the forensic community and demonstrates its potential utility for child abuse and infant fatality investigations. The database is intended to be a source of evidence‐based research for coroners/medical examiners and clinicians in the recognition and diagnosis of child abuse. RR estimates were employed to quantify the relationship between individual autopsy findings to trauma‐related and nontrauma‐related causes of death. For example, unsurprisingly, the RR of trauma cases with multiple injury types is significantly greater than other causes of death, but the RR results provide a quantitative representation of the relationship. ROC curve modeling of the presence/absence of various injury types performed well at discriminating trauma from other causes of death (AUC = 0.96).     

The effect of the unrestrained back seat passenger on the injuries suffered by drivers and front seat passengers in head-on collisions

In head-on collisions, loose items in the rear of the car, such as luggage or unrestrained back seat passengers can cause substantial loading on the back of the front seats. The purpose of this paper is to study if such loading increases the injury severity for the front seat occupants. Data were collected from all fatal automobile accidents for a period of 1 year in Sweden. Information was collected about the survivors as well as the decreased. Head-on collisions were selected, and the injuries of the front seat occupants were scored according to the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). In evaluating the injury severity, the collision energy was taken into account. The results indicate that belted front seat passengers sustain a higher injury risk with an unrestrained passenger in the back seat. These results are valid for collision speeds below 45 km/h.     

Injury Patterns Sustained in Fatal Motor Vehicle Collisions with Driver's Third‐Generation Airbag Deployment

The Office of the Chief Coroner for Ontario database for 2011–2012 was used to compare fatal injury patterns in drivers whose third‐generation airbags deployed compared to first‐ and second‐generation airbag deployments and airbag nondeployments with and without seatbelt use. There were 110 frontal and offset frontal crashes analyzed. The small sample size meant that the odds of craniocerebral, cervical spinal, thoracic, and abdominal injuries were not statistically different for airbag generation, deployment status, and seatbelt use; however, the risk of fatal thoracic injuries in third‐ and second‐generation cases was increased. Seatbelt usage in third‐ and second‐generation deployment cases reduced the risk of all injuries except abdominal trauma. High severity impacts and occupant compartment intrusion were frequently observed. The analyses in this retrospective study were challenged by data that were not collated in a standardized way and were limited in details about scene, vehicle, and driver variables.     

创伤的AIS评分与损伤程度评定的对比分析

目的 探讨损伤程度评定的分级方法。方法 收集546例损伤程度评定的案例资料,给予AIS评分,然后比较损伤程度评定和AIS评分结果。结果 两组一致性比较,经x2检验,P<0.001;两组相关性比较,经Spear-man等级相关检验,rs’=0.940,P<0.001,均有高度显著性。结论 两组比较结果,反映损伤程度变化与.AIS分级变化有密切关系,“轻伤”、“重伤”可参照AIS严重度进行分级、编码。     

外伤在与疾病共同存在的案件中参与度的评判标准（草案）

在刑事和民事审判中，经常遇到一些损伤与疾病共同存在的案件，审判人员要求法医工作者分析二者在案件中所起的作用。目前国内尚无评定这二者关系的参考标准，为解决这一问题，我们以实际检案、审判实践和医学理论为基础，制定了本标准。根据损伤与疾病的作用大小不同，将外伤参与因果关系的程度划分了若干等级（０％～１００％），就涉及死亡、刑事案件的损伤程度评定（重伤、轻伤、轻微伤）和损害赔偿问题（医疗费、营养费、误工费、伤残者生活补助费、死者丧葬费等）提出了具体的外伤参与度评判方法和量化意见。     

Practical application of the Injury Severity Score (ISS) in expert forensic testimony

The retrospective analysis of the autopsy records of 50 homicides showed that the Injury Severity Score (ISS), a numerical scoring system initially developed to quantify the severity of injuries sustained in road traffic accidents, can also be useful for objectively describing and ranking the overall severity of trauma with regard to forensic issues. The present case report illustrates to what extent the ISS can help to assess the contribution of each assailant in homicides committed by several perpetrators. In the case presented the court was convinced that one perpetrator had inflicted four deep stab wounds to the victim's face (each with bony lesions), 2 stabs to the chest piercing the right lower pulmonary lobe and causing a haemothorax of 200 ml, an abdominal stab wound without involvement of a parenchymatous organ as well as multiple defence wounds of the arms. Thereafter, a second perpetrator was thought to have inflicted several heavy blows with a full water bottle causing severe contusions on the right side of the forehead, the chin, the left side of the face and a spider's web fracture of the frontal bone. Using the ISS an injury severity score of 24 was assigned to the first complex of injuries and a score of 10 to the second complex. The forensic conclusions with regard to prognosis and lethal outcome are discussed.     

The MMPI-2 Symptom Validity Scale (FBS) Is an Empirically Validated Measure of Overreporting in Personal Injury Litigants and Claimants: Reply to Butcher et al. (2008)

We address issues raised by Butcher et al. (Psychological Injury and the Law 1:191–209, 2008) in their critique of the Minnesota Multiphasic Personality Inventory-2 Symptom Validity Scale (FBS) and show that their analyses and conclusions are based on faulty premises, a misunderstanding of basic concepts in the assessment of overreporting, a selective review of the literature and mischaracterization of the findings they do cite, problematic analyses of a dataset that had already been similarly analyzed, and a flawed analysis of a legal case they discuss. We complement the review of existing research with some new findings that provide further empirical support and clarification of current interpretive recommendations for proper use of the FBS in evaluations of personal injury litigants and claimants.     

17例颈椎外伤合并颈椎退行性病变的伤病关系分析

目的研究颈椎外伤合并颈椎退行性病变的法医学鉴定案件特点,探讨如何利用临床资料,法医学检查和影像学检查等对损伤和病变参与程度进行认定等问题。方法收集17例颈椎外伤合并颈椎退行性病变的法医学鉴定案例,对其年龄分布、损伤方式、损伤程度、影像学表现等进行分析,综合评定伤病关系。结果 17例案件以中老年为主。所有案例均存在椎间盘突出,损伤以过伸性损伤为主。按照影像学表现,将损伤程度和脊椎退变程度进行分级,综合计算伤病参与程度。结论颈椎外伤合并颈椎退行性病变的法医学鉴定案件应综合运用临床资料、法医学体格检查和影像学检查结果进行评定。     

轻型颅脑损伤的损伤程度评定探讨

根据１８５例轻型颅脑损伤的法医学鉴定，证实颅骨骨折是颅内并发症的危险因素，支持临床观点。３１例颅骨骨折组，经ＣＴ发现颅内并发症的２０例，以ＥＤＨ和ＳＤＨ多见．行ＣＳＦ检查对诊断有价值．同时提出轻型颅脑损伤分级标准，依此明确轻伤评定等级．     

Injuries due to deliberate violence in areas of Argentina. II. Lesions. Copenhagen Study Group

As part of a transcultural investigation of violent behavior in Argentina and Denmark, the lesions from accidents involving deliberate violence registered in the emergency wards of Hospital Fernandez and Hospital Pinero in Capital Federal Buenos Aires over a period of 13 and 17 months, respectively, were studied. Among the 281 victims entering the two emergency wards blunt violence without use of instruments was most often reported to be the violation method. Frequently indicated violation instruments against the male victims were batons (18.7%), sharp instruments (17.7%), and firearms (17.7%), the corresponding figures for female victims being 9.6%, 8.4% and 4.8%. The use of firearms and batons was considerably more pronounced in Argentina than in Denmark, particularly against male victims. A total of 373 primary and secondary diagnoses were reported from the patients, the most frequent diagnoses being contusions and open wounds in the head/neck region. Forty-three percent of the diagnoses were related to the head/neck region, being the most frequently injured region and the trunk the second most frequently injured region (30%). The degree of predominance of lesions in the head/neck region was much less than in the Danish material. Injuries of internal organs of the trunk were considerably more frequent in Argentina than in Denmark. Eighty-five percent of the victims had moderate or less serious lesions when assessed on the basis of the scores in the Abbreviated Injury Scale (AIS), (score less than or equal to 2). The AIS scores of the lesions in female victims were on average only slightly higher than those recorded in the Danish study, while 16.1% of the male Argentinian victims had lesions scored greater than or equal to 3 compared to 1.8% in male Danish victims. The need for treatment and hospitalization was more pronounced than in the Danish study. It may be concluded that the frequency of serious cases of deliberate violence probably would decrease if more restrictive rules for the possessing of firearms were enacted and enforced.     

A New Tool for Coding and Interpreting Injuries in Fatal Airplane Crashes: The Crash Injury Pattern Assessment Tool Application to the Air France Flight AF447 Disaster (Rio de Janeiro–Paris), 1st of June 2009

For investigation of air disasters, crash reconstruction is obtained using data from flight recorders, physical evidence from the site, and injuries patterns of the victims. This article describes a new software, Crash Injury Pattern Assessment Tool (CIPAT), to code and analyze injuries. The coding system was derived from the Abbreviated Injury Score (AIS). Scores were created corresponding to the amount of energy required causing the trauma (ER), and the software was developed to compute summary variables related to the position (assigned seat) of victims. A dataset was built from the postmortem examination of 154/228 victims of the Air France disaster (June 2009), recovered from the Atlantic Ocean after a complex and difficult task at a depth of 12790 ft. The use of CIPAT allowed to precise cause and circumstances of deaths and confirmed major dynamics parameters of the crash event established by the French Civil Aviation Safety Investigation Authority.     

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.     

论人体损伤程度鉴定的原则

《人体损伤程度鉴定标准》明确了损伤程度鉴定的标准和原则。等级分明的鉴定标准和充分考虑人体损伤程度鉴定的法律属性、与-瞄床诊疗的关系及实践经验的鉴定原则为司法鉴定活动提供了新的技术类法律规范。     

National Vaccine Injury Compensation Program (VICP): effective date provisions of coverage of certain vaccines to the vaccine injury table--HRSA. Final rule

Section 904(b) of the Taxpayer Relief Act of 1997 provides for an excise tax for three new vaccines, effective August 6, 1997. Petitions for compensation for injuries or deaths related to hepatitis B, Hib, and varicella vaccines may now be filed under the Vaccine Injury Compensation Program (VICP). This technical amendment amends the Code of Federal Regulations (CFR) to include a date certain (August 6, 1997) in section 100.3(c) of the Vaccine Injury Compensation regulations, so that there will be no uncertainty as to the coverage of these three vaccines.     

Occupational injury and illness recording and reporting requirements. Occupational Safety and Health Administration (OSHA), U.S. Department of Labor. Final rule

The Occupational Safety and Health Administration (OSHA) is revising its rule addressing the recording and reporting of occupational injuries and illnesses (29 CFR parts 1904 and 1952), including the forms employers use to record those injuries and illnesses. The revisions to the final rule will produce more useful injury and illness records, collect better information about the incidence of occupational injuries and illnesses on a national basis, promote improved employee awareness and involvement in the recording and reporting of job-related injuries and illnesses, simplify the injury and illness recordkeeping system for employers, and permit increased use of computers and telecommunications technology for OSHA recordkeeping purposes. This rulemaking completes a larger overall effort to revise Part 1904 of Title 29 of the Code of Federal Regulations. Two sections of Part 1904 have already been revised in earlier rulemakings. A rule titled Reporting fatalities and multiple hospitalization incidents to OSHA, became effective May 2, 1994 and has been incorporated into this final rule as Section 1904.39. A second rule entitled Annual OSHA injury and illness survey of ten or more employers became effective on March 13, 1997 and has been incorporated into this final rule as Section 1904.41. The final rule being published today also revises 29 CFR 1952.4, Injury and Illness Recording and Reporting Requirements, which prescribes the recordkeeping and reporting requirements for States that have an occupational safety and health program approved by OSHA under Section 18 of the Occupational Safety and Health Act (the "Act" or "OSH Act").     

Injury analyses of fatal motorcycle collisions in south-east Scotland

The timing of death and pathological findings in fatal motorcycle accidents in south-east Scotland between 1987 and 1997 were investigated. Of the 59 motorcyclists who died, 38 were dead when found at the accident scene, six others were alive when found but died at the scene, two died in an ambulance in transit to hospital and 13 died after reaching hospital. Scoring of the injuries according to the Abbreviated Injury Scale revealed Injury Severity Scores (ISS) ranging from 25 to 75. Overall, injuries to the head, neck and chest were responsible for the most severe injuries. Twenty-five motorcyclists had injuries acknowledged to be unsurvivable (ISS = 75), most of which involved the thoracic aorta, brainstem and cervical spinal cord. The greatest potential to reduce the death rate amongst motorcyclists lies with accident prevention/injury reduction measures, rather than through improved treatment of injuries. Efforts to try to alter driving behaviour and to improve the design of vehicles and helmets need to continue.     

112例脑弥漫性轴索损伤分析

目的探讨脑弥漫性轴索损伤（diffuse axonal injury,DAI）与脑挫裂伤和原发性脑干损伤的关系。方法分析112例DAI伤者的法医临床学资料和影像学特点,对原发性脑损伤的特征进行比较。结果112例DAI伤者中70.5%为交通事故致伤,多次暴力致伤比较多见（60.7%）,伴脑挫裂伤者80例（71.4%）。CT或MRI发现出血灶者90例。结论DAI多伴有脑皮质挫裂伤和原发性脑损伤,CT或MRI有助于法医学死因分析和伤残程度鉴定。     

Investigation of Italy's deadliest building collapse: forensic aspects of a mass disaster

We describe the investigation of the 1999 collapse of an apartment building in Foggia, Italy. Sixty-one victims were recovered in the rubble of the building, and five people were unaccounted for. All the bodies were well preserved except for two who had been burned. The majority of the victims were identified visually or by comparing body features, clothing, or personal effects with information collected from relatives or friends. Positive identifications of the two victims who were burned were obtained by dental comparison and DNA analysis. Approximately half of the victims (51.6%) sustained fatal injuires, while the remainder died from asphyxia. The injuries were characterized using the Abbreviated Injury Scale (AIS) and the New Injury Severity Score (NISS) systems. Injury severity associated with the location of victims inside the apartment may provide useful information for those involved in building design and/or search and rescue operations. Engineers determined that the collapse was the result of the use of inappropriate foundation material.