Strontium90 for determination of time since death

Strontium90 (Sr90) is an artificial nuclear fission product of the atmospheric a-bomb testing between 1945 and 1979. It was spread throughout the atmosphere in the following years. Sr90 is an analogue to calcium and therefore enriched in human bones. Several studies especially in the 1960s and 1970s were undertaken to investigate the Sr90 burden and the resulting incorporated radiation in humans, but present studies are missing. In this study nine bone samples, three from 1931/32 and six from 1989 to 1994 were examined by measuring the Sr90 radiation. The samples from 1931/32 did not show any Sr90 activity. All the samples from 1989 and later showed a Sr90 activity, but the intensity was very variable. Subsequent investigations should be done to determine the cut-off year for measurable Sr90 activity. Furthermore the determination of a specific time since death depending on Sr90 activity should be possible, due to the ranging Sr90 pollution between 1950 and 1980 and different uptake in adolescents and adults.     

Estimation of the time since death

The main principle of the determination of the time since death is the calculation of a measurable date along a time-dependent curve back to the start point. Characteristics of the curve (e.g. the slope) and the start point are influenced by internal and external, antemortem and postmortem conditions. These influencing factors have to be taken into consideration quantitatively in order to improve the precision of death time estimation. It does not make any sense to study the postmortem time course of any analyte without considering influencing factors and giving statistical parameters of the variability. Comparison of different methods requires an investigation of the same postmortem interval. For practical purposes, it must be concluded that the amount of literature on estimating the time since death has a reverse correlation with its importance in practice.     

The eye as a chemical indicator of environmental temperature at the time of death

Vitreous humor chemistry profiles were reviewed on 133 autopsied cases in which death occurred outdoors during a six-year period, to determine whether environmental temperature at the time of death influenced chemistry values obtained at autopsy. The glucose concentration and total carbon dioxide content varied inversely with temperature. Values were significantly higher in the winter than the summer months. The mean glucose level was higher in deaths caused by cold exposure than in other deaths occurring in the cold, but individual cases could not be distinguished on the basis of chemistry values. Potassium levels tended to be slightly lower in winter. It was noted that chemistry studies could be used to help determine whether a body found outdoors in winter actually died in a different, warmer environment.     

Estimation of the time since death: sudden increase of ambient temperature

This work presents a procedure for the postmortem interval estimation in the presence of a rapid increase of ambient temperature occurred during the cooling phase. The resulting disturbance produced on the cooling curve is proved to obey a two-exponential law and is removed from the actually measured body temperature. This yields a theoretical/modified body temperature, which enables the estimation of the time since death by means of the standard Nomogram method.     

The Haddon matrix: applying an epidemiologic research tool as a framework for death investigation

The Haddon matrix is a research tool used by injury epidemiologists. Although this matrix has typically been used only in epidemiologic studies, it may serve as a framework to investigate the circumstances of traumatic deaths. This matrix consists of three rows representing time phases (before the injury incident, during the incident, and after the incident) and four columns representing the energy agent, characteristics of the deceased person, the environment, and the vehicle or vector resulting in the abnormal energy exchange, which are considered in the context of the three time phases. The authors present four cases illustrating how this epidemiologic tool can be useful during death investigations. Although the objectives for epidemiologic studies and medicolegal death investigations differ, this approach can be used to describe the circumstances surrounding an injury-related death.     

Diagnosing death by drowning in fresh water using blood strontium as an indicator

The interpretation of the level of strontium (Sr) in blood has been demonstrated to be useful in the diagnosis of death by drowning occurred in sea water, but its use in fresh water drownings is not so evident because of the low Sr concentration present in most of fresh water media. In this paper, we show a survey of the results obtained in the casework analysis of Sr in ventricular blood used in the diagnosis of drowning in 144 bodies found immersed in fresh water over a period of 10 years. Thirty-two percent of the immersion cases examined could be diagnosed as drownings with a reasonable degree of confidence. It is thought that this percentage of positive diagnoses could be largely improved in the case of blood samples taken a few hours after death.     

Microscopical study on estimation of time since death in skeletal remains

For the purpose of estimating time since death in skeletal remains, postmortem changes in human compact bones were examined by microradiography and electron microscopy. The UV-fluorescence of the peripheral zone of compact bone was also examined by microscopic spectrophotometry. Microradiographic examination revealed no morphological changes in bones left in the open air for long periods, except one of 15 years since death. In bones left in the soil, vacuoles of 5-10 microns diameter, which contained a honeycomb-like structure formed by small vacuoles of 0.5-1 microns diameter, were found in the peripheral zone of the substantia compacta approximately 5 years since death, and in bones of 6 years or more, this change extended to the mid-zone. In bones left in the sea for 4-5 years, vacuoles of 5-10 microns diameter were observed in the outer peripheral zone of the substantia compacta. The relative intensity of UV-fluorescence in bones dwindled with time since death and the correlation coefficient was considerably high.     

End-position nystagmus as an indicator of ethanol intoxication.

The Horizontal Gaze Nystagmus test is used by law enforcement agencies in the United States to determine whether drivers are intoxicated. It has a high baseline error and a dose/response relationship that varies greatly according to whether the subject's blood alcohol concentration is rising or falling. Confusion exists among practitioners of the test about whether it quantifies alcohol concentration or evaluates impairment. Fatigue exacerbates one component of the HGN test, end-position nystagmus. Video tapes recorded by cameras in police vehicles revealed that police officers rarely comply with the minimum requirements of the nystagmus examination procedures for which they were trained and certified.     

Identification procedures as a part of death investigation in Turkey

Forensic identification techniques include the examination of ID cards, the decedent's private belongings, fingerprints, footprints, lip marks, dental findings, red blood cell enzymes, performing photograph matching, facial reconstruction, visual identification, and DNA "fingerprinting." As part of forensic examinations, the identification of corpses that are fresh, decomposed, fragmented, or skeletonized as well as individual body parts and human remains can be requested. Identification becomes a challenging task for forensic terms particularly in mass-disaster situations. Each identification case should be considered to its own merit and the way to do that should be based on the effectiveness and cost of each method used. In Turkey, one of the major duties of the medicolegal system on the investigation of deaths is to identify the deceased if unknown.This study is undertaken to investigate the procedures, as well as their validities, used to deal with individualization of dismembered bodies directly sent to the Council of Forensic Medicine, Ministry of Justice, for autopsy and/or visual identification, as well as those received from peripheral districts for forensic identification. According to the Turkish Penal Procedural Law, a positive identification of the deceased is mandatory before performing an autopsy. According to the law, the ID cards are not taken to be sufficient for recognition of the deceased, and the major way of identification in daily practice is visual identification by a relative or any recognizant person to approve the identification to the prosecutor. If visual identification fails, fingerprints, dental x-rays or body x-rays, and DNA "fingerprinting" can be used to establish identity when compared with known records of the individual obtained by law enforcement.This retrospective study was carried out into 421 dismembered bodies, among 3063 autopsies performed in year 2002 by the Department of Morgue at the Council of Forensic Medicine, with particular insight into the identification procedures undertaken and their results. The overall negative identification rate was 30.4%, and in 1% of the cases, the visual identification by relatives were not confirmed by DNA identification and taken as misidentified.     

Beta-hydroxybutyric acid--an indicator for an alcoholic ketoacidosis as cause of death in deceased alcohol abusers

We analyzed the postmortem blood of a total of 100 fatal cases for beta-hydroxybutyric acid (BHBA). In 25 cases of sudden and unexpected death of alcoholics we found pathologically increased levels of BHBA of 1260 to 47200 (median 8000) micromol/L. This led us to the diagnosis of an alcoholic ketoacidosis (AKA) as cause of death in these cases. The control group of 69 postmortem cases revealed that BHBA concentrations below 500 can be regarded as normal, and values up to 2500 micromol/L as elevated. Our study shows that BHBA values over 2500 micromol/L could lead to death, if no medical attention is sought. During storage we did not find any indication of postmortem formation or decomposition of BHBA in blood in vitro or in the corpses. In our opinion, BHBA should be considered the diagnostic marker of choice for the postmortem determination of alcoholic ketoacidosis (AKA) as the cause of death. The classical indications of such deaths are: unexpected death of a chronic alcoholic; none or only traces of ethanol in the blood; increased acetone blood concentration; and neither autopsy, histology, microbiology, nor toxicology reveal the cause of death. In six further cases a diabetic ketoacidosis (DKA) was diagnosed as the cause of death.     

Quality assurance review of death certificates: a pilot study

BACKGROUND: Although quality assurance programs for medical examiners are required by the National Association of Medical Examiners' Inspection and Accreditation Checklist, quality assurance programs specifically targeting death certificate completion have not been addressed. The Fulton County Medical Examiner, Atlanta, GA, has implemented a pilot quality assurance program for death certificate information, and this report contains information about 1 year's experience with the program. METHODS: All death certificates are reviewed by the case medical examiner(s) and chief medical examiner prior to their release to funeral homes. Death certificates with errors are retained for quality assurance and review purposes, and needed corrections are made before death certificates are released. During a 1-year period, death certificates with errors were collected and then reviewed and tabulated by type of error. RESULTS: Between May 26, 2003, and May 25, 2004, the Fulton County Medical Examiner certified 1267 deaths. Of these, 47 (4%) were found to contain errors that were corrected and an additional 52 (4%) had been amended for various reasons. The most common errors were misspellings in causes of death or poor or incomplete wording in injury-related information. Forty-seven percent of errors involved omitted, incomplete, or incorrect information that was potentially significant. The most common reason for amended certificates was unexpected detection of acute intoxications among people with significant cardiovascular disease. CONCLUSIONS: Quality assurance review of death certificates can assist in preventing the release of death certificates with incomplete, erroneous, or omitted information and may also be useful as an educational forum regarding completion of the death certificate.     

Continuous quality improvement as a management concept for death investigation systems

Continuous quality improvement (CQI) represents a management technique where the basic approach to managing quality consists of setting a standard for a work process, measuring variation in the work process in relation to the standard, and then implementing programs to decrease variation and improve end results. Everyone providing a service becomes involved both in understanding how quality is measured and in discussing how to improve quality. A team approach is adopted and instead of focusing on poor quality outcomes and how to avoid them, the team becomes involved in setting continuously improving standards for better performance and in finding ways to meet those standards. The objective is to meet or exceed consumer or user expectations. Relevant related concepts such as survey research, needs determination and outcomes analysis, and the importance of a mission statement are discussed using a medical examiner system as an example.     

Precision of estimating the time since death by vitreous potassium--comparison of two different equations

The precision of death time estimation by vitreous potassium using two different formulas [1-3] is compared on an independent random sample of 100 cases. The very flat slope in Sturner's equation is the reason for a systematic overestimation of the time since death with much wider 95%-limits of confidence compared to the results using an own equation with a steeper slope of vitreous potassium.