Peculiarities of combined blunt head injuries in children and adolescents

The objective of the present study was to evaluate the frequency and peculiar features of combined head injuries in children and adolescents who suffered the fatal blunt trauma. A total of 101 corpses and 188 archive records were available for the analysis. The control data group was comprised of 227 original observations of adult corpses. It was shown that head injuries prevail over injuries to other parts of the body in children with combined blunt traumas. The craniocerebral injuries are more frequent in children and adolescents than in adult subjects but their extent is smaller. Fractures of the facial bone skeleton in adults occur twice as frequently as in children. A peculiar feature of craniocerebral injuries in children and adolescents is incomplete splintered fractures and folded deformation of the bone plate. Subarachnoidal hemorrhage occurs equally frequently in children and adults with craniocerebral injuries. Other intracranial manifestations of the injury, such as ruptured brain tunics, epidural and subdural hemorrhage, cerebral contusion and ventricular hemorrhage in children occur less frequently than in adults.     

Fatal child abuse-maltreatment syndrome. A retrospective study in Ontario,Canada, 1990-1995

Child death due to repeated episodes of physical assault or neglect has been termed the child abuse-maltreatment syndrome (CAMS). We characterized the injuries in a series of fatally abused or maltreated child to delineate objective diagnostic criteria for the CAMS for use by clinicians and pathologists. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990-1995 were reviewed. Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The nature and frequency of the various injuries was determined. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. Most cases had significant recent head injury with intra-cranial hemorrhage (71%). Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases). A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involve head trauma including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A proportion of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment. All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation.     

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.     

有限元方法在法医学颅脑损伤分析中的应用

有限元方法(finite element method,FEM)是一种与现代计算机技术相联系的计算应力分析方法,已逐渐被应用于生物力学领域仿真人体结构力学功能研究,尤其是在颅脑损伤研究中最为广泛和深入。本文综述了现有头部有限元模型的特点、材料属性的赋值以及颅脑损伤有限元模型在钝力击打、高坠、交通事故等鉴定中的应用情况,探讨FEM建模在法医学颅脑损伤预测中的优劣势及其应用价值。     

3D reconstruction of emergency cranial computed tomography scans as a tool in clinical forensic radiology after survived blunt head trauma--report of two cases

When requested to evaluate surviving victims of blunt head trauma the forensic expert has to draw mainly on medical documentation from the time of hospital admission. In many cases these consist of written clinical records, radiographs and in some cases photographic documentation of the injuries. We report two cases of survived severe blunt head trauma where CT images, which had primarily been obtained for clinical diagnostic purposes, were used for forensic assessment. 3D reconstructions of the clinical CT-images yielded valuable information regarding the sequence, number and direction of the impacts to the head, their gross morphology and the inflicting weapon. We conclude that computed tomography and related imaging methods, along with their 3D reconstruction capabilities, provide a useful tool to approach questions in clinical forensic casework.     

Discrimination of Falls and Blows in Blunt Head Trauma: Assessment of Predictability Through Combined Criteria*

Abstract: The discrimination of falls from homicidal blows in blunt head injuries is a common but difficult problem in both forensic anthropology and pathology. Three criteria have been previously proposed for this distinction: the hat brim line rule, side lateralization of fractures, and number of lacerations. The aim of the present study was to achieve a better distinction rate by combining those criteria and assess the predictability of these combined criteria tools. Over a 6‐year period, a total of 114 cases (92 males and 22 females) were studied: 21 cases of downstairs falls, 29 cases of falls from one’s own height, and 64 cases of head trauma by a blunt weapon. The results revealed predictability rates varying from 62.5 to 83.3% for criteria pointing towards a fall. As for combined criteria in favor of a blow, the assumption was accurate in all cases (100%).     

Investigative and autopsy findings in sport aircraft-related deaths in southwest Florida

Aircraft designated for sport or recreational use only, including ultralights, experimental aircraft and light-sport aircraft, have become increasingly popular. Because of their relative safety and the rarity of fatalities resulting from crashes of these aircraft, the forensic literature contains little information concerning the pathologic findings in such deaths. We report 9 deaths resulting from 6 sport aircraft crashes in southwest Florida, 6 pilots and 3 passengers. The vehicles involved 3 experimental aircraft, 1 ultralight and 2 "ultralight-like" aircraft. The patterns of injuries included trauma predominantly to the chest (3 cases), abdomen (1) or head (1), as well as multiple blunt force injuries involving the chest and abdomen (1) or the head and torso (3). Extremity fractures were found in only 2 cases, whereas injuries to the symphysis pubis were found in six. No "control-type" injuries were identified. These cases illustrate the varied pathologies associated with deaths due to crashes of sport aircraft and reveal the lack of uniformity associated with the investigations of such deaths.     

Household furniture tip-over deaths of young children

The potential for the injury or death of a child resulting from the tip-over of a piece of household furniture or a domestic appliance has not been previously well recognized. We reviewed nine accidental deaths of young children that resulted from avoidable residential hazards and/or lapses in supervision of the children by their caregivers. The offending household items included televisions, bedroom dressers, a kitchen stove, and a lounge chair. The causes of death were mechanical asphyxia, blunt trauma, and combined blunt head trauma and asphyxia. All of the deaths could have been prevented by appropriate anchoring of the piece of furniture and/or closer supervision of the child. A thorough multidisciplinary investigation is essential in establishing the cause and manner of death in such cases and in identifying risk factors that may aid in the prevention of future childhood deaths.     

Influence of alcohol intoxication of pedestrians on injuries in fatal road accidents

Pedestrians belong to the group of road users with the highest mortality rate. The frequency of road accidents involving pedestrians is 2% but pedestrians represent as many as 13% of all road accident deaths. Because of the mechanism and dynamics of injury and the effects of alcohol on physical and mental performance, pedestrians under the influence of alcohol are classed among the road users most at risk.Our retrospective study included 125 pedestrian fatalities treated at the Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana between 1999 and 2006. We classified the victims into two groups by blood alcohol level Group I (alcohol positive) and Group II (alcohol negative), defined differences in gender, age, incidence of injuries and established causes of death and period of survival following the road accident. In Group I (n = 53) 96% were male and 4% female; the average age was 45.6 years. In Group II (n = 72) 40% were male and 60% female; the average age was 63.1 years. The percentage of injuries to individual parts of the body was higher in Group I than among the deceased pedestrians in Group II. The most common cause of death in both groups was craniocerebral trauma. Death occurred in the first 6 h following the accident in 92% of cases in Group I and in 69% of cases in Group II.Alcohol-positive pedestrians are predominantly younger men, who have a higher level of risk of a road accident, greater incidence of injuries and a shorter period of survival following a road accident.     

眼部损伤程度法医学鉴定60例分析

目的探讨眼外伤的特点及其损伤程度法医学鉴定要点。方法对60例眼外伤的法医学鉴定案例进行回顾性分析,对所有案例按照性别、年龄、职业、致伤物及损伤类型进行分类研究。结果眼外伤中农民、工人占61.7%,钝性损伤达85.0%,且大多属单纯挫伤,占63.3%。结论眼外伤大多属钝性外力所致,眼底病变是影响视力的重要原因,对外力与视力受损关系的评价要充分考虑致伤物种类、打击部位及伤前眼病史等诸多因素的影响。     

A review of blunt force injury homicides of children aged 0 to 5 years in bexar county, Texas, from 1988 to 2009

ABSTRACT: It is essential that clinical physicians, medical personnel, medical examiners, and law enforcement agencies understand the types of injuries seen and demographics of children affected by intentional blunt force as this understanding can be crucial to the death and/or criminal investigations. An understanding of the injuries can also assist in drawing conclusions regarding how those injuries could have been sustained. This study discusses the types and patterns of injuries seen in blunt force homicides in children younger than 6 years. The study found that male infants are more often intentionally injured than are female infants and that fatal head injuries most frequently occur in the first year of life, whereas most fatal thoracoabdominal injuries occur in the first 3 years of life. In children with head injuries, subdural hemorrhage was the most common finding, followed by subarachnoid hemorrhage. In 2.5% of deaths due to head injury, concurrent neck injury was seen, a percentage far lower than previous literature would suggest if shaking was the primary mechanism of injury. Twelve legal confessions were also reviewed, none of which disclosed a pure mechanism of shaking the infant.     

钝力性心脏外伤38例尸检病理学研究

本文研究表明钝力作为原始致伤因素作用于胸部通过压、拉、剪切、旋转等可引起钝力性心脏外伤包括心脏震荡、心脏挫裂伤、心脏玻裂、心脏断离等原发性心脏外伤和继发性乃至迟发性心脏外伤，诸如外伤性心脏炎、冠脉血管炎、血栓形成、外伤性心肌梗塞、外伤性冠状动脉瘤、外伤性室壁瘤、迟发性外伤性心脏破裂等。致命性的心脏震荡，除急性冠循环障碍和心失常外，还可有心脏传导系统和神经组织损伤，尤其心肌肌膜爆裂（ｓａｒｃｏｌｅｍｍａｂｕｒｓｔ）及相应的原纤维膨出畸形变可以作为心脏震荡性外伤的形态学指证。外伤性心肌梗塞和迟发性外伤性心脏破裂以突然发生在外伤后的一定间隔期为特征，应予特殊注意．     

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.     

The forensic-medical expertise in craniofacial trauma

Archive materials of the recent 6 years, including 14720 death cases of victims, were analyzed for the purpose of detecting the general regularities of injuries within the craniofacial trauma (CFT). The diversity of CFT with injuries to skull bones and medullary substance was found not to interfere with establishing an actual type and mechanism of trauma provided all injuries are thoroughly and comprehensively examined. The trauma specificity must be evaluated with respect to a location and direction of traumatic force in order to define an actual impact that caused death. CFT is special variation of craniocerebral trauma, whose onset mechanism needs more research. The efficiency of forensic-medical examination of CFT cadavers directly depends on the coordination and logic of measure undertaken by expert as well as on his technical outfit and knowledge of such trauma. The diversity of variations of damage to anatomic head structures requires an interdisciplinary approach with the need to isolate a predominant chain that affects the course and outcome of trauma.     

Shopping cart injuries, entrapment, and childhood fatality

Shopping carts may be associated with a variety of injuries, particularly in toddlers and young children. These usually relate to falls from carts or to tip-overs. Injuries that are sustained include hematomas/contusions, abrasions, lacerations, fractures, and fingertip amputations. Fatal episodes are uncommon and are usually due to blunt craniocerebral trauma from falls. A case involving a 19-month-old girl is reported who became entrapped when she inserted her head through the side frame of a cart that had been removed from a supermarket and left at her home address. Death was caused by neck compression. Although rare, the potential for lethal entrapment during unsupervised play means that the presence of stray shopping carts at private residences and in public places, including playgrounds and parks, is of concern. Strategies, such as coin deposits, should be encouraged to assist in the return of such carts to supermarkets.     

About the so-called "Geserick sign"

Geserick et al. were the first who reported about fractures of the medial and basal wall of the orbita, originating from blunt occipital trauma leading to consecutive contrecoup lesions of the bulbus/orbita complex. A case history with (survived) occipital craniocerebral trauma and monocle hematoma (48-year-old drunken homeless person, found unconscious in a small street of the redlight quarter) is presented. The question was whether the injuries were caused by falling or inflicted by an assailant.     

Flail Chest Following Failed Cardiopulmonary Resuscitation

Following the death of a woman with blunt force chest trauma, the question was asked how common was the finding at autopsy of a flail chest in decedents after failed cardiopulmonary resuscitation. It was suggested in court that this was an uncommon occurrence. To address this issue, autopsy cases in adults (>18 years) with rib fractures attributable to cardiopulmonary resuscitation were taken from the files of Forensic Science SA over a 7‐year period from 2008 to 2014. Flail chest injuries were defined as those arising from fractures at two sites in at least three consecutive ribs. From 236 cases with rib fractures attributed to resuscitation, a total of 43 flail chest injuries were found in 35 cases (14.8%). The majority occurred in the 60‐79‐year‐old age group. These data suggest that flail chest injuries are a more common sequelae of cardiopulmonary resuscitation than has been previously appreciated in autopsy cases, particularly in the elderly.     

Comparing Known and Reconstructed Circumstances of Death Involving a Blunt Force Trauma Mechanism through a Retrospective Analysis of 21 Skeletonized Individuals

Little is known about to what extent the events surrounding death can be reliably reconstructed from blunt force trauma analysis alone. In this study, we reconstruct circumstances of death from a blind blunt force trauma analysis using a sample of 21 individuals of known death circumstances, obtained from two identified skeletal collections in Portugal. Fresh versus dry bone trauma and probable mechanism of fracture production were identified. The overall pattern of injuries was then used to reconstruct the most likely circumstances of death. Results show an agreement between the proposed and the reported circumstances for 13 individuals (68.4%), disagreement for 3 (15.8%), and similarity in 3 cases (15.8%). Although the significant amount of agreement highlights the potential of trauma analysis, the cases with disagreement draw attention to the pitfalls and shortcomings of attempting to reconstruct the death circumstances from skeletal trauma analysis alone.     

Children in motor vehicle collisions: analysis of injury by restraint use and seat location

This study was a retrospective chart review of hospital records and autopsy reports of 499 children nine years old or younger involved in motor vehicle collisions from 1994 to 1998. The objective was to evaluate the frequency and severity of injuries as a function of age, restraint use, and seat position. We found that 33% of the children were unrestrained and 20% were improperly restrained. Unrestrained children had the highest mean Maximum Abbreviated Injury Scores (MAIS) and Injury Severity Scores (ISS), accounted for 70% of the fatalities, and had the highest incidence of head injuries. Although most of the head injuries were superficial, 80% of the fatalities were the result of a head injury. Improperly restrained children had the highest frequency of abdominal injuries. Regardless of restraint use, the back seat was associated with fewer head injuries and lower mean MAIS and ISS scores compared to the front seat. Also, properly restrained children in the front seat had lower mean MAIS and ISS scores than unrestrained children in the back seat, suggesting that restraint use is more beneficial than seat position.     

Cardiac Injuries Caused by Blunt Trauma: An Autopsy Based Assessment of the Injury Pattern

Abstract:  Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common, particularly as a result of rapid deceleration in high-speed vehicular accidents, over the past 2–3 decades. The high mortality rate of cardiac injuries and possible late onset complications make blunt cardiac injuries an important challenging point for legal medicine. One hundred and ninety cases with blunt cardiac injuries in a period of 3 years were analyzed retrospectively in terms of patterns of cardiac injury, survival times, and demographic profiles of the cases in this study.