Perineal‐Vaginal Injuries in Children: Accident or Abuse?

Abstract: A large number of conditions have been mistaken for abuse. Differentiating accidental injuries from inflicted injuries is important in the management of injured children. In this work, the authors describe two cases of accidental perineal‐vaginal injury in children. In case 1, a 4‐year‐old girl suffered a vaginal tear caused by violent stretching during play; in case 2, a 3‐year‐old girl had minor lacerations of labia minora and majora. The intervention of a multi‐specialist team including a forensic pathologist and forensic psychiatrist was the key factor in being able to exclude abuse by third parties in the described cases.. This leads to the appropriate recommendations to be adopted in the forensic medicine setting.     

Characteristics of Medical Examiner/Coroner Offices Accredited by the National Association of Medical Examiners

The National Association of Medical Examiners accredits medical examiner and coroner offices. Approximately 60 offices were fully or provisionally accredited as of late 2011, and these offices serve one‐quarter of the U.S. population. The calculated average population served was 1.6M but ranged from 0.3 to 10.5M. The calculated mean death rate was 794 deaths/100K population, and the mean homicide rate was 7.2 homicides/100K population. The calculated mean budget was $4.35M, but budgets ranged from $0.67 to $26.8M. The calculated mean budget/capita was $3.02 but ranged from $0.62 to $10.22. The average size of the facility was under 30,000 sq. ft. The calculated average staffing was found to include five forensic pathologists, four and a half autopsy technicians, and nine investigators. The mean forensic pathologists/1M population was 3.7. Calculated workload indices included 222 autopsies/pathologist and an autopsy rate of 77.6/100K population. These results show that offices of every size can achieve accreditation.     

Certifying Death in the United States

Accurately identifying death and its causes is integral to the compilation of mortality data and ultimately to the operation of the criminal justice and public health systems. A clear understanding of who is in charge of such processes is paramount to establishing the quality, or lack thereof, of the information provided in death certificates. Our study provides a comprehensive overview of all state statutes identifying death investigators charged with classifying and certifying death in the United States. We found that state statutes designate a broad range of individuals as responsible for the classification and certification of death. Those vary by state and set of circumstances and can include medical examiners, coroners, pathologists, other physicians, registered nurses, and more. Our findings highlight the important need for a unified standard of qualifications in the medico‐legal system, as well as, regulatory reform at the state level regarding who can complete and sign death certificates.