摘要:

Every death is unique, but deaths also share similar features that allow them to be grouped into categories. Since its initial description over 800 years ago, the position of coroner has been charged with the determination of manner of death. This determination has been made by examination into the circumstances surrounding death and of wounds on the surface of the body. Over the years, physicians have gained sufficient understanding of the body such that the autopsy became an important part of a death investigation. With additional time, laws were changed so that individuals charged with the determination of manner of death were required to have appropriate training. Death certification is the means by which deaths are grouped together according to similar characteristics. The practice of death certification has led to effective public health programs and the advancement of medical science. The addition of manner of death to the death certificate is an American contribution to vital statistics registration. The purpose of the autopsy report differs from that of the death certificate; the report fully addresses the unique aspects of a death, while the certificate captures the essence of the circumstances surrounding death in a few words.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

More than 700 physician medical examiner/coroners (ME/Cs) were surveyed to assess differences in manner of death classifications for typical but often controversial death scenarios: 198 physicians participated by choosing the manner of death (homicide, suicide, accident, natural, undetermined) for 23 such scenarios. Sixteen questions related to death certificate training, work location, and manner of death issues were also asked. The classification of manner of death by ME/Cs was highly variable. For some challenging death scenarios, majority agreement was lacking. Agreement was ≥80% for only 11 of the 23 scenarios and was 100% for only 1. Manner of death classification method was not influenced by forensic pathology board certification status, by whether or not the physician actually completed death certificates, or by previous threats of lawsuits over manner of death classification. However, there were some differences by state. No textbook or individual was widely recognized as authoritative on manner of death issues. Few ME/Cs had formal death certification training in medical school or residency. The data lend credence to the practice of the National Center for Health Statistics (NCHS) of classifying manner of death for statistical purposes by using coding and classification rules and selection criteria rather than solely on the basis of the classification of manner chosen by ME/Cs. The data also indicate that caution is in order when one compares manner of death statistics of one ME/C with those of another. Published guidelines and more uniform training are needed so that ME/Cs may become more consistent in their manner of death classifications. Further information is presented in Part I (history of manner of death classification) and in Part III (individual death scenarios and their analysis) companion articles in this issue of the Journal.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

In 1995, a questionnaire was distributed to the >700 physician medical examiner/coroners (ME/Cs) who are members of the National Association of Medical Examiners (NAME, St. Louis, MO, U.S.A.). The questionnaire consisted of 23 death scenarios for which individual responders were asked to assign a manner of death (homicide, suicide, accident, natural, or undetermined); 198 questionnaires were completed and analyzed. The distribution of manner of death responses was tabulated. In addition, a nosologist from the National Center for Health Statistics was provided with a cause-of-death statement based on each scenario and was asked to assign an International Classification of Diseases (ICD) code for the underlying cause of death, from which a manner of death was inferred from the ICD code's literal text description.Overall, agreement on a given manner of death in a single scenario was >90% in only 4 of 23 scenarios and >70% in only 12 of 23 scenarios. However, in 21 scenarios, the most common response comprised a majority. The manner of death inferred from the ICD code that was assigned by the National Center for Health Statistics (NCHS) matched the most common response of participants in 18 of the 23 scenarios.The questionnaire results show that there is substantial disagreement among experienced MEs concerning the manner of death classification that is preferred for selected types of death. Encouraging, however, is the fact that the manner of death coded for statistical purposes generally agreed with the most common classification of manner made by ME/Cs.Highlights from the discussion of each scenario that occurred during the NAME interim meeting (Nashville, Tennessee, February 1996) are also included. Other portions of the program including history of manner of death concepts and results of questions regarding responder training and characteristics are published separately in this issue of the Journal. Information derived from the questionnaire should be useful to those planning strategies to improve the consistency of manner of death classifications by ME/Cs.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The homogeneity of drug concentrations in skeletal muscle was assessed in eight fatal overdoses. Ten to 30 random samples were taken from leg muscle weighing 1,650 to 7,985 g. For cases involving paracetamol the mean muscle-to-blood ratio ranged from 0.1 to 1.1 (n = 4) for amitriptyline 1.1 to 3.6 (n = 3), and for dothiepin 0.8 to 2.1 (n = 2). The coefficient of variance was large for all drugs, ranging from 10.5 (carbamazepine) to 50 (thioridazine). Skeletal muscle is not homogeneous with respect to drug concentrations in fatal overdose cases. Of 16 instances of drug detection in blood 2 (nortriptyline and promethazine) were not detected in muscle. Muscle-to-blood drug ratios varied significantly among cases, possibly influenced by survival time after drug ingestion. Quantitative interpretations of muscle drug levels present significant difficulties. However, skeletal muscle can be used for qualitative corroboration of blood analyses and is a suitable specimen for drug detection where none other is available.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Traumatic carotid artery dissection is rarely seen as a cause of death in the forensic setting. Three cases of traumatic carotid artery dissection that demonstrate many of the typical features are presented. There is usually a history of some violent trauma to the head or neck, motor vehicle accidents being the commonest cause. The carotid artery may be injured anywhere from the common carotid portion to the cavernous sinus, resulting in infarction of the corresponding cerebral hemisphere. Clinically, symptoms may include loss of consciousness, hemiparesis, aphasia, and Horner's syndrome, these typically occurring after an interval of hours to days. Carotid artery injury may not be associated with evidence of external injury and initially may go undetected or may be misinterpreted in the setting of associated neck or head trauma. The commonest mechanisms are thought to be blunt neck trauma and neck hyperextension. The cases presented highlight the importance of early diagnosis if surgery is to be possible to avoid a fatal outcome.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We analyzed 75 cases of fatal ground-level falls that were investigated by the King County Medical Examiner over a 48-month period, with autopsies performed on 87% of the deaths: 69% of the cases were men and 61% occurred in ages ≥70 years; only 12% were aged <50 years, with the youngest aged 28 years. Most of the falls occurred in or about the residence, and many individuals were known to have fallen onto hard surfaces. In 77% of cases there was significant pre-existing natural disease, mostly cardiovascular disease. Liver disease was more frequently a contributing factor in those aged <50 years. Ethanol was present in 48% of those cases tested, more frequently present in men than in women. Basal skull fractures were present in 37% of cases, and acute subdural hematomas, the most common intracranial lesion, were present in 85%. We concluded that fatal ground-level falls were much more common in elderly persons, owing to a greater predisposition to falling, as well as intrinsic age-related changes, including a greater susceptibility to acute subdural hematoma.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Autopsy data from individual aviation crashes have long been used in aviation safety research in the form of case reports and case series studies. Injuries sustained from aviation crashes, however, have not been well documented at a national level. This study examines the injury patterns for persons who died in aviation crashes in the United States and the implications for preventive strategies. Death certificate data for all aviation-related fatalities for the years 1980 (n = 1,543) and 1990 (n = 1,011) were obtained from the National Center for Health Statistics. The immediate cause of death and all injury diagnoses recorded on the death certificates were analyzed in relation to year of injury, crash category, and type of victim. Despite a 34% reduction in the number of aviation-related fatalities between 1980 and 1990, injury patterns were fairly stable. Multiple injuries were listed as the immediate cause of death in 42% of the fatalities, followed by head injury (22%); internal injury of thorax, abdomen, or pelvis (12%); burns (4%); and drowning (3%). Head injuries were most common among children. The majority (86%) died at the scene or were dead on arrival at the hospital. Eighteen percent of the victims were reported to have sustained a single injury, with head injury being the cause of death in nearly a third of these fatalities. Blunt injuries resulting from deceleration forces, in particular head injury, are still the most important hazard threatening occupants' survival in aviation crashes. To further reduce aviation-related fatalities requires more effective restraint systems and other improvements in aircraft design.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We report two cases in which a medicolegal autopsy disclosed small and previously undiagnosed gliomas. The first case was a 38-year-old woman who was found dead in bed; her autopsy revealed a 1.3-cm low-grade astrocytoma in the right subthalamic area. The second case involved a 32-year-old man who drowned in shallow water after his canoe capsized. A 0.5-cm oligodendroglioma of the left temporal lobe and a 0.1-cm ganglionic hamartoma of the hypothalamus were found. In both cases the tumors may, directly or indirectly, have been the underlying cause of death. We emphasize the importance of a thorough neuropathological examination for all cases of sudden unexpected death in which no extracerebral cause of death has been found.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A 15-month-old girl underwent several emergency department (ED) visits and two admissions for parent-reported histories of ingestions, apnea, and seizures. She was initially admitted following reports of several unusual episodes of syncope accompanied by convulsive movements and was discharged on mephobarbital with a diagnosis of atypical seizure disorder. The day after discharge, she was brought to the ED in cardiopulmonary arrest and was resuscitated after a prolonged period. She was declared brain dead 2 days later. Ante- and postmortem toxicology produced several inconclusive findings, none of which explained death. Autopsy findings, including neuropathology, failed to demonstrate any significant disease processes. Approximately 3 months later, a 4-month-old female sibling was brought to the ED with a parent-reported history of apnea and seizures similar to the deceased child. A stool specimen obtained 2 days after admission contained numerous tiny seeds, which were found by gas chromatography-mass spectrometry analysis to contain lorazepam and temazepam. The role of these benzodiazepines in the apnea episodes in this infant was unknown, but the presence of the seeds in such a young infant coupled with the parent's aberrant behavior, led to the tentative diagnosis of Munchausen syndrome by proxy. This diagnosis was strengthened when results from these studies persuaded legal authorities to remove the surviving sibling from the parents, resulting in an asymptomatic recovery.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Concussion of the heart (commotio cordis) occurs in traffic accidents in which blunt force impact over the precordial area occurs, even in the absence of multiple blunt force injuries. The functional dynamics of the heart, with ventricular arrythmias and conduction disturbances, serve as the pathophysiological basis of this condition. As a cause of death in vehicular accidents, it is less common than other causes. However, it should be considered in the differential diagnosis, especially in cases with minor or no apparent injuries.

ISSN:0195-7910    

出版商:OVID    

年代:1997

数据来源: OVID