Medicine › Radiology, Nuclear Medicine and Imaging

Autopsy Techniques and Outcomes

Works Count: 34681

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Description

This cluster of papers revolves around the advancements in post-mortem imaging techniques, such as virtual autopsy, forensic pathology, and the use of magnetic resonance imaging and computed tomography for diagnostic validation. The focus is on minimizing errors in autopsy diagnosis, validating alternative autopsy methods, improving death certification accuracy, and analyzing medical errors.

Keywords

Post-mortem Imaging; Virtual Autopsy; Forensic Pathology; Diagnostic Errors; Magnetic Resonance Imaging; Computed Tomography; Autopsy Validation; Death Certification; Minimally Invasive Autopsy; Medical Error Analysis

Virtopsy, a New Imaging Horizon in Forensic Pathology: Virtual Autopsy by Postmortem Multislice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI)—a Feasibility Study

2003-03-01

Michael J. Thali , Kathrin Yen , Wolf Schweitzer +7 more

Using postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), 40 forensic cases were examined and findings were verified by subsequent autopsy. Results were classified as follows: (I) cause … Using postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), 40 forensic cases were examined and findings were verified by subsequent autopsy. Results were classified as follows: (I) cause of death, (II) relevant traumatological and pathological findings, (III) vital reactions, (IV) reconstruction of injuries, (V) visualization. In these 40 forensic cases, 47 partly combined causes of death were diagnosed at autopsy, 26 (55%) causes of death were found independently using only radiological image data. Radiology was superior to autopsy in revealing certain cases of cranial, skeletal, or tissue trauma. Some forensic vital reactions were diagnosed equally well or better using MSCT/MRI. Radiological imaging techniques are particularly beneficial for reconstruction and visualization of forensic cases, including the opportunity to use the data for expert witness reports, teaching, quality control, and telemedical consultation. These preliminary results, based on the concept of "virtopsy," are promising enough to introduce and evaluate these radiological techniques in forensic medicine.

Problems With Proper Completion and Accuracy of the Cause-of-Death Statement

2001-01-22

Ann E. Smith Sehdev , Grover M. Hutchins

Mortality statistics are largely based on death certificates, so it is important that the data on the death certificate is accurate. At our institution, clinicians complete cause-of-death statements (CODs) prior … Mortality statistics are largely based on death certificates, so it is important that the data on the death certificate is accurate. At our institution, clinicians complete cause-of-death statements (CODs) prior to autopsy. Since May 1995, separate CODs have been included in autopsy face sheets.Clinical and autopsy-based CODs filled out separately on 494 cases between June 1995 and February 1997 were compared for proper reporting and accuracy using the published guidelines and definitions of immediate, intermediate, and underlying causes of death put forth by the College of American Pathologists and the National Center for Health Statistics.Of the 494 death certificates, 204 (41%) contained improperly completed CODs. Of these, 49 (24%) contained major discrepancies between clinicians' and pathologists' CODs. Of the 494 death certificates, 290 (59%) had properly completed CODs. Of the 290 properly completed CODs, 141 (49%) contained disagreements: 73 (52%) on underlying CODs; 44 (31%) on immediate CODs; and 47 (33%) on other significant conditions (part II).The reliability and accuracy of CODs remain a significant problem. Despite its limitations, the autopsy remains the best standard against which to judge premortem diagnoses. The CODs of the death certificate may be improved if death certificates are completed in conjunction with the postmortem examination and amended when the autopsy findings show a discrepancy.

“Gray's Anatomy”

1985-10-01

Roger Warwick , Peter Williams , Mary Dyson +1 more

The comparison, made by Dr. W. D. Jeans in your last issue*, of Gray's Anatomy with the latest revision of its American offspring is an interesting exercise; but his conclusion … The comparison, made by Dr. W. D. Jeans in your last issue*, of Gray's Anatomy with the latest revision of its American offspring is an interesting exercise; but his conclusion that the original is a ‘better buy’, though pleasing to the producers of the “British” Gray's Anatomy, a much larger and more up-to-date book, is based upon the false premise that a second version is necessary. Here a little history helps: the first edition, published by Parker and the copyright at once purchased by Longmans, was immediately popular and must have contributed much to the profits of the latter firm.

Fetal blood, sampling during pregnancy with use of a needle guided by ultrasound: A study of 606 consecutive cases

1985-11-01

F. Daffos , M Capella‐Pavlovsky , F Forestier

Childhood deaths in Africa: uses and limitations of verbal autopsies

1992-08-01

Robert W. Snow , Maria Winstanley , Vicki Marsh +7 more

Organ weight in 684 adult autopsies: new tables for a Caucasoid population

2001-06-01

Geoffroy Lorin de la Grandmaison , I. Clairand , Michel Durigon

A prospective study of 1152 hospital autopsies: I. Inaccuracies in death certification

1981-04-01

H. M. Cameron , Euphemia McGoogan

Comparison of certified clinical diagnoses with autopsy findings showed that, while the major cause of death was confirmed in 61 per cent. of cases, many diagnoses--both major and contributory--were wrong; … Comparison of certified clinical diagnoses with autopsy findings showed that, while the major cause of death was confirmed in 61 per cent. of cases, many diagnoses--both major and contributory--were wrong; many clinical diagnoses were either disproved or relegated to a less important role, and many autopsy findings had not apparently been anticipated. Accuracy was particularly poor in some clinical categories: notably cerebrovascular disease and infections. In these, the diagnosis was more often wrong than right. Thus, death certificates are unreliable as a source of diagnostic data. The clinician's confidence in his major diagnosis bore a fairly close relationship to the frequency of its confirmation. Nevertheless, even when certified as "fairly certain", the major diagnosis was wrong in about one-quarter of these cases. An attempt was made to assess the significance of incorrect diagnoses; one half of these might be clinically significant. Diagnostic accuracy did not improve with the time spent in hospital, and it bore an inverse relationship to the patient's age.

Algorithms for enhancing public health utility of national causes-of-death data

2010-05-10

Mohsen Naghavi , Susanna Makela , Kyle J Foreman +3 more

Coverage and quality of cause-of-death (CoD) data varies across countries and time. Valid, reliable, and comparable assessments of trends in causes of death from even the best systems are limited … Coverage and quality of cause-of-death (CoD) data varies across countries and time. Valid, reliable, and comparable assessments of trends in causes of death from even the best systems are limited by three problems: a) changes in the International Statistical Classification of Diseases and Related Health Problems (ICD) over time; b) the use of tabulation lists where substantial detail on causes of death is lost; and c) many deaths assigned to causes that cannot or should not be considered underlying causes of death, often called garbage codes (GCs). The Global Burden of Disease Study and the World Health Organization have developed various methods to enhance comparability of CoD data. In this study, we attempt to build on these approaches to enhance the utility of national cause-of-death data for public health analysis.Based on careful consideration of 4,434 country-years of CoD data from 145 countries from 1901 to 2008, encompassing 743 million deaths in ICD versions 1 to 10 as well as country-specific cause lists, we have developed a public health-oriented cause-of-death list. These 56 causes are organized hierarchically and encompass all deaths. Each cause has been mapped from ICD-6 to ICD-10 and, where possible, they have also been mapped to the International List of Causes of Death 1-5. We developed a typology of different classes of GCs. In each ICD revision, GCs have been identified. Target causes to which these GCs should be redistributed have been identified based on certification practice and/or pathophysiology. Proportionate redistribution, statistical models, and expert algorithms have been developed to redistribute GCs to target codes for each age-sex group.The fraction of all deaths assigned to GCs varies tremendously across countries and revisions of the ICD. In general, across all country-years of data available, GCs have declined from more than 43% in ICD-7 to 24% in ICD-10. In some regions, such as Australasia, GCs in 2005 are as low as 11%, while in some developing countries, such as Thailand, they are greater than 50%. Across different age groups, the composition of GCs varies tremendously - three classes of GCs steadily increase with age, but ambiguous codes within a particular disease chapter are also common for injuries at younger ages. The impact of redistribution is to change the number of deaths assigned to particular causes for a given age-sex group. These changes alter ranks across countries for any given year by a number of different causes, change time trends, and alter the rank order of causes within a country.By mapping CoD through different ICD versions and redistributing GCs, we believe the public health utility of CoD data can be substantially enhanced, leading to an increased demand for higher quality CoD data from health sector decision-makers.

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The Vanishing Nonforensic Autopsy

2008-02-27

Kaveh G Shojania , Elizabeth C. Burton

We've all heard about cases in which a patient presumed to have died from acute myocardial infarction was discovered at autopsy to have had an aortic dissection, or a patient … We've all heard about cases in which a patient presumed to have died from acute myocardial infarction was discovered at autopsy to have had an aortic dissection, or a patient who presented with decompensated liver failure from presumed alcoholic cirrhosis but proved at autopsy to have widely metastatic hepatocellular carcinoma. Indeed, an extensive literature documents the frequency with which autopsy reveals clinically significant diagnoses that were missed before death.1 Autopsies also generate more accurate vital statistics, provide pathological descriptions of new diseases, and offer powerful tools for education and quality assurance (see Benefits of Nonforensic Autopsies). Yet despite these benefits, . . .

Pathologic Basis of Disease

1974-09-23

Nelson R. Niles

<i>Pathologic Basis of Disease</i>by Stanley L. Robbins is really the fourth edition of his<i>Pathology</i>. Appropriate updating and addition enhance the otherwise identical format, sequence, writing, and illustrations. So many medical … <i>Pathologic Basis of Disease</i>by Stanley L. Robbins is really the fourth edition of his<i>Pathology</i>. Appropriate updating and addition enhance the otherwise identical format, sequence, writing, and illustrations. So many medical students have benefited from this source that it may be the best known general book in the field. I recommend it even more now. Like his former texts, this will be enjoyed for its readability. He clearly lays out a great deal of information. When he includes minutiae, the reasons are clear and one feels that all the material is pertinent. Robbins keeps the whole field in perspective—that is, he does not dwell so long or so heavily on pathologic anatomy or pathogenesis as to tempt the reader to overlook clinical presentation or prognosis. A great strength of the subject of pathology is that it bonds strongly with many other medical sciences and specialties and thus occupies the

Accuracy of Death Certificates for Coding Coronary Heart Disease as the Cause of Death

1998-12-15

Donald M. Lloyd‐Jones , David O. Martin , Martin G. Larson +1 more

Background: Death certificates are widely used in epidemiologic and clinical investigations and for national statistics. Objective: To examine the accuracy of death certificates for coding coronary heart disease as the … Background: Death certificates are widely used in epidemiologic and clinical investigations and for national statistics. Objective: To examine the accuracy of death certificates for coding coronary heart disease as the underlying cause of death. Design: Community-based inception cohort followed since 1948. Setting: Framingham, Massachusetts. Patients: 2683 deceased Framingham Heart Study participants. Measurements: Sensitivity, specificity, and predictive values of the death certificate. The reference standard was cause of death adjudicated by a panel of three physicians. Results: Among 2683 decedents, the death certificate coded coronary heart disease as the underlying cause of death for 942; the physician panel assigned coronary heart disease for 758. The death certificate had a sensitivity of 83.8% (95% CI, 81.1% to 86.4%), positive predictive value of 67.4% (CI, 64.4% to 70.4%), specificity of 84.1% (CI, 82.4% to 85.7%), and negative predictive value of 92.9% (CI, 91.7% to 94.1%) for coronary heart disease. The death certificate assigned coronary heart disease in 51.2% of 242 deaths (9.0% of total deaths) for which the physician panel could not determine a cause. Compared with the physician panel, the death certificate attributed 24.3% more deaths to coronary heart disease overall and more than twice as many deaths to coronary heart disease in decedents who were at least 85 years of age. When deaths that were assigned unknown cause by the physician panel were excluded, the death certificate still assigned more deaths to coronary heart disease (7.9% overall and 43.1% in the oldest age group). Conclusions: Coronary heart disease may be overrepresented as a cause of death on death certificates. National mortality statistics, which are based on death certificate data, may overestimate the frequency of coronary heart disease by 7.9% to 24.3% overall and by as much as two-fold in older persons.

A post mortem study of the hip joint. Including the prevalence of the features of the right side.

1970-01-01

P. D. Byers , C A Contepomi , Tamás Farkas

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DIFFUSE COLLAGEN DISEASE

1942-05-23

Paul Klemperer , Abou D. Pollack , George Baehr

The thesis of Morgagni that diseases reside in certain organs of the human body has dominated pathologic anatomy and clinical investigation for centuries. Every diagnostic endeavor was directed toward establishing … The thesis of Morgagni that diseases reside in certain organs of the human body has dominated pathologic anatomy and clinical investigation for centuries. Every diagnostic endeavor was directed toward establishing the fundamental organ disease. No doubt, this working hypothesis has been the cornerstone on which rests the edifice of modern medicine. The great advance of medicine throughout the nineteenth century is essentially founded on the method of correlating observations made in the hospital ward with those at the postmortem table. This clinicopathologic concept was further advanced by the recognition of an interdependence and unity of certain organs to form organ or tissue systems. Diseases of the hemopoietic or of the reticuloendothelial system represent such an extension of the scope of organ pathology. Nevertheless, one cannot justly maintain that an essential site is established in every disease. A number of acute infections and intoxications do not produce characteristic or even significant

Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study

2011-11-22

Ian S D Roberts , Rachel Benamore , E W Benbow +7 more

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The Value of the Autopsy in Three Medical Eras

1983-04-28

Lee Goldman , Robert Sayson , Stanley L. Robbins +3 more

To determine whether advances in diagnostic procedures have reduced the value of autopsies, we analyzed 100 randomly selected autopsies from each of the academic years 1960, 1970, and 1980 at … To determine whether advances in diagnostic procedures have reduced the value of autopsies, we analyzed 100 randomly selected autopsies from each of the academic years 1960, 1970, and 1980 at one university teaching hospital. In all three eras about 10 per cent of the autopsies revealed a major diagnosis that, if known before death, might have led to a change in therapy and prolonged survival; another 12 per cent showed a clinically missed major diagnosis for which treatment would not have been changed. Among 1980 autopsies, renal disease and pulmonary embolus were less common causes of death than before, but systemic bacterial, viral, and fungal infections increased significantly and were missed clinically 24 per cent of the time. The introduction of radionuclide scans, ultrasound, and computerized tomography as diagnostic procedures did not reduce the use of conventional tests in patients who subsequently died and were studied by autopsy. Over-reliance on these new procedures occasionally contributed directly to missed major diagnoses. We conclude that advances in diagnostic technology have not reduced the value of the autopsy, and that a goal-directed autopsy remains a vital component in the assurance of good medical care.

Changes in Rates of Autopsy-Detected Diagnostic Errors Over Time

2003-06-04

Kaveh G Shojania , Elizabeth C. Burton , Kathryn M McDonald +1 more

Context Substantial discrepanies exist between clinical diagnoses and findings at autopsy. Autopsy may be used as a tool for quality management to analyze diagnostic discrepanies. Objective To determine the rate … Context Substantial discrepanies exist between clinical diagnoses and findings at autopsy. Autopsy may be used as a tool for quality management to analyze diagnostic discrepanies. Objective To determine the rate at which autopsies detect important, clinically missed diagnoses, and the extent to which this rate has changed over time. Data Sources A systematic literature search for English-language articles available on MEDLINE from 1966 to April 2002, using the search terms autopsy , postmortem changes , post-mortem , postmortem , necropsy , and posthumous , identified 45 studies reporting 53 distinct autopsy series meeting prospectively defined criteria. Reference lists were reviewed to identify additional studies, and the final bibliography was distributed to experts in the field to identify missing or unpublished studies. Study Selection Included studies reported clinically missed diagnoses involving a primary cause of death (major errors), with the most serious being those likely to have affected patient outcome (class I errors). Data Extraction Logistic regression was performed using data from 53 distinct autopsy series over a 40-year period and adjusting for the effects of changes in autopsy rates, country, case mix (general autopsies; adult medical; adult intensive care; adult or pediatric surgery; general pediatrics or pediatric inpatients; neonatal or pediatric intensive care; and other autopsy), and important methodological features of the primary studies. Data Synthesis Of 53 autopsy series identified, 42 reported major errors and 37 reported class I errors. Twenty-six autopsy series reported both major and class I error rates. The median error rate was 23.5% (range, 4.1%-49.8%) for major errors and 9.0% (range, 0%-20.7%) for class I errors. Analyses of diagnostic error rates adjusting for the effects of case mix, country, and autopsy rate yielded relative decreases per decade of 19.4% (95% confidence interval [CI], 1.8%-33.8%) for major errors and 33.4% (95% [CI], 8.4%-51.6%) for class I errors. Despite these decreases, we estimated that a contemporary US institution (based on autopsy rates ranging from 100% [the extrapolated extreme at which clinical selection is eliminated] to 5% [roughly the national average]), could observe a major error rate from 8.4% to 24.4% and a class I error rate from 4.1% to 6.7%. Conclusion The possibility that a given autopsy will reveal important unsuspected diagnoses has decreased over time, but remains sufficiently high that encouraging ongoing use of the autopsy appears warranted.

The Autopsy as a Measure of Accuracy of the Death Certificate

1985-11-14

Tobias Kircher , Judith Kay Nelson , Harold Burdo

To determine the extent of agreement on underlying cause of death between death certificates and autopsy reports, we analyzed 272 randomly selected autopsy reports and corresponding death certificates from among … To determine the extent of agreement on underlying cause of death between death certificates and autopsy reports, we analyzed 272 randomly selected autopsy reports and corresponding death certificates from among all such data on autopsies performed in Connecticut in 1980. In 29 per cent of the deaths, a major disagreement on the underlying cause of death led to reclassification of the death in a different International Classification of Diseases major disease category. In an additional 26 per cent, the death certificate and autopsy report agreed on the major disease category but attributed the death to a different specific disease. Deaths due to neoplasms were most accurately diagnosed, with a sensitivity of 87 per cent and a positive predictive value of 85 per cent. Deaths resulting from diseases of the respiratory or digestive system were associated with the highest rates of disagreement. Diseases most commonly overdiagnosed were circulatory disorders, ill-defined conditions, and respiratory diseases. Diseases most commonly underdiagnosed as the cause of death on the death certificate were specific traumatic conditions and gastrointestinal disorders. The autopsy remains an important method for ensuring the quality of mortality statistics.

Incidence of venous thromboembolism verified by necropsy over 30 years.

1991-03-23

Bengt Lindblad , Nils H. Sternby , David Bergqvist

OBJECTIVE--To determine the incidence of venous thromboembolism in all necropsy reports over 30 years. DESIGN--Study of all necropsies in one hospital in 1987 and longitudinal analysis of results of necropsy … OBJECTIVE--To determine the incidence of venous thromboembolism in all necropsy reports over 30 years. DESIGN--Study of all necropsies in one hospital in 1987 and longitudinal analysis of results of necropsy in 1957, 1964, 1975, and 1987. SETTING--Departments of general surgery, infectious diseases, internal medicine, oncology, and orthopaedics in a Swedish general hospital. MAIN OUTCOME MEASURE--Number of cases of venous thromboembolism. RESULTS--About a third of all necropsies showed venous thromboembolism. In 1987, 260 of 347 necropsies showing venous thromboembolism found pulmonary embolism, of which 93 were classified as fatal, 90 as contributory, and 77 as incidental. Only 21 contributory or fatal postoperative pulmonary emboli were seen. In only 106 of 260 patients with pulmonary embolism did routine necropsy not show the source of embolism. Calf veins were not routinely examined. Deep venous thrombosis was seen in 239 patients in 1987. The incidence of venous thromboembolism in the four years studied was remarkably stable except in the department of orthopaedics, where the proportion fell from 60.7% in 1975 to 32.2% in 1987 (p less than 0.05), although there were only a few patients. CONCLUSIONS--The overall incidence of venous thromboembolism has not changed over 30 years. During this period the proportion of the population aged over 65 has doubled, and this may have masked the beneficial effects of prophylaxis and early mobilisation. Prevalences corrected for age are needed.

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CYANOSIS IN INFANTS CAUSED BY NITRATES IN WELL WATER

1945-09-08

Hunter H. Comly

Two examples of a previously unrecognized condition which may be confused with congenital heart disease are cited in this report. The condition may occur anywhere in rural areas where well … Two examples of a previously unrecognized condition which may be confused with congenital heart disease are cited in this report. The condition may occur anywhere in rural areas where well water is used in infant feeding. <h3>REPORT OF CASES</h3><h3>Case 1.—</h3> C. H., a white female baby, was born two weeks before the expected date by cesarean section because of toxemia of pregnancy, which had been severe for one month. The birth weight was 3,870 Gm. (8 pounds 8 ounces). There was no known neonatal distress. On the twelfth day after birth, when she left the hospital, she weighed 3,720 grams (8 pounds 3 ounces). The formula she was receiving at that time was evaporated milk 210 cc. and water 540 cc. with 30 Gm. of a dextrin-maltose preparation. She was admitted to a local hospital at 18 days of age because of vomiting, excessive crying and failure to gain

Anatomical Variations in the Pituitary Gland and Adjacent Structures in 225 Human Autopsy Cases

1968-02-01

Richard M. Bergland , Bronson S. Ray , Richard M. Torack

Incidence of severe acute renal failure in adults: results of a community based study.

1993-02-20

Terry Feest , Alfred D. Round , S N Hamad

OBJECTIVE--To determine the age related incidence of severe acute renal failure in adults in two health districts in England. DESIGN--Prospective study of patients identified as having severe acute renal failure … OBJECTIVE--To determine the age related incidence of severe acute renal failure in adults in two health districts in England. DESIGN--Prospective study of patients identified as having severe acute renal failure within a two year period; subsequent monitoring of outcome for a further two years. SETTING--Two health districts in Devon. SUBJECTS--Those adults in a population of 444,971 who developed severe acute renal failure (serum creatinine concentration > 500 mumol/l) for the first time during two years, with subsequent fall of the serum creatinine concentration below the index value. MAIN OUTCOME MEASURES AND RESULTS--125 adults (140 per million total population yearly, 172 per million adults) developed severe acute renal failure, of whom 90 (72%) were over 70. Age related incidence rose from 17 per million yearly in adults under 50 to 949 per million yearly in the 80-89 age groups. In 31 patients (25%) the cause was prostatic disease, which was related to a good prognosis (84% (26) alive at three months). Overall survival was 54% (67) at three months and 34% (42) at two years and was not significantly age related. 18 per million total population yearly (22 per million adult population) received acute dialysis. Referral rate for specialised opinion was 51 per million total population yearly with an estimated appropriate referral rate of 70 per million per year. CONCLUSIONS--The incidence of severe acute renal failure in the community is at least twice as high as the incidence reported from renal unit based studies. Prostatic disease, a preventable and treatable problem, is the most common cause. Survival figures indicate that age alone should not be a bar to specialist referral or treatment.

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Accuracy of cause-of-death coding in Taiwan: types of miscoding and effects on mortality statistics

2000-04-01

Tsung‐Hsueh Lu , Meng-Chih Lee , Ming-Chih Chou

Background The objectives of this study were to assess the accuracy of cause-of-death coding, determine the extent to which coders follow the selection rules of coding set out in the … Background The objectives of this study were to assess the accuracy of cause-of-death coding, determine the extent to which coders follow the selection rules of coding set out in the International Classification of Diseases, 9th Revision (ICD-9), and the effects of miscoding on mortality statistics in Taiwan. Method A systematic sample of 5621 death certificates was reviewed. The underlying cause of death (UCD) selected by the reviewer for each death certificate was compared with that selected by the original coder. The UCD was selected according to ACME (Automated Classification of Medical Entities) Decision Tables. Results The overall agreement rates between the reviewer and coders according to the three-digit and two-digit categories of ICD-9 were 80.9% and 83.9%, respectively. Good agreement was found for malignant neoplasms (kappa = 0.94) and injuries and poisoning (kappa = 0.97), but there was poor agreement for nephrotic diseases (kappa = 0.74), hypertension-related diseases (kappa = 0.74), and cerebral infarction (kappa = 0.77). Reasons for disagreements included disagreement in nomenclature (42.8%), inappropriate judgement of causal relationships (41.5%), and incorrect interpretation of Selection Rule 3 and Modification Rules (15.7%). Conclusion This study showed various levels of agreement for different diseases between the reviewer and the original coders in selection of the UCD. Owing to the ‘compensatory effect of errors’, the national mortality statistics were not affected significantly. The national administration should undertake routine internal studies to control the quality of UCD coding practices.

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VIRTOPSY: Minimally Invasive, Imaging-guided Virtual Autopsy

2006-09-01

Richard Dirnhofer , Christian Jackowski , Peter Vock +2 more

Invasive "body-opening" autopsy represents the traditional means of postmortem investigation in humans. However, modern cross-sectional imaging techniques can supplement and may even partially replace traditional autopsy. Computed tomography (CT) is … Invasive "body-opening" autopsy represents the traditional means of postmortem investigation in humans. However, modern cross-sectional imaging techniques can supplement and may even partially replace traditional autopsy. Computed tomography (CT) is the imaging modality of choice for two- and three-dimensional documentation and analysis of autopsy findings including fracture systems, pathologic gas collections (eg, air embolism, subcutaneous emphysema after trauma, hyperbaric trauma, decomposition effects), and gross tissue injury. Various postprocessing techniques can provide strong forensic evidence for use in legal proceedings. Magnetic resonance (MR) imaging has had a greater impact in demonstrating soft-tissue injury, organ trauma, and nontraumatic conditions. However, the differences in morphologic features and signal intensity characteristics seen at antemortem versus postmortem MR imaging have not yet been studied systematically. The documentation and analysis of postmortem findings with CT and MR imaging and postprocessing techniques ("virtopsy") is investigator independent, objective, and noninvasive and will lead to qualitative improvements in forensic pathologic investigation. Future applications of this approach include the assessment of morbidity and mortality in the general population and, perhaps, routine screening of bodies prior to burial. © RSNA, 2006

Broken Heart: A Statistical Study of Increased Mortality among Widowers

1969-03-22

Colin Murray Parkes , B. Benjamin , Ryan Fitzgerald

A total of 4,486 widowers of 55 years of age and older have been followed up for nine years since the death of their wives in 1957. Of these 213 … A total of 4,486 widowers of 55 years of age and older have been followed up for nine years since the death of their wives in 1957. Of these 213 died during the first six months of bereavement, 40% above the expected rate for married men of the same age. Thereafter the mortality rate fell gradually to that of married men and remained at about the same leveLThe greatest increase in mortality during the first six months was found in the widowers dying from coronary thrombosis and other arteriosclerotic and degenerative heart disease. There was also evidence of a true increase in mortality from other diseases, though the numbers in individual categories were too small for statistical analysis.In the first six months 22.5% of the deaths were from the same diagnostic group as the wife's death. Some evidence suggests that this may be a larger proportion than would be expected by chance association, but there is no evidence suggesting that the proportion is any different among widows and widowers who have been bereaved for more than six months.

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Clinical, educational, and epidemiological value of autopsy

2007-03-24

Julian Burton , James Underwood

Verbal autopsy

2006-03-01

Nadia Soleman

Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems.In some regions of … Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems.In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death.Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia.In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems.We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries.The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites.We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data.We also highlight further steps needed in the development of a standard VA process.

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Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta‐analysis and review

2005-11-22

J. Roulson , E W Benbow , P S Hasleton

The autopsy is in decline, despite the fact that accurate mortality statistics remain essential for public health and health service planning. The falling autopsy rate combined with the Coroners Review … The autopsy is in decline, despite the fact that accurate mortality statistics remain essential for public health and health service planning. The falling autopsy rate combined with the Coroners Review and Human Tissue Act have contributed to this decline, and to a falling use of autopsy histology, with potential impact on clinical audit and mortality statistics. At a time when the need for reform and improvement in the death certification process is so prominent, we felt it important to assess the value of the autopsy and autopsy histology. We carried out a meta‐analysis of discrepancies between clinical and autopsy diagnoses and the contribution of autopsy histology. There has been little improvement in the overall rate of discrepancies between the 1960s and the present. At least a third of death certificates are likely to be incorrect and 50% of autopsies produce findings unsuspected before death. In addition, the cases which give rise to discrepancies cannot be identified prior to autopsy. Over 20% of clinically unexpected autopsy findings, including 5% of major findings, can be correctly diagnosed only by histological examination. Although the autopsy and particularly autopsy histology are being undermined, they are still the most accurate method of determining the cause of death and auditing accuracy of clinical diagnosis, diagnostic tests and death certification.

The Danish Register of Causes of Death

2011-07-01

Karin Helweg‐Larsen

Cause-specific mortality statistics is a valuable source for the identification of risk factors for poor public health.Since 1875, the National Board of Health has maintained the register covering all deaths … Cause-specific mortality statistics is a valuable source for the identification of risk factors for poor public health.Since 1875, the National Board of Health has maintained the register covering all deaths among citizens dying in Denmark, and since 1970 has computerised individual records.Classification of cause(s) of deaths is done in accordance to WHO's rules, since 1994 by ICD-10 codes. A change in coding practices and a low autopsy rate might influence the continuity and validity in cause-specific mortality.The longstanding national registration of causes of death is essential for much research. The quality of the register on causes of death relies mainly upon the correctness of the physicians' notification and the coding in the National Board of Health.

An introduction to the Barell body region by nature of injury diagnosis matrix

2002-06-01

Vita Barell , Limor Aharonson‐Daniel , Lois A. Fingerhut +6 more

The Barell body region by nature of injury diagnosis matrix standardizes data selection and reports, using a two dimensional array (matrix) that includes all International Classification of Diseases (ICD)-9-CM codes … The Barell body region by nature of injury diagnosis matrix standardizes data selection and reports, using a two dimensional array (matrix) that includes all International Classification of Diseases (ICD)-9-CM codes describing trauma.To provide a standard format for reports from trauma registries, hospital discharge data systems, emergency department data systems, or other sources of non-fatal injury data. This tool could also be used to characterize the patterns of injury using a manageable number of clinically meaningful diagnostic categories and to serve as a standard for casemix comparison across time and place.The matrix displays 12 nature of injury columns and 36 body region rows placing each ICD-9-CM code in the range from 800 to 995 in a unique cell location in the matrix. Each cell includes the codes associated with a given injury. The matrix rows and columns can easily be collapsed to get broader groupings or expanded if more specific sites are required. The current matrix offers three standard levels of detail through predefined collapsing of body regions from 36 rows to nine rows to five rows. MATRIX DEVELOPMENT: This paper presents stages in the development and the major concepts and properties of the matrix, using data from the Israeli national trauma registry, and from the US National Hospital Discharge Survey. The matrix introduces new ideas such as the separation of traumatic brain injury (TBI), into three types. Injuries to the eye have been separated from other facial injuries. Other head injuries such as open wounds and burns were categorized separately. Injuries to the spinal cord and spinal column were also separated as are the abdomen and pelvis. Extremities have been divided into upper and lower with a further subdivision into more specific regions. Hip fractures were separated from other lower extremity fractures. FORTHCOMING DEVELOPMENTS: The matrix will be used for the development of standard methods for the analysis of multiple injuries and the creation of patient injury profiles. To meet the growing use of ICD-10 and to be applicable to a wider range of countries, the matrix will be translated to ICD-10 and eventually to ICD-10-CM.The Barell injury diagnosis matrix has the potential to serve as a basic tool in epidemiological and clinical analyses of injury data.

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Validation of 1989 Tennessee Birth Certificates using Maternal and Newborn Hospital Records

1993-04-01

Joyce M. Piper , Edward F. Mitchel , Mary Snowden +3 more

In 1989, the state of Tennessee adopted a new birth certificate which incorporates changes recommended by the National Center for Health Statistics in the revised US Standard Certificate of Live … In 1989, the state of Tennessee adopted a new birth certificate which incorporates changes recommended by the National Center for Health Statistics in the revised US Standard Certificate of Live Birth. The data now being collected are intended to provide improved information for understanding maternal and infant health issues. To assess data quality, the authors compared information reported on the 1989 Tennessee birth certificates with the same data obtained from an ongoing case-control study in which the delivery hospital medical records of mothers and infants were reviewed by trained nurse abstractors using a structured data collection instrument. Cases (n = 1,016) were all infants born in Tennessee in 1989 with birth weights less than 1,500 g or other infants who died during the first 28 days of life. The infants were identified from linked birth-death certificate files. Control infants (n = 634) were randomly selected from the noncase population. The most reliable information obtained from birth certificates was descriptive demographic data and birth weight. The quality of information obtained from the new birth certificate checkboxes varied. Routine medical procedures were better reported on the birth certificates than relatively uncommon conditions and occurrences, even serious ones. Caution is needed in using birth certificate data for assessment of maternal medical risk factors, complications of labor and delivery, abnormal conditions of the newborn, and congenital anomalies, since sensitivity is low.

The Danish registers of causes of death.

1999-09-01

Knud Juel , Karin Helweg‐Larsen

In 1875 registration of causes of death in Denmark was established by the National Board of Health, and annual statistics of death have since been published. Until 1970 the national … In 1875 registration of causes of death in Denmark was established by the National Board of Health, and annual statistics of death have since been published. Until 1970 the national statistics were based upon punched cards with data collected from the death certificates. Since then the register has been fully computerized and includes individual based data of all deaths occurring among all residents in Denmark dying in Denmark. Furthermore, a microfilm of all death certificates from 1943 and onward is kept in the National Board of Health. The Danish Institute for Clinical Epidemiology (DICE) has established a computerized register of individual records of deaths in Denmark from 1943 and onwards. No other country covers computerized individual based data of death registration for such a long period, now 54 years. This paper describes the history of the registers, the data sources and access to data, and the research based upon the registers, presenting some examples of research activities.

Prognosis of Cancers Associated with Venous Thromboembolism

2000-12-21

Henrik Toft Sørensen , Lene Mellemkjær , Jørgen H. Olsen +1 more

Little is known about the prognosis of cancer discovered during or after an episode of venous thromboembolism. Little is known about the prognosis of cancer discovered during or after an episode of venous thromboembolism.

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The Clinical Course of Pulmonary Embolism

1992-05-07

Jeffrey L. Carson , Mark A. Kelley , Amy Duff +7 more

Pulmonary embolism is a potentially fatal disorder. Information about the outcome of clinically recognized pulmonary embolism is sparse, particularly given that new treatments for more seriously ill patients are now … Pulmonary embolism is a potentially fatal disorder. Information about the outcome of clinically recognized pulmonary embolism is sparse, particularly given that new treatments for more seriously ill patients are now available.We prospectively followed 399 patients with pulmonary embolism diagnosed by lung scanning and pulmonary angiography, who were enrolled in a multicenter diagnostic trial. We reviewed all hospitalizations, all new investigations of pulmonary embolism, and all deaths among the patients within one year of diagnosis.Of the 399 patients, 375 (94 percent) received treatment for pulmonary embolism, usually conventional anticoagulation. Only 10 patients (2.5 percent) died of pulmonary embolism; 9 of them had clinically suspected recurrent pulmonary embolism. Clinically apparent pulmonary embolism recurred in 33 patients (8.3 percent), of whom 45 percent died during follow-up. Ninety-five patients with pulmonary embolism (23.8 percent) died within one year. The conditions associated with these deaths were cancer (relative risk, 3.8; 95 percent confidence interval, 2.3 to 6.4), left-sided congestive heart failure (relative risk, 2.7; 95 percent confidence interval, 1.5 to 4.6), and chronic lung disease (relative risk, 2.2; 95 percent confidence interval, 1.2 to 4.0). The most frequent causes of death in patients with pulmonary embolism were cancer (in 34.7 percent), infection (22.1 percent), and cardiac disease (16.8 percent).When properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death, and it recurred in only a small minority of patients. Most deaths were due to underlying diseases. Patients with pulmonary embolism who had cancer, congestive heart failure, or chronic lung disease had a higher risk of dying within one year than did other patients with pulmonary embolism.

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Deaths: Final Data for 2013.

2016-02-16

Jiaquan Xu , Sherry L Murphy , Kenneth D. Kochanek +1 more

This report presents final 2013 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends, by selected characteristics such as age, sex, Hispanic origin, race, state of residence, … This report presents final 2013 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends, by selected characteristics such as age, sex, Hispanic origin, race, state of residence, and cause of death.Information reported on death certificates, which are completed by funeral directors, attending physicians, medical examiners, and coroners, is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention’s National Center for Health Statistics. Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision.In 2013, a total of 2,596,993 deaths were reported in the United States. The age-adjusted death rate was 731.9 deaths per 100,000 U.S. standard population, a record low figure, but the decrease in 2013 from 2012 was not statistically significant. Life expectancy at birth was 78.8 years, the same as in 2012. Age-specific death rates decreased in 2013 from 2012 for age groups 15–24 and 75–84. Age-specific death rates increased only for age group 55–64. The 15 leading causes of death in 2013 remained the same as in 2012, although Accidents (unintentional injuries), the 5th leading cause of death in 2012, became the 4th leading cause in 2013, while Cerebrovascular diseases (stroke), the 4th leading cause in 2012, became the 5th leading cause of death in 2013. The infant mortality rate of 5.96 deaths per 1,000 live births in 2013 was a historically low value, but it was not significantly different from the 2012 rate.Although statistically unchanged from 2012, the decline in the age-adjusted death rate is consistent with long-term trends in mortality. Life expectancy in 2013 remained the same as in 2012.

Knight's Forensic Pathology, 3Ed

2004-01-30

Pekka Saukko , Bernard Knight

In this third edition, Knight's Forensic Pathology continues to be the definitive international postgraduate textbook for forensic pathologists, covering all aspects of the medico-legal autopsy, including the cause and time … In this third edition, Knight's Forensic Pathology continues to be the definitive international postgraduate textbook for forensic pathologists, covering all aspects of the medico-legal autopsy, including the cause and time of death, interpretation of wounds and every other facet of the investigation of a fatality. The emphasis is on the practical

NEW PATHOLOGICAL INSTITUTE AT THE LONDON

1965-05-01

Debra Evans , H E DEWARDENER , J R CURTIS +2 more

Google DeepMind and healthcare in an age of algorithms

2017-03-16

Julia Powles , Hal Hodson

Data-driven tools and techniques, particularly machine learning methods that underpin artificial intelligence, offer promise in improving healthcare systems and services. One of the companies aspiring to pioneer these advances is … Data-driven tools and techniques, particularly machine learning methods that underpin artificial intelligence, offer promise in improving healthcare systems and services. One of the companies aspiring to pioneer these advances is DeepMind Technologies Limited, a wholly-owned subsidiary of the Google conglomerate, Alphabet Inc. In 2016, DeepMind announced its first major health project: a collaboration with the Royal Free London NHS Foundation Trust, to assist in the management of acute kidney injury. Initially received with great enthusiasm, the collaboration has suffered from a lack of clarity and openness, with issues of privacy and power emerging as potent challenges as the project has unfolded. Taking the DeepMind-Royal Free case study as its pivot, this article draws a number of lessons on the transfer of population-derived datasets to large private prospectors, identifying critical questions for policy-makers, industry and individuals as healthcare moves into an algorithmic age.

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The Swedish cause of death register

2017-09-01

Hannah L. Brooke , Mats Talbäck , Jesper Hörnblad +5 more

Sweden has a long tradition of recording cause of death data. The Swedish cause of death register is a high quality virtually complete register of all deaths in Sweden since … Sweden has a long tradition of recording cause of death data. The Swedish cause of death register is a high quality virtually complete register of all deaths in Sweden since 1952. Although originally created for official statistics, it is a highly important data source for medical research since it can be linked to many other national registers, which contain data on social and health factors in the Swedish population. For the appropriate use of this register, it is fundamental to understand its origins and composition. In this paper we describe the origins and composition of the Swedish cause of death register, set out the key strengths and weaknesses of the register, and present the main causes of death across age groups and over time in Sweden. This paper provides a guide and reference to individuals and organisations interested in data from the Swedish cause of death register.

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The Human Skeleton in Forensic Medicine

1963-09-01

Alice M. Brues , Wilton Marion Krogman

Automated deep-neural-network surveillance of cranial images for acute neurologic events

2018-08-06

J. Titano , Marcus A. Badgeley , Javin Schefflein +7 more

The RSNA Pediatric Bone Age Machine Learning Challenge

2018-11-27

Safwan S. Halabi , Luciano M. Prevedello , Jayashree Kalpathy‐Cramer +7 more

Purpose The Radiological Society of North America (RSNA) Pediatric Bone Age Machine Learning Challenge was created to show an application of machine learning (ML) and artificial intelligence (AI) in medical … Purpose The Radiological Society of North America (RSNA) Pediatric Bone Age Machine Learning Challenge was created to show an application of machine learning (ML) and artificial intelligence (AI) in medical imaging, promote collaboration to catalyze AI model creation, and identify innovators in medical imaging. Materials and Methods The goal of this challenge was to solicit individuals and teams to create an algorithm or model using ML techniques that would accurately determine skeletal age in a curated data set of pediatric hand radiographs. The primary evaluation measure was the mean absolute distance (MAD) in months, which was calculated as the mean of the absolute values of the difference between the model estimates and those of the reference standard, bone age. Results A data set consisting of 14 236 hand radiographs (12 611 training set, 1425 validation set, 200 test set) was made available to registered challenge participants. A total of 260 individuals or teams registered on the Challenge website. A total of 105 submissions were uploaded from 48 unique users during the training, validation, and test phases. Almost all methods used deep neural network techniques based on one or more convolutional neural networks (CNNs). The best five results based on MAD were 4.2, 4.4, 4.4, 4.5, and 4.5 months, respectively. Conclusion The RSNA Pediatric Bone Age Machine Learning Challenge showed how a coordinated approach to solving a medical imaging problem can be successfully conducted. Future ML challenges will catalyze collaboration and development of ML tools and methods that can potentially improve diagnostic accuracy and patient care. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Siegel in this issue.

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Deaths: Final Data for 2017.

2019-06-01

Kenneth D. Kochanek , Sherry L Murphy , Jiaquan Xu +1 more

Objectives-This report presents final 2017 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends, by selected characteristics such as age, sex, Hispanic origin and race, state of … Objectives-This report presents final 2017 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends, by selected characteristics such as age, sex, Hispanic origin and race, state of residence, and cause of death. Methods-Information reported on death certificates is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the National Center for Health Statistics. Causes of death are processed in accordance with the International Classification of Diseases, 10th Revision. Results-In 2017, a total of 2,813,503 deaths were reported in the United States. The age-adjusted death rate was 731.9 deaths per 100,000 U.S. standard population, an increase of 0.4% from the 2016 rate. Life expectancy at birth was 78.6 years, a decrease of 0.1 year from the 2016 rate. Life expectancy decreased from 2016 to 2017 for non-Hispanic white males (0.1 year) and non-Hispanic black males (0.1), and increased for non- Hispanic black females (0.1). Age-specific death rates increased in 2017 from 2016 for age groups 25-34, 35-44, and 85 and over, and decreased for age groups under 1 and 45-54. The 15 leading causes of death in 2017 remained the same as in 2016 although, two causes exchanged ranks. Chronic liver disease and cirrhosis, the 12th leading cause of death in 2016, became the 11th leading cause of death in 2017, while Septicemia, the 11th leading cause of death in 2016, became the 12th leading cause of death in 2017. The infant mortality rate, 5.79 infant deaths per 1,000 live births in 2017, did not change significantly from the rate of 5.87 in 2016. Conclusions-The age-adjusted death rate for the total, male, and female populations increased from 2016 to 2017 and life expectancy at birth decreased in 2017 for the total and male populations.

Bone Marrow Transplant

2016-01-01

Knight's Forensic Pathology

2015-11-04

Saukko Pekka , Bernard Knight

The Forensic Autopsy The Pathophysiology of Death The Establishment of Identity of Human Remains The Pathology of Wounds Head and Spinal Injuries Chest and Abdominal Injuries Self-Inflicted Injury Gunshot and … The Forensic Autopsy The Pathophysiology of Death The Establishment of Identity of Human Remains The Pathology of Wounds Head and Spinal Injuries Chest and Abdominal Injuries Self-Inflicted Injury Gunshot and Explosion Deaths Transportation Injuries Abuse of Human Rights: Deaths in Custody Burns and Scalds Electrical Fatalities Complications of Injury Suffocation and 'Asphyxia' Fatal Pressure on the Neck Immersion Deaths Neglect, Starvation and Hypothermia Deaths Associated with Sexual offences Deaths Associated with Pregnancy Child Homicide Sudden Death in Infancy Fatal Child Abuse Deaths Associated with Surgical Procedures Dysbaric Fatalities and Barotrauma The Pathology of Sudden Death Forensic Dentistry for the Pathologist Poisoning and the Pathologist Forensic Aspects of Alcohol Carbon Monoxide Poisoning Organophosphorus Poisoning Poisoning by Medicines Death from Narcotic and Hallucinogenic Drugs Corrosive and Metallic Poisoning Deaths from Organic Solvents Appendix

INTENSIVE OXYGEN THERAPY AS A POSSIBLE CAUSE OF RETROLENTAL FIBROPLASIA: A CLINICAL APPROACH

1951-07-01

Kate M. Campbell

Sudden Death in a Buffalo Due to Pulmonary Tuberculosis: Diagnostic and Zoonotic Implications

2025-06-25

Peer Rayees Aziz , D. Thakur , Kirti Jamwal | Journal of Scientific Research and Reports

Bovine tuberculosis (bTB), primarily caused by Mycobacterium bovis, is a chronic infectious disease of domestic and wild animals with significant zoonotic implications. This report describes a fatal case of pulmonary … Bovine tuberculosis (bTB), primarily caused by Mycobacterium bovis, is a chronic infectious disease of domestic and wild animals with significant zoonotic implications. This report describes a fatal case of pulmonary tuberculosis in a buffalo (Bubalus bubalis), emphasizing the diagnostic challenges and public health concerns associated with the disease. A adult female buffalo was brought to the Veterinary Clinical Complex (VCC) with clinical signs including anaemia, anorexia, respiratory distress, poor body condition, severe weight loss and exercise intolerance. The animal was admitted to the In-Patient Department (IPD) for symptomatic treatment. Despite supportive care, the buffalo collapsed and died suddenly on the second day of hospitalization. Post-mortem examination revealed multiple caseous and calcified granulomas in the whole thoracic cavity. Histopathological analysis showed granulomatous inflammation with Langhans giant cells. Ziehl-Neelsen staining confirmed the presence of acid-fast bacilli (AFB), consistent with Mycobacterium bovis infection. These findings led to a definitive diagnosis of pulmonary tuberculosis. This case highlights the importance of including tuberculosis in the differential diagnosis of buffaloes presenting with chronic wasting and respiratory signs. Early detection and confirmation through post-mortem and laboratory diagnostics are critical on order to prevent further spread. Given its zoonotic potential, this report highlights the importance of regular surveillance, public health awareness and coordinated One Health strategies for the effective management of bovine tuberculosis (bTB) in livestock.

A useful data presentation tool: Ternary plots in forensic medicine

2025-06-24

Stefan Potente , Frank Ramsthaler , Jan M. Federspiel | Legal Medicine

Artificial Intelligence in Aiding in the Identification of Patients Who Have Experienced Violence

2025-06-24

J. Uittamo | International Journal of Oral and Maxillofacial Surgery

Advancing Forensic Medicine Through Postmortem CT

2025-06-24

| Radiographics

AI-Powered Mortality Prognostication from Head Injury Narratives

2025-06-24

Simon Holmes , Paul Coulthard , Declan Hughes | International Journal of Oral and Maxillofacial Surgery

The value of Micro-CT imaging in the forensic evaluation of neck trauma

2025-06-23

Gary Timmerman , Alexia Van Goethem , Daniël Docter +7 more | Forensic Science International

Forensic application of micro-radiological analysis and 3D-printed vertebrae in a stab wound homicide case

2025-06-22

Oriana Cuman , Federico Toselli , Guido Viel +6 more | Legal Medicine

Concerns with police practice in investigations into the deaths of Indigenous people in Canada

2025-06-19

Steff King , Ted Palys , annie Principle Investigator ross +1 more | Policing & Society

Unusual supravital muscle reaction of the upper limbs caused by an attempt to obtain an idiomuscular tumor

2025-06-18

И. Н. Иванов , A. Zbirovskaya | Forensic Medical Expertise

The article shows the role of long-lasting postmortem spinal reflexes’ potential in rigor mortis development on an example of fatal railway injury. Strokes with metal rod on both biceps caused … The article shows the role of long-lasting postmortem spinal reflexes’ potential in rigor mortis development on an example of fatal railway injury. Strokes with metal rod on both biceps caused a spinal reflex (forearms’ flexion in elbow joints and fingers) instead of an idiomuscular tumor with simultaneous development of a pronounced rigor mortis of the upper limbs on the decapitated corpse of a 20-year-old woman 7.25 h after death.

Uncharacteristic soft tissue injuries detectable in cases of death from general accidental hypothermia

2025-06-18

Aleksandr Chudakov , I A Tolmachev , Alexandra Alexandrovna Kuznetsova | Forensic Medical Expertise

General accidental hypothermia, which leads to death, is a complex problem, the scale of which is significantly underestimated. Statistics on mortality from general deep hypothermia are underreported because the diagnosis … General accidental hypothermia, which leads to death, is a complex problem, the scale of which is significantly underestimated. Statistics on mortality from general deep hypothermia are underreported because the diagnosis is often established after the fact, especially if death occurs in conditions complicating the body discovery or the cause of death determination. Many cases of death, erroneously classified as cardiovascular diseases or other causes, may actually be the result of long-term exposure to cold. In such situations, especially in remote areas or in the absence of proper forensic examination, the true cause of death may remain unknown. Objective. To describe the local signs of human death from hypothermia. Material and methods. In order to establish additional local signs of death from hypothermia, the findings of forensic experts and personal observations on the corpses of people who died from hypothermia on land (150 observations) were analyzed, as well as the personal photo archives of A.Yu. Chudakov. Results. The article describes uncharacteristic but very common soft tissue injuries for death from general hypothermia, including bite wounds of the fingers, abrasions, minor wounds on the back of the hands and fingers, detached nails from terminal self-digging, linear stripe-like abrasions on the face, wounds and bruises on the face and head, areas of the elbow and knee joints, which may indicate events that occurred in the terminal phase and some other data. Conclusion. Diagnosis of death from hypothermia requires a comprehensive approach, including inspection of the accident site (place of the corpse’s discovery), analysis of history, external examination, forensic investigation, histological examination, as well as toxicological and other laboratory tests. Only a comprehensive analysis of all the data allows to establish the exact cause of death and exclude other factors. The mechanisms of human behavior in cooling are complex and require further research, including the study of neurochemical processes occurring in the brain under critical hypothermia.

Placental Pathology Reporting Practices in Australian Stillbirths: A Quality Review

2025-06-17

Tania Marsden , T. Yee Khong , Jane E. Dahlstrom +7 more | Pediatric and Developmental Pathology

Background: Stillbirth continues to pose a significant public health challenge. Autopsy and placental assessments are recognized as the gold standard for stillbirth investigation. The utility of these procedures can vary … Background: Stillbirth continues to pose a significant public health challenge. Autopsy and placental assessments are recognized as the gold standard for stillbirth investigation. The utility of these procedures can vary based on the quality of the examination. The aim of this study is to determine the quality of placenta pathology reporting in Australia in the context of a stillbirth. Materials and Methods: Placenta pathology reports from stillbirths were reviewed from 18 maternity hospital from 2013 to 2018. The Khong tool was used to produce a placenta quality score (PQS), by a blinded panel of assessors to the cause of death. Outcome measures were the number of reports achieving the minimal acceptable score (MAS) of 75% or a poor score (PS) of 50% of the PQS. Results: 560 placental pathology reports of which 494 were singleton and 66 were twin placentas. 282 (50%) achieved the MAS score. Macroscopic items were recorded well and microscopic items recorded poorly. Conclusions: The standard of placenta pathology reporting can be improved in Australia. The use of templates or checklists for both macroscopic descriptions and histological reporting is recommended to ensure all key components are described.

Sudden Death and Post-mortem Techniques

2025-06-17

| CABI eBooks

Bridging Social and Structural Factors in Addressing Firearm Mortality: A PMESII-informed Approach

2025-06-17

Michael Olayinka Gbadebo , Oluwafemi Adeola Gbadebo | Asian Journal of Advanced Research and Reports

This study investigates the social and infrastructural determinants of firearm violence in the United States through a PMESII-informed analytical framework. Drawing from open-access national datasets, including CDC WISQARS, the American … This study investigates the social and infrastructural determinants of firearm violence in the United States through a PMESII-informed analytical framework. Drawing from open-access national datasets, including CDC WISQARS, the American Community Survey, County Health Rankings & Roadmaps, and the CDC/ATSDR Social Vulnerability Index, the research analyzes data from 2,914 U.S. counties. Employing multivariate linear regression, principal component analysis with clustering, and interaction term modeling, the study evaluates how systemic variables contribute to firearm homicide rates. The findings highlight that higher educational attainment (β = -0.176, p < .001) and stricter gun laws (β = -0.045, p < .001) are the most significant protective factors. Furthermore, infrastructural strength measured through healthcare access, housing quality, digital connectivity, and civic support shows a strong inverse correlation with firearm mortality. Notably, a compounded risk effect (β = 3.303, p < .001) emerges in counties with both high social vulnerability and weak infrastructure, underscoring the need for integrated interventions. The study advocates for targeted policy reforms that strengthen educational equity, enforce robust firearm regulations, and expand infrastructure in high-risk areas. These findings emphasize the critical importance of multi-dimensional, data-driven strategies in mitigating gun violence and offer an actionable framework for researchers, policymakers, and urban planners addressing public safety through systemic resilience.

Multi‐Society Guideline for Coding, Billing, and Clinician Training for Detailed Fetal Anatomy Ultrasound in the First Trimester

2025-06-16

| Journal of Ultrasound in Medicine

P41 Percutaneous nephroscopy for extraction of a left kidney bullet

2025-06-16

J. Purvaneckas , Sergejus Gaižauskas , Andrius Gaižauskas | European Urology Open Science

Unveiling liver pathology in autopsy cases

2025-06-15

G. Harshitha , Bharati M Bhavikatti , U T Kanchana +2 more | Indian Journal of Pathology and Oncology

ISNS General Guidelines for Neonatal Bloodspot Screening 2025

2025-06-14

Dianne Webster , Amy Gaviglio , Aysha Habib Khan +7 more | International Journal of Neonatal Screening

Part of the vision of the ISNS is 'to enhance the quality of neonatal screening and medical services through dissemination of information, guidelines and best practices.' Although newborn screening encompasses … Part of the vision of the ISNS is 'to enhance the quality of neonatal screening and medical services through dissemination of information, guidelines and best practices.' Although newborn screening encompasses testing in the newborn period for critical congenital heart disease, hearing impairment, birth defects, and congenital biochemical disorders (usually on bloodspots), this guideline is specifically about bloodspot screening. The ISNS has provided neonatal screening guidelines for many years and here presents the renewed 2025 General Guidelines for Neonatal Bloodspot Screening. They are intended to provide a framework for screening programs to develop specific policies around all aspects of the newborn screening system, offering the basic set of items for consideration. These guidelines provide trusted anchors to build, expand, or maintain robustly organized neonatal or newborn screening (NBS) programs and a checklist to evaluate and improve the essential elements of those programs. For starting or developing programs, it is a set of elements for which provisions need to be in place and a checklist of items that the screening program should at a minimum have provisions for. The publication of these guidelines is meant as a starting point for interactive discussion, to further improve this document and expand where necessary.

Advanced Interpretation of Bullet-Affected Chest X-Rays Using Deep Transfer Learning

2025-06-13

Shadab Khan , Nirban Bhowmick , Azib Farooq +5 more | AI

Deep learning has brought substantial progress to medical imaging, which has resulted in continuous improvements in diagnostic procedures. Through deep learning architecture implementations, radiology professionals achieve automated pathological condition detection, … Deep learning has brought substantial progress to medical imaging, which has resulted in continuous improvements in diagnostic procedures. Through deep learning architecture implementations, radiology professionals achieve automated pathological condition detection, segmentation, and classification with improved accuracy. The research tackles a rarely studied clinical medical imaging issue that involves bullet identification and positioning within X-ray images. The purpose is to construct a sturdy deep learning system that will identify and classify ballistic trauma in images. Our research examined various deep learning models that functioned either as classifiers or as object detectors to develop effective solutions for ballistic trauma detection in X-ray images. Research data was developed by replicating controlled bullet damage in chest X-rays while expanding to a wider range of anatomical areas that include the legs, abdomen, and head. Special deep learning algorithms went through a process of optimization before researchers improved their ability to detect and place objects. Multiple computational systems were used to verify the results, which showcased the effectiveness of the proposed solution. This research provides new perspectives on understanding forensic radiology trauma assessment by developing the first deep learning system that detects and classifies gun-related radiographic injuries automatically. The first system for forensic radiology designed with automated deep learning to classify gunshot wounds in radiographs is introduced by this research. This approach offers new ways to look at trauma which is helpful for work in clinics as well as in law enforcement.

Rethinking ‘Probable Cause of Death’: A comparative analysis of Physician-Certified Verbal Autopsy and Forensic Autopsy Outputs in community deaths in Lusaka, Zambia

2025-06-12

Bwalya Mulenga , Chibamba Mumba , Nathan M. Kayonde +2 more | Forensic Science International Synergy

Illness and Disease Behind Bars

2025-06-12

Lior Gideon | Routledge eBooks

Sepsis detection at autopsy

2025-06-12

Arjun Chandran , Arneet Arora , Sagar Khadanga | Journal of Laboratory Physicians

CIBAS AND DUCATMAN’SCYTOLOGYDiagnostic Principles and Clinical Correlates

2025-06-02

| Elsevier eBooks

Classifying stillbirths using CODAC simplified classification and placental histopathology: A prospective observational study in a tertiary care hospital

2025-06-01

Rupa Satish Padwalkar , Pia Muriel Cardoso | The New Indian Journal of OBGYN

Potassium chloride intracardiac fetal injection and tissue degeneration at fetal autopsy following induction abortion

2025-06-01

Kelvin CHUI , Jefferson Terry , Jennifer A. Hutcheon +2 more | Contraception

To assess the impact of potassium chloride intracardiac injection (KCl) on tissue degeneration at fetal autopsy, which may help inform termination care and autopsy expectations. In this retrospective cohort of … To assess the impact of potassium chloride intracardiac injection (KCl) on tissue degeneration at fetal autopsy, which may help inform termination care and autopsy expectations. In this retrospective cohort of induction abortions with fetal autopsies (N=266), we estimated the association between KCl and fetal tissue degeneration (qualitative assessment and quantitative ratio of basophilia:eosinophilia). We used log binomal and linear regression to calculate risk ratios and mean differences with 95% confidence intervals. Those who received KCl were more likely to have qualitative tissue degeneration than those who did not (RR 2.8 [95% CI 1.3-6.1]). Quantitative basophilia:eosinophilia ratios were lower among those with KCl (mean difference in cardiac tissues of -0.031 [95%CI -0.039 to -0.023]), which further supports increased tissue degeneration in these cases. Fetal autopsies from induction abortions that had KCl fetal injection had increased risk of tissue degeneration compared with those that did not.

Head Injuries and Serial Killers: Explore the Link Between Head Trauma and Criminal Behaviour

2025-06-01

Melissa Nwako | BJPsych Open

Aims: This research aims to investigate whether there is a significant correlation between head injuries and the development of violent, repetitive criminal behaviours, particularly serial killers. Examining the neurological and … Aims: This research aims to investigate whether there is a significant correlation between head injuries and the development of violent, repetitive criminal behaviours, particularly serial killers. Examining the neurological and psychological factors associated with head injuries. This study seeks to understand better their influence on criminal tendencies and patterns of behaviour. Methods: 1. Neuroimaging: This showed reduced amygdala and frontal cortex interconnection. 2. Documented cases of serial killers with a history of head injuries. 3. Nature and timing of head injury; behavioural changes post-injury. 4. Statistics from findings out of 11 serial killers that were studied. Results: 1. Neuroimaging showed reduced amygdala and frontal cortex interconnection and decreased grey matter. 2. High-profile serial killers who had documented head injuries: Richard Ramirez, Glen Edward Rogers, and John Wayne Gacy. Arthur Shawcross, Fred West. 3. Nature: Richard Ramirez, aged 2; a dresser fell on him and aged 5 was knocked out by a swing in the park; both of these caused him to have epileptic seizures throughout his childhood (temporal lobe epilepsy). Glen Edward Rogers, aged 1–2, would rock back and forth, continually banging his forehead against hard surfaces; Arthur Shawcross, aged 16, was hit in the head with a sports discus; and Arthur Shawcross, aged 19, fell off a ladder, concussing himself. Fred West, aged 17, had a motorcycle accident, and aged 19, was punched in the face, which led him to fall two floors, causing him to black out and frequently suffer from violent rages. Brain injuries before the age of 5 permanently disrupt the development of key foundational brain structures, whereas brain injuries in teenage years disrupt ongoing development, altering existing behaviour. Behavioural changes post-injury: emotional instability, social withdrawal, impulsiveness, and poor decision-making. 4. 80% of the most high-profile serial killers have had significant brain injuries. Conclusion: The findings suggest that head injuries, especially those affecting specific brain regions, can lead to problems with impulse control, emotional regulation, and decision-making. Findings also suggest that timing plays a key role too. Early-life brain injuries, particularly during critical developmental stages, disrupt emotional and social development, whereas brain injuries during adolescence often impair impulse control and judgment. For example, the parts of Richard Ramirez’s brain that were damaged were his prefrontal cortex and temporal lobe. These injuries link to his crime as his crimes escalated in brutality, his sadistic behaviour, and also his opportunistic and impulsive nature. Arthur Shawcross similarly, although his injuries were in adolescence, led to sexual deviance and compulsions leading to abnormal sexual behaviour.

Developing and Integrating Regular Training in Serious Incident Investigations and Coroner’s Inquests Into the Higher Trainees Teaching at Kent and Medway NHS and Social Care Partnership Trust (KMPT)

2025-06-01

Maria Moisan , Chiara Rubino , Rachel Daly | BJPsych Open

Aims: This project aims to develop and integrate regular training on Serious Incident (SI) Investigations and Coroner’s Inquests into the Higher Trainees Teaching at Kent and Medway NHS and Social … Aims: This project aims to develop and integrate regular training on Serious Incident (SI) Investigations and Coroner’s Inquests into the Higher Trainees Teaching at Kent and Medway NHS and Social Care Partnership Trust (KMPT). The goal is to enhance trainees’ understanding and confidence in these critical areas, ultimately improving patient safety and supporting psychiatric trainees in their professional development. Methods: Using Quality Improvement (QI) methodology, the project began with a baseline survey to assess trainees’ knowledge and confidence regarding SI investigations and Coroner’s Inquests. Based on identified needs, an Initial Training Event was held in November 2023, which included sessions on SI investigation processes, thematic reviews of suicides, patient safety, and involvement in investigations. The second QI cycle focused on developing and delivering a tailored training programme for Core and Higher Trainees in January 2024. This programme consisted of two sessions: “Introduction to Legal Services HM Coroner” and “Managing Serious Incidents”. Feedback from trainees was gathered through questionnaires to evaluate the effectiveness of the training. Results: The baseline survey (April–May 2023) showed that 71.88% of respondents had limited understanding of SI investigations, with 87.5% expressing interest in further training. The Initial Training Event in November 2023 had 47 attendees, with 92.86% expressing a need for additional training. The tailored training programme in January 2024 had 20 attendees, with 100% of respondents indicating that the training would improve patient safety in their clinical practice. All trainees reported a better understanding of the Coroner’s Inquest process, and 100% agreed that the training should be repeated annually. Notably, the SI investigation process, including Root Cause Analysis (RCA), is now being replaced by the Patient Safety Incident Response Framework (PSIRF), which represents a shift toward a more flexible, learning-focused approach to managing patient safety incidents. The results from the baseline survey and the initial training event were published in BJPsych and presented at the International Congress RCPsych in June 2024. Conclusion: The project successfully identified a significant gap in training regarding SI investigations and Coroner’s Inquests for psychiatric trainees at KMPT. The first two cycles of the QI process have demonstrated positive outcomes, and the need for regular, ongoing training has been clearly established. As a result, this training is now integrated into the Higher Trainees Teaching programme. Future considerations include evaluating feedback from the 2025 training session and potentially introducing Mock Coroner sessions and protocols for trainee involvement in SI investigations, under the new PSIRF framework.

Clinical experience of a fetal post-mortem imaging service using microfocus computed tomography

2025-06-01

Ian C. Simcock , Audrey Lamouroux , Susan C. Shelmerdine +3 more | American Journal of Obstetrics and Gynecology