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Thicot F, Egger C, Castiglioni C, Magnin V, Boudabbous S, Angelakopoulos N, Grabherr S, Genet P. Forensic age estimation at the University Center of Legal Medicine Lausanne-Geneva: a retrospective study over 12 years. Int J Legal Med 2024; 138:1881-1889. [PMID: 38740629 PMCID: PMC11306310 DOI: 10.1007/s00414-024-03254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
With the undeniable increase in asylum requests from unaccompanied alleged minors, age estimation of living individuals has become an essential part of the routine work in European forensic centers. This study aims to review the forensic age estimations performed in our center since 2010, to evaluate the state-of-the-art of this practice in Switzerland with the evolution of the methodology according to upcoming recommendations. Our institute's expert reports performed between 2010 and 2022 were retrospectively analyzed. We gathered the following parameters: demographic data, morphological characteristics, alleged age compared with the assessed minimum age, sexual maturation, dental and bone age. When available, we collected personal and family history, medical history, records of torture-related/self-inflicted injuries, and information about eating habits that might affect skeletal development. Data collection amounted to 656 cases. Forensic age estimations ordered by the Swiss Secretariat for Migration (SEM) represented 76.4% of cases, with 23.6% of them ordered by the Court/Public Prosecutor. Most alleged minors were male (94.5%) and came from Afghanistan (53.4%). Adjunction of CT scans of the sternoclavicular joints was necessary in 86.4% of cases. Only 25.2% of our reports concluded on most probable minority, with 55.6% of definite majors; in 19.2% of our cases, minority could not be excluded. This study aspires to further broaden our expertise regarding forensic age estimations. Given the increasing migratory flows, we can expect a notable increase in the frequency of these requests. Consequently, this study aims to promote a multidisciplinary approach and the international standardization of the methodology of these estimations.
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Affiliation(s)
- Frederique Thicot
- Unit of Forensic Medicine, University Center of Legal Medicine Lausanne-Geneva (CURML), Geneva University Hospitals and University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland.
| | - Coraline Egger
- Unit of Forensic Medicine, University Center of Legal Medicine Lausanne-Geneva (CURML), Geneva University Hospitals and University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland
| | - Claudia Castiglioni
- Unit of Forensic Medicine, University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Chemin de La Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Virginie Magnin
- Unit of Forensic Medicine, University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Chemin de La Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Sana Boudabbous
- Radiology Division, Diagnostic Department, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Nikolaos Angelakopoulos
- Unit of Forensic Medicine, University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Chemin de La Vulliette 4, 1000, Lausanne 25, Switzerland
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Silke Grabherr
- Unit of Forensic Medicine, University Center of Legal Medicine Lausanne-Geneva (CURML), Geneva University Hospitals and University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland
- Unit of Forensic Medicine, University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Chemin de La Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Pia Genet
- Unit of Forensic Medicine, University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Chemin de La Vulliette 4, 1000, Lausanne 25, Switzerland
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Scendoni R, Giuseppe C, Zolotenkova GV, Zolotenkov DD, Rosamaria DV, Giulio D, Recchia L, Cameriere R. Medico-legal indicators and cut-offs in different age classes through quantitative analysis of epiphyseal fusion segments on knee CT scans. Leg Med (Tokyo) 2023; 65:102318. [PMID: 37639821 DOI: 10.1016/j.legalmed.2023.102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Scientists are interested in determining age in subadults for several forensic purposes. High- resolution instrumental techniques are being increasingly used for age estimation, driven by the need to minimize errors; in this context, several studies have focused on the knee joint, recognized as a potential site for age examination in late adolescence. We analyzed 200 CT scans performed on Russian subjects (106 males and 94 females) between 13 and 20 years, without growth diseases, endocrine disorders, or osteodystrophy. Each subject underwent two scans, one for each leg. Two indicators were measured for each bone (femur, tibia and fibula): the entire length of the epiphyseal scar and the length of the part/s that is/are fused with metaphysis. Intra class Correlation Coefficient (ICC) was performed to evaluate the intra-operator reproducibility. The ratio between the two lengths was calculated for each bone (FemurR, TibiaR and FibulaR). The first aim was to evaluate a correlation between the ratios of the three bones and the three bones treated as a single parameter (given by the sum of the ratios) versus age. The results showed good correlations in both cases (τ a = 0.74, 0.64, 0.57 and 0.67). The second aim was to estimate the cut-offs derived from the sum of the three ratios respect to four age classes (14-15 years: cut-off ≤ 0.63, 15-16 years: cut-off ≤ 1.19, 16-17 years: cut-off ≥ 0.68 and 17-18 years: cut-off ≥ 1.49. The results from this research encourage further studies of the knee joint as an indicator of legal adult age.
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Affiliation(s)
- Roberto Scendoni
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy.
| | - Campagna Giuseppe
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - Galina V Zolotenkova
- Department of Forensic Medicine, First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Dmitry D Zolotenkov
- Department of Forensic Medicine, First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - De Vivo Rosamaria
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - D'Aguanno Giulio
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Laura Recchia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Roberto Cameriere
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Ruder TD, Kuhnen SC, Zech WD, Klaus JB, Lombardo P, Ith M. Standards of practice in forensic age estimation with CT of the medial clavicular epiphysis-a systematic review. Int J Legal Med 2023; 137:1757-1766. [PMID: 37691040 PMCID: PMC10567934 DOI: 10.1007/s00414-023-03061-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/08/2023] [Indexed: 09/12/2023]
Abstract
The AGFAD (Arbeitsgemeinschaft für Forensische Alterdiagnostik, Study Group on Forensic Age Diagnostics) has published several recommendations regarding both technical aspects of computed tomography (CT) of the medial clavicular epiphysis (MCE) and the process of reading and interpreting the CT images for forensic age estimations (FAE). There are, however, no published recommendations regarding CT scan protocols and no dose reference values for CT of the MCE. The objective of this analysis was to assess adherence to AGFAD recommendations among practitioners of FAE and analyse reported dose-relevant CT scan parameters with the objective of helping to establish evidence-based dose reference values for FAE. A systematic literature search was conducted in PubMed and in Google Scholar with specific MeSH terms to identify original research articles on FAE with CT of the MCE from 1997 to 2022. A total of 48 studies were included. Adherence to AGFAD recommendations among practitioners of FAE is high regarding the use of Schmeling main stages (93%), bone window (79%), ≤ 1 mm CT slices (67%), axial/coronal CT images (65%), and Kellinghaus sub-stages (59%). The reporting of CT technique and CT dose-relevant scan parameters is heterogeneous and often incomplete in the current literature. Considering the success achieved by the AGFAD in creating standards of practice of FAE in living subjects, there is potential for the AGFAD to establish standards for radiation protection in FAE as well.
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Affiliation(s)
- Thomas D Ruder
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | - Saskia C Kuhnen
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Jeremias B Klaus
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
- Roentgen Institute Thun, Thun, Switzerland
| | - Paolo Lombardo
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Michael Ith
- Institute of Diagnostic, Interventional and Pediatric Radiology, InselspitaI, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
- Radiation Protection, Image Processing Systems & Radiological Processes, Hirslanden Private Hospital Group, Zurich, Switzerland
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Kihara EN, Karanja SM, Wanzala P, Wagaiyu EG. Age assessment services in public dental health facilities in Kenya: burden and sources of referral (a cross-sectional study). Pan Afr Med J 2023; 45:125. [PMID: 37790153 PMCID: PMC10543910 DOI: 10.11604/pamj.2023.45.125.37365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 07/05/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction the need for age assessment remains relevant due to unregistered births or lack of identification documents as a result of political and socioeconomic conflicts. Dentists play a significant role in age assessment. In order to establish the need for capacity building and collaboration, the study set out to determine the proportion of dental patients referred for age assessment and their sources of referral. Methods a cross-sectional study, based on 5-year records (2014-2018) of dental patients and a selected sample of 316 patients who visited for age assessment in 2019-2020 in the same hospitals. The study centers were 8 county hospitals. Variables included gender, dental visits, health facility, and sources of referral. One-way Analysis of Variance (ANOVA) and Fisher´s Exact test were used to identify a significant association between variables. Results from the records, 12,738 (5.7%) patients sought age assessment services. Females 6,410 (50.3%) and males 6,328 (49.7%) were nearly equal. There was a statistically significant difference in the average number of patients who required age assessment services from different facilities, p=0.000. The selected sample comprised of 186 (58.9%) and 130 (41.1%) males and females respectively. Sources of referral included; court of law (267, 84.5%), prior to acquiring identification documents (47, 14.9%), and others (2, 0.6%). Conclusion an average of 5% of dental patients seek age assessment services signifying the need for sustained capacity building so as to ensure competent service delivery. The majority of the sampled patients were referrals from the court of law. Further research on how the dental fraternity can collaborate with the Judiciary to ensure justice in age disputes is recommended.
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Affiliation(s)
- Eunice Njeri Kihara
- School of Public Health, Jomo Kenyatta University of Science and Technology, Nairobi, Kenya
| | - Simon Muturi Karanja
- School of Public Health, Jomo Kenyatta University of Science and Technology, Nairobi, Kenya
| | - Peter Wanzala
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Evelyn Gaceri Wagaiyu
- Department of Periodontology/Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, Nairobi, Kenya
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Bjelopavlovic M, Reder SR, Fritzen I, Brockmann MA, Hardt J, Petrowski K. Forensic Age Estimation: A Multifactorial Approach in a Retrospective Population Study. Diagnostics (Basel) 2023; 13:2029. [PMID: 37370924 DOI: 10.3390/diagnostics13122029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Objectives: The objective of this study was to evaluate the accuracy of forensic age estimation in a German population by combining clavicle and wisdom teeth assessments based on cone beam computed tomography (CT) data. The study aimed to determine the reliability of this approach in predicting biological age. Material and Methods: A total of 161 CT data sets from 120 males and 41 females with known exact ages were evaluated by three raters. The clavicle was assessed according to stages 1-5 (including substages 2a-c and 3a-c), and the Demirjian stage's classification method was used for the wisdom teeth. Inter-class correlation (ICC) was calculated to assess the agreement among the three raters. Additionally, ordinary least square regressions were performed to predict chronological age using the clavicle or one of the four teeth. Finally, age prediction models using multiple indicators were developed. Results: The ICCs ranged from 0.82 for the clavicle to 0.86 and 0.88 for the wisdom teeth. Linear estimation tended to overestimate chronological age, especially in subjects over 18 years old. The clavicle showed the strongest overestimation. Combining age estimation from the clavicle with the upper and lower wisdom teeth improved the predictive power, resulting in a 14% and 15% increase in R² for the upper and lower wisdom teeth, respectively. Adding more than one tooth to the prediction did not improve the predictive power (all ΔR² < 1%). Conclusions: Age estimation using CT can be significantly improved by combining information from the analysis of wisdom teeth with age estimation based on the clavicle.
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Affiliation(s)
- Monika Bjelopavlovic
- Department of Prosthetic Dentistry, University Medical Center, Johannes Gutenberg University Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Sebastian R Reder
- Department of Neuroradiology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Isabel Fritzen
- Department of Prosthetic Dentistry, University Medical Center, Johannes Gutenberg University Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Jochen Hardt
- Department of Medical Psychology and Medical Sociology, University Medical Center, Johannes Gutenberg University Mainz, Duesbergweg 6, 55131 Mainz, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University Medical Center, Johannes Gutenberg University Mainz, Duesbergweg 6, 55131 Mainz, Germany
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Zolotenkova GV, Makarov IY, Minaeva PV, Zolotenkov DD, Poletaeva MP. [Forensic medical examination of the age of living persons in Russia: problematic aspects and solutions]. Sud Med Ekspert 2023; 66:11-17. [PMID: 37796454 DOI: 10.17116/sudmed20236605111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The article presents the results of the study of quantitative indicators and analytical compilation of forensic medical expert practice data in terms of the age of living persons in Russia examination as a whole and in individual federal districts and subjects of Russia in the period from 2003 to 2021. It has been established that against the background of the rather low number of expert examinations, performed to determine the living persons age, there has been an increase in this indicator since 2018, mainly due to the Central Federal District. Regional differences in the studied indicators were identified. A systematic survey study of literature (electronic search of publications in PubMed, Science Direct Scopus and eLIBRARY databases) was conducted on the issue of forensic medical assessment of living persons' age, including the methodical support of this examination type, to form an idea of existing scientific clusters. Search modes allowed to form an array of 184 publications indexed in the database Scopus, PubMed, and 8 publications presented in Russian Science Citation Index. The study results were used as a predictor of the efficacy of the package of measures to modernize this type of expert study. The proposed set of measures to improve the scientific and methodical support of forensic medical examination for age establishment will optimize practical activities and increase the evidential efficacy of expert opinions.
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Affiliation(s)
- G V Zolotenkova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - I Yu Makarov
- Russian Centre of Forensic Medical Expertise, Moscow, Russia
- Moscow Academy of the Investigative Committee of the Russia, Moscow, Russia
| | - P V Minaeva
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
- Russian Centre of Forensic Medical Expertise, Moscow, Russia
| | - D D Zolotenkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M P Poletaeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Taranilla Castro AM, Pujol-Robinat A, Badía García MA, Milián Sebastià S, Martínez Alcázar H, Pomés Tallo J, Oleaga Zufiría L, Xifró Collsamata A. Forensic age estimation in Barcelona: analysis of expert reports issued between 2011 and 2018. Int J Legal Med 2023; 137:395-402. [PMID: 36507962 PMCID: PMC9743109 DOI: 10.1007/s00414-022-02926-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In recent years, there has been a notable increase of migratory movements into Europe with the arrival of not (reliably) documented young individuals within EU-Member States. Accordingly, the need for forensic age assessments likewise increased in order to administratively differentiate along the legally relevant cut-off age of 18 completed years. The objective of our study was to analyse the expert reports of forensic age estimation issued in Barcelona between 2011 and 2018. METHOD In all cases, data on the medical history, physical examination, radiology of the left hand and orthopantomography were collected. In cases without third molars and a complete ossification of the hand, a CT scan of the clavicles was also performed. RESULTS A total of 2754 expert reports were evaluated; 96.7% were males, the majority were of North African origin, mainly from Morocco (63.6%), and 19.6% were sub-Saharan Africans; 65.4% had a level of bone maturation corresponding to the last three standards of Greulich and Pyle. Most cases had mineralization of the third molar corresponding to the F, G or H stages of Demirjian. In 85.9%, there was a correspondence between bone and dental age. A total of 28.8% of the subjects were evaluated as being aged over 18 years; 86.2% of North Africans were considered to be younger than 18, and 82% of sub-Saharan Africans were considered to be over 18 years old. CONCLUSIONS In Barcelona, most of the subjects evaluated were male and North African, and 71.2% of the cases were considered to be minors.
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Affiliation(s)
| | - Amadeo Pujol-Robinat
- Institut de Medicina Legal i Ciències Forenses de Catalunya, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Jaume Pomés Tallo
- grid.410458.c0000 0000 9635 9413Servei de Radiodiagnòstic, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Laura Oleaga Zufiría
- grid.410458.c0000 0000 9635 9413Servei de Radiodiagnòstic, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Alexandre Xifró Collsamata
- Institut de Medicina Legal i Ciències Forenses de Catalunya, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona, Barcelona, Spain
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Bjelopavlovic M, Zeigner AK, Hardt J, Petrowski K. Forensic Dental Age Estimation: Development of New Algorithm Based on the Minimal Necessary Databases. J Pers Med 2022; 12:jpm12081280. [PMID: 36013229 PMCID: PMC9409726 DOI: 10.3390/jpm12081280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Dental age determination relies on the presence of wisdom teeth, which can be assigned to specific age ranges according to their stage of development. The purpose of this study is to highlight the applicability of the Demirjian staging of layman compared to expert, as well as the inclusion of all four wisdom teeth in the overall assessment, in order to emphasize and critically highlight a precise age estimation in clinical practice, especially in the case of agenesis or the presence of less than all four wisdom teeth. Material and Methods: In this study, dental age determination is performed and compared by a trained layperson and an expert using 385 orthopantomograms. The radiographs of known chronological age from male patients in the age range of 11−22 years were acquired from the University Medical Center Mainz. All four wisdom teeth were radiologically viewed if present. Demirjian staging with stages A−H was applied, and regression analysis was performed. Results: The relationship between mineralization of wisdom teeth (18, 28, 38 and 48) and age was linear for all teeth (p < 0.01), except for tooth 18 (p = 0.02). Comparing the prediction of the four teeth individually revealed that the lower teeth gave better predictions than the upper ones (R2 ≥ 0.50 vs. R2 < 0.50). Conclusions: For clinical use, the mandibular wisdom teeth should be preferred when performing dental age estimation using the Demirjian staging method. As a result of the present analysis, two ways of determining dental age by wisdom teeth can be suggested. One is to take only tooth 38, with the formula: age = 3.3 + 0.73 × mineralization of tooth_38. The second recommendation would be to take tooth_48. If both are unavailable, the formula would be age = −0.5 + 0.94 × mineralization tooth_28. Utilizing tooth 18 would not lead to more precise results.
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Affiliation(s)
- Monika Bjelopavlovic
- Department of Prosthetic Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany
- Correspondence: ; Tel.: +49-6131-17-5263; Fax: +49-6131-17-5517
| | - Ann-Katrin Zeigner
- Private Practice S12 Fachzahnärzte Mehlingen, Schulstraße 12, 67678 Mehlingen, Germany
| | - Jochen Hardt
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Duesbergweg 6, 55131 Mainz, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Duesbergweg 6, 55131 Mainz, Germany
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