1
|
Kim DG, Choi HS, Lee TH, Na JY. Postmortem injury evaluation using the Forensic Injury Severity Score Template (FISST): a preliminary study. Forensic Sci Med Pathol 2023; 19:484-498. [PMID: 36749470 DOI: 10.1007/s12024-023-00583-9] [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] [Accepted: 01/11/2023] [Indexed: 02/08/2023]
Abstract
The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are important evaluation tools used in clinical practice to determine the degree of injury in patients with trauma. However, they are not suitable for forensic practice and their use in forensic applications is limited. This study aimed to present a system that can objectively and quantitatively determine the severity of postmortem injuries and that can be applied to forensic medicine. Subsequently, we applied this system to individual postmortem cases and analyzed the injuries identified during autopsy. We performed a retrospective study of 119 autopsies performed between 2018 and 2021. Data were categorized and analyzed using the Forensic Injury Severity Score Template (FISST), a scoring system developed based on the AIS and ISS. The mean FISST scores were as follows: men, 53.6; women, 46.8; 20-65 years old, 55.6; older than 65 years, 41.4; natural death, 13.8; unnatural death, 66.3; and all deaths, 51.8. Statistically significant differences in the FISST scores were found between natural and unnatural deaths, suicidal and accidental deaths, and trauma-related death subtypes. Injuries identified during autopsy can be objectively and quantitatively evaluated using FISST. We suggest that FISST is a useful tool in forensic medicine because it is tailor-made for injury evaluation from a postmortem perspective.
Collapse
Affiliation(s)
- Dae Geon Kim
- Department of Medicine, Pusan National University School of Medicine, 49 Busandaehak-ro Mulgeum-eup, Yangsan, 50612, Republic of Korea
| | - Hae-Sung Choi
- Department of Medicine, Pusan National University School of Medicine, 49 Busandaehak-ro Mulgeum-eup, Yangsan, 50612, Republic of Korea
| | - Tae Hwan Lee
- Department of Medicine, Pusan National University School of Medicine, 49 Busandaehak-ro Mulgeum-eup, Yangsan, 50612, Republic of Korea
| | - Joo-Young Na
- Department of Forensic Medicine, Pusan National University School of Medicine, 49 Busandaehak-ro Mulgeum-eup, Yangsan, 50612, Republic of Korea.
- Department of Pathology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, 50612, Republic of Korea.
| |
Collapse
|
2
|
Levin JH, Pecoraro A, Ochs V, Meagher A, Steenburg SD, Hammer PM. Characterization of fatal blunt injuries using postmortem computed tomography. J Trauma Acute Care Surg 2023; 95:186-190. [PMID: 37068024 DOI: 10.1097/ta.0000000000004012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Rapid triage of blunt agonal trauma patients is necessary to maximize survival, but autopsy is uncommon, slow, and rarely informs resuscitation guidelines. Postmortem computed tomography (PMCT) can serve as an adjunct to autopsy in guiding blunt agonal trauma resuscitation. METHODS Retrospective cohort review of trauma decedents who died at or within 1 hour of arrival following blunt trauma and underwent noncontrasted PMCT. Primary outcome was the prevalence of mortal injury defined as potential exsanguination (e.g., cavitary injury, long bone and pelvic fractures), traumatic brain injury, and cervical spine injury. Secondary outcomes were potentially mortal injuries (e.g., pneumothorax) and misplacement airway devices. Patients were grouped by whether arrest occurred prehospital/in-hospital. Univariate analysis was used to identify differences in injury patterns including multiple-trauma injury patterns. RESULTS Over a 9-year period, 80 decedents were included. Average age was 48.9 ± 21.7 years, 68% male, and an average ISS of 42.3 ± 16.3. The most common mechanism was motor vehicle accidents (67.5%) followed by pedestrian struck (15%). Of all decedents, 62 (77.5%) had traumatic arrest prehospital while 18 (22.5%) arrived with pulse. Between groups there were no significant differences in demographics including ISS. The most common mortal injuries were traumatic brain injury (40%), long bone fractures (25%), moderate/large hemoperitoneum (22.5%), and cervical spine injury (25%). Secondary outcomes included moderate/large pneumothorax (18.8%) and esophageal intubation rate of 5%. There were no significant differences in mortal or potentially mortal injuries, and no differences in multiple-trauma injury patterns. CONCLUSION Fatal blunt injury patterns do not vary between prehospital and in-hospital arrest decedents. High rates of pneumothorax and endotracheal tube misplacement should prompt mandatory chest decompression and confirmation of tube placement in all blunt arrest patients. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
Collapse
Affiliation(s)
- Jeremy H Levin
- From the Division of Acute Care Surgery, Department of Surgery (J.H.L., A.M., P.M.H.), Department of Surgery (A.P.), Indiana University School of Medicine, Indiana University School of Medicine (V.O.), and Division of Emergency Radiology, Department of Radiology and Imaging Sciences (S.D.S.), Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | | | | |
Collapse
|
3
|
Gonçalves AC, Parreira JG, Gianvecchio VAP, Lucarelli-Antunes PDES, Pivetta LGA, Perlingeiro JAG, Assef JC. The role of autopsy on the diagnosis of missed injuries and on the trauma quality program goal definitions: study of 192 cases. Rev Col Bras Cir 2022; 49:e20223319. [PMID: 36449941 PMCID: PMC10578793 DOI: 10.1590/0100-6991e-20223319_en] [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: 03/06/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE to assess the role of autopsy in the diagnosis of missed injuries (MI) and definition of trauma quality program goals. METHOD Retrospective analysis of autopsy reports and patient's charts. Injuries present in the autopsy, but not in the chart, were defined as "missed". MI were characterized using Goldman's criteria: Class I, if the diagnosis would have modified the management and outcome; Class II, if it would have modified the management, but not the outcome; Class III, if it would not have modified neither the management nor the outcome. We used Mann-Whitney's U and Pearson's chi square for statistical analysis, considering p<0.05 as significant. RESULTS We included 192 patients, with mean age of 56.8 years. Blunt trauma accounted for 181 cases, and 28.6% were due to falls from the same level. MI were diagnosed in 39 patients (20.3%). Using Goldman's criteria, MI were categorized as Class I in 3 (1.6%) and Class II in 11 (5.6%). MI were more often diagnosed in the thoracic segment (25 patients, 64.1% of the MI). The variables significantly associated (p<0.05) to MI were: time of hospitalization < 48 h, severe trauma mechanism, and not undergoing surgery or computed tomography. At autopsy, the values of ISS and NISS were higher in patients with MI. CONCLUSION the review of the autopsy report allowed diagnosis of MIs, which did not influence outcome in their majority. Many opportunities of improvement in quality of care were identified.
Collapse
Affiliation(s)
- Augusto Canton Gonçalves
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - José Gustavo Parreira
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | | | | | | | - Jacqueline Arantes Gianninni Perlingeiro
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | - Jose Cesar Assef
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| |
Collapse
|
4
|
Racial Differences in Firearms Used and Autopsies Following Gun Deaths Exist. J Surg Res 2022; 279:666-681. [PMID: 35932721 DOI: 10.1016/j.jss.2022.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Disparities in gun violence across race are well documented. Studying these disparities is essential to reduce preventable gun deaths. This study evaluates the relationship between sociodemographic factors and firearms used in gun deaths. MATERIALS AND METHODS This retrospective cohort study of firearm mortalities from 2009 to 2018 used the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics. The primary outcome was the type of firearm used and the secondary outcome was autopsy status. Factors of interest include race, ethnicity, gender, marital status, age, education, and place of death. Factors significantly associated with outcomes in univariate analyses were included in separate multivariate logistic regression models for assaults, intentional self-harm, and accidents. RESULTS A total of 276,127 firearm deaths from 2009 to 2018 were analyzed. Compared to White victims, Black victims were less likely to die from handguns (accident: odds ratio [OR] = 0.70, P < 0.05; self-harm: OR = 0.84, P < 0.001; assault: OR = 0.58, P < 0.001) and rifles, shotguns, or large firearms (accident: OR = 0.30, P < 0.001; self-harm: OR = 0.37, P < 0.001; assault: OR = 0.28, P < 0.001). Black decedents were more likely to undergo autopsy than White decedents (accident: OR = 2.14, P < 0.001; intentional self-harm: OR = 2.02, P < 0.001; assault: OR = 2.02, P < 0.001). Ethnicity, gender, marital status, age, education, and other racial identities were also associated with firearms used and autopsy rates (P < 0.05). CONCLUSIONS Differences in firearms used and autopsy rates following gun deaths exist by race, ethnicity, gender, marital status, age, and education. Future studies should investigate the relationship between sociodemographic factors and firearms used and autopsy status following gun deaths.
Collapse
|
5
|
Dhillon NK, Patel DC, Huang R, Yang AR, Sekhon HK, Margulies DR, Ley EJ, Barmparas G. Impact of Aggressive Treatments in Trauma: Using the Emergent Department Thoracotomy to Death Ratio. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
6
|
GONÇALVES AUGUSTOCANTON, PARREIRA JOSÉGUSTAVO, GIANVECCHIO VICTORALEXANDREPERCINIO, LUCARELLI-ANTUNES PEDRODESOUZA, PIVETTA LUCAGIOVANNIANTONIO, PERLINGEIRO JACQUELINEARANTESGIANNINNI, ASSEF JOSECESAR. Valor da autópsia no diagnóstico de lesões despercebidas e na definição de metas para programa de qualidade em trauma: estudo de 192 casos. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RESUMO Objetivo: Avaliar a utilidade da autópsia no diagnóstico de lesões despercebidas (LD) e no estabelecimento de metas para programa de qualidade em trauma. Método: análise retrospectiva dos laudos de autópsia por trauma entre outubro/2017 e março/2019 provenientes do mesmo hospital. Lesões descritas na autópsia, mas não no prontuário médico, foram consideradas como despercebidas (LD) e classificadas pelos critérios de Goldman: Classe I: mudariam a conduta e alterariam o desfecho; Classe II: mudariam a conduta, mas não o desfecho; Classe III: não mudariam nem a conduta nem o desfecho. As variáveis coletadas foram comparadas entre o grupo com LD e os demais, através de método estatístico orientado por profissional na área. Consideramos p<0,05 como significativo. Resultados: analisamos 192 casos, com média etária de 56,8 anos. O trauma fechado foi o mecanismo em 181 casos, sendo 28,6% por quedas da própria altura. LD foram observadas em 39 casos (20,3%), sendo 3 (1,6%) classe I e 11 (5,6%) classe II. O tórax foi o segmento com maior número de LD (25 casos - 64,1% das LD). Foram associados à presença de LD (p<0,05): tempo de internação menor que 48 horas, mecanismo de trauma grave e a não realização de procedimento cirúrgico ou tomografia. Nos óbitos até 48h, valores de ISS e NISS nas autópsias foram maiores que os da internação. Conclusão: a revisão das autópsias permitiu identificação de LD, na sua maioria sem influência sobre conduta e prognóstico. Mesmo assim, várias oportunidades foram criadas para o programa de qualidade.
Collapse
Affiliation(s)
| | - JOSÉ GUSTAVO PARREIRA
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil; Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| | | | | | | | | | - JOSE CESAR ASSEF
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil; Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| |
Collapse
|
7
|
Motsumi MJ, Ayane G, Kwati M, Panzirah-Mabaka K, Walsh M. Preventable deaths following road traffic collisions in Botswana: A retrospective review. Injury 2021; 52:2665-2671. [PMID: 33888332 DOI: 10.1016/j.injury.2021.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/02/2023]
Abstract
Road traffic collisions (RTC) are a major cause of mortality and morbidity in Botswana. To our knowledge no research has been conducted in Botswana to investigate preventable deaths that occur as a result of RTCs. The aim of this study is to establish the rate of preventable deaths from RTCs in the greater Gaborone area in Botswana. This was a 5-year retrospective study conducted at the forensic pathology department for the greater Gaborone area, in Botswana. Nine hundred and nine (909) forensic pathology reports were retrieved. Sixty-eight percent (68.2%) of RTC deaths were considered preventable. Head injury in isolation and in combination with other injuries accounted for 87.6% (796/909) of deaths. Haemorrhagic shock was present in 70.2% (638) of all documented injuries. Another documented injury contributing to fatal RTCs was high spinal cord injury. This injury was documented in 13.1% (119/909) of all deaths. We recommend the implementation of a comprehensive trauma system in Botswana to reduce the number of deaths from RTCs.
Collapse
Affiliation(s)
- Mpapho Joseph Motsumi
- Department of Surgery, Faculty of Medicine, University of Botswana, P.O. Box 37 Mogoditshane, Botswana.
| | - Gezahen Ayane
- Department of Surgery, Faculty of Medicine, University of Botswana, P.O. Box 37 Mogoditshane, Botswana
| | - Morapedi Kwati
- Department of Surgery, Princess Marina hospital, Botswana
| | | | - Michael Walsh
- Department of Surgery, Bokamoso private hospital, Botswana
| |
Collapse
|
8
|
Elkbuli A, Boserup B, Sen-Crowe B, Autrey C, McKenney M. Effects of mode and time of EMS transport on the rate and distribution of dead on arrival among trauma population transported to ACSCOT-verified trauma centers in the United States. Am J Emerg Med 2021; 50:264-269. [PMID: 34418717 DOI: 10.1016/j.ajem.2021.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Unintentional injury remains the leading cause of death for adults worldwide. We aimed to investigate the rates and distribution of dead on arrival (DOA) patients according to emergency medical services (EMS) mode of transport (MoT), EMS transport time (TT), injury severity score (ISS), and type of injury. METHODS This retrospective study utilized de-identified incident-based data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP PUF) dataset (2013-2018) to study Adult DOA patients. DOA was defined according to the data point, "arrived with no signs of life and did not recover". Patients with unknown vitals and patients with no EMS vitals at the scene (HR = 0, RR = 0, and SBP = 0) were excluded to identify DOAs who died during transport. The DOAs included for analysis were sorted into three groups based on injury severity score [low (ISS < 15), intermediate (ISS = 15-24), and severe (ISS ≥ 25)] and subdivided according to injury type (blunt vs. penetrating), EMS Mode of transport and transport times. Statistical significance was defined as p < 0.05. RESULTS The majority of the evaluated 6030 adult DOA patients were male (73.3%) and 18-64 years of age (79.6%). Most patients sustained blunt injuries (58.2%), and the most common mechanism of injury was motor vehicle collisions (MVCs). Patients who traveled by helicopter EMS (HEMS) experienced less deaths than those traveling by ground EMS (GEMS) despite transporting more severely injured patients over longer time intervals. Median HEMS TTs were greater than their GEMS counterparts for blunt and penetrating injuries across all ISS groups but were associated with fewer deaths. CONCLUSION Helicopter emergency medical service use with intermediate and severely injured patients with penetrating injuries is associated with a reduced number of DOAs. Future studies should prospectively investigate EMS performance to confirm the findings identified in this retrospective analysis. Additionally, other factors affecting pre-hospital EMS performance (e.g., geographic variations, weather-related characteristics, in-flight interventions/procedures) should be investigated. Finally, the results of this study highlight the need for standardized HEMS utilization triage criteria.
Collapse
Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
| | - Brad Boserup
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Brendon Sen-Crowe
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Cody Autrey
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, United States of America
| |
Collapse
|
9
|
The usefulness of a trauma probability of survival model for forensic life-threatening danger assessments. Int J Legal Med 2021; 135:871-877. [PMID: 33388971 PMCID: PMC8036213 DOI: 10.1007/s00414-020-02499-3] [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: 11/13/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
Clinical forensic medical examinations constitute an increasing proportion of our institution’s tasks, and, concomitantly, the authorities are now requesting forensic life-threatening danger assessments based on our examinations. The aim of this retrospective study was to assess if a probability of survival (PS) trauma score could be useful for these forensic life-threatening danger assessments and to identify a cut-off PS score as a supporting tool for the forensic practice of assessing life-threatening danger. We compared a forensic database and a trauma database and identified 161 individuals (aged 15 years or older) who had both a forensic life-threatening danger assessment and a PS score. The life-threatening danger assessments comprised the following statements: was not in life-threatening danger (NLD); could have been in life-threatening danger (CLD); or was in life-threatening danger (LD). The inclusion period was 2012–2016. A statistically significant difference was found in the PS scores between NLD, CLD and LD (chi-square test: p < 0.0001). The usefulness of the PS score for categorizing life-threatening danger assessments was determined by a receiver-operator characteristic (ROC) curve. The area under the curve was 0.76 (95% CI, 0.69 to 0.84) and the ROC curve revealed that a cut-off PS score of 95.8 would appropriately identify LD. Therefore, a PS score below 95.8 would indicate life-threatening danger. We propose a further exploration of how the evidence-based PS score, including a cut-off value, might be implemented in clinical forensic medical statements to add to the scientific strength of these statements.
Collapse
|
10
|
Ducatman BS, Ducatman AM, Crawford JM, Laposata M, Sanfilippo F. The Value Proposition for Pathologists: A Population Health Approach. Acad Pathol 2020; 7:2374289519898857. [PMID: 31984223 PMCID: PMC6961144 DOI: 10.1177/2374289519898857] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 01/09/2023] Open
Abstract
The transition to a value-based payment system offers pathologists the opportunity to play an increased role in population health by improving outcomes and safety as well as reducing costs. Although laboratory testing itself accounts for a small portion of health-care spending, laboratory data have significant downstream effects in patient management as well as diagnosis. Pathologists currently are heavily engaged in precision medicine, use of laboratory and pathology test results (including autopsy data) to reduce diagnostic errors, and play leading roles in diagnostic management teams. Additionally, pathologists can use aggregate laboratory data to monitor the health of populations and improve health-care outcomes for both individual patients and populations. For the profession to thrive, pathologists will need to focus on extending their roles outside the laboratory beyond the traditional role in the analytic phase of testing. This should include leadership in ensuring correct ordering and interpretation of laboratory testing and leadership in population health programs. Pathologists in training will need to learn key concepts in informatics and data analytics, health-care economics, public health, implementation science, and health systems science. While these changes may reduce reimbursement for the traditional activities of pathologists, new opportunities arise for value creation and new compensation models. This report reviews these opportunities for pathologist leadership in utilization management, precision medicine, reducing diagnostic errors, and improving health-care outcomes.
Collapse
Affiliation(s)
- Barbara S. Ducatman
- Department of Pathology, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI,
USA
| | - Alan M. Ducatman
- Department of Occupational and Environmental Health Sciences, West Virginia
University School of Public Health, Morgantown, WV, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker
School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael Laposata
- Department of Pathology, University of Texas Medical Branch, Galveston, TX,
USA
| | - Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University School of
Medicine, Atlanta, GA, USA
| |
Collapse
|