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Cina A, Tarozzi I, Arunkumar P, Gitto L. Firearm Fatalities in the Pediatric Population: A Retrospective Study From the Cook County Medical Examiner's Office. Am J Forensic Med Pathol 2024:00000433-990000000-00212. [PMID: 39133144 DOI: 10.1097/paf.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
ABSTRACT Gunshot injuries are one of the leading causes of death from trauma in the United States. In recent years, the US has experienced an increasing number of fatal pediatric cases related to firearms.A search of the database of the Cook County Medical Examiner's Office over the period January 2016-December 2021 revealed 418 deaths by gunshot wounds (GSWs) among people aged between 0 and 18 years old. Subjects were subcategorized in infants (0 to 1 year), toddlers (≥1 to 3 years), preschool (≥3 to 6 years), preadolescents (≥6 to 12 years), and adolescents (≥12 to 18 years).Most victims were males (n = 374) and adolescents (357 males and 30 females). Homicide (n = 373) was the most common manner of death. Only 2 deaths were accidental. Single GSWs deaths (n = 232) were more common than multiple GSWs (n = 186) and preferentially directed to the head in both homicides and suicides. Gang or robbery related events in areas of readily available firearms explained 4.5% of homicides (17 out of 373 cases). Among deaths by self-inflicted GSWs (n = 36), 7 cases were linked to psychiatric disorders, 3 to family difficulties, 2 to history of playing Russian roulette, and 2 to bullying at school.Pediatric gunshot injuries and deaths are an important public health problem. Understanding and addressing individual and societal risk factors should be the first step toward prevention.
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Affiliation(s)
- Alexandra Cina
- From the Albert Einstein Medical Center, Philadelphia, PA
| | - Ilaria Tarozzi
- Modena Local Health Agency, Legal Medicine and Risk Management Department, Modena, Italy
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Gill JR, Christensen E, Dennison EH, Ely SF, Gilson T, Keyes K, Lear K, Lucas J, Mahar TJ, Quinton R. The National Association of Medical Examiners Position Paper on the Investigation and Certification of Pediatric Deaths From Environmental Neglect. Am J Forensic Med Pathol 2024; 45:e1-e4. [PMID: 38215052 DOI: 10.1097/paf.0000000000000911] [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: 01/14/2024]
Abstract
ABSTRACT Pediatric deaths that occur because of environmental neglect often involve 4 common scenarios: (1) hyperthermia due to environmental exposure, (2) ingestion of an accessible drug or poison, (3) unwitnessed/unsupervised drownings, and (4) unsafe sleep practices. Given the same fact pattern, the manner of death will vary from accident to homicide to undetermined based on local custom and/or the certifier's training and experience. Medical examiner/coroner death certifications are administrative public health determinations made for vital statistical purposes. Because the manner of death is an opinion, it is understandable that manner determinations may vary among practitioners. No prosecutor, judge, or jury is bound by the opinions expressed on the death certificate. This position paper does not dictate how these deaths should be certified. Rather, it describes the challenges of the investigations and manner determinations in these deaths. It provides specific criteria that may improve consistency of certification. Because pediatric deaths often are of public interest, this paper provides the medical examiner/coroner with a professional overview of such manner determination issues to assist various stakeholders in understanding these challenges and variations.
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Affiliation(s)
- James R Gill
- From the Office of the Chief Medical Examiner, Farmington, CT
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Mahar TJ, Keyes K, Ely SF, Dennison EH, Gill JR. Assessing Neglect in Pediatric Environmental Deaths: A Survey of Manner of Death Determinations. Am J Forensic Med Pathol 2023; 44:251-257. [PMID: 37728903 DOI: 10.1097/paf.0000000000000882] [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: 09/22/2023]
Abstract
ABSTRACT There are 4 common types of environmental pediatric deaths that may involve various degrees of neglect: hyperthermia, ingestion, drownings, and unsafe infant sleep practices. Because the circumstances surrounding each are disparate, there is no set of standards by which these factors may be weighed and interpreted. Given the same facts, the manner of death certification may differ depending upon training/experience and/or local practice.To assess certification variations, 147 board-certified forensic pathologists were surveyed for the choice of manner in scenarios with different degrees of negligence intent. In addition to evaluating certification consistency, the survey examined whether certain factors affected the choice. The results demonstrated strong consistency in certain scenarios and widely disparate certifications in others.Medical examiner/coroner certifications are administrative decisions for vital statistical purposes. The manner of death reflects an evidence-based conclusion, but because it is ultimately an opinion, determinations may vary. Based on the survey, some certification criteria were identified (ie, intent, child age, and knowingly placing a child in an environment with a reasonable risk of harm). Using these criteria may improve consistency, but it is unreasonable to expect 100% concordance. Understanding the certificate's role helps to place the manner in the proper legal and public health contexts.
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Affiliation(s)
- Tara J Mahar
- From the Erie County Medical Examiner's Office, Buffalo, NY
| | - Kelly Keyes
- Investigations Program, RTI International, Center for Forensic Science Advancement and Application, Raleigh, NC
| | - Susan F Ely
- New York City Office of Chief Medical Examiner, New York, NY
| | | | - James R Gill
- Connecticut Office of the Chief Medical Examiner, Farmington, CT
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Omoke NI, Lasebikan OA. Firearm Injury Among Children and Adolescents in Nigerian Civilian Trauma Setting: Prevalence, Pattern, and Implications for Prevention. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:55-63. [PMID: 33795982 PMCID: PMC7995932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Firearm injury in children and adolescents and the morbidity associated with it is an appreciable burden in resource-limited settings, though it is under-reported. This study aimed to determine its prevalence and pattern in Nigerian civilian trauma setting. We undertook a retrospective study of all the patients with firearm injury aged 19 years or under who visited the Emergency Department (ED) of two tertiary hospitals in Nigeria over a period of 15 years. Of the 46,734 children and adolescents seen in the ED, firearm injury was the reason for the visit in 56 of them, giving a prevalence of 1.2 per 1000 ED attendance (95% CI: 0.9-1.6). The male-to-female ratio was 1.8:1, and the mean age was 13.98 ± 5.6 years. The preponderance of firearm injury was in the rural areas, during the dry season, at home, and in the daytime. Armed robbery (20, 35.7%) and communal clash (7, 12.5%) were the two topmost incidents leading to gunshot wounds. Armed robbery-related gunshot occurred mostly on the roads and at nighttime and involved predominantly 15-19-year-olds. Lower extremity was the topmost anatomical region involved. The majority (67%) had no pre-hospital care; the mean and median injury-hospital arrival interval respectively was 352 hrs and 4.2 hrs. Wound infection was the topmost complication. The mean hospital length of stay was 22.6 days. One (1.8%) of the patients died on the third day of hospital admission. Educational campaigns for prevention intensified during the dry season should highlight the risk of firearm injury to this age group and emphasize the importance of proper supervision and guidance of vulnerable children and adolescents. Improving the rates of pre-hospital care and early presentation of victims to the hospital should be considered in tertiary injury prevention strategies.
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Affiliation(s)
- Njoku Isaac Omoke
- Department of Surgery, Ebonyi State University/Alex
Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State –
Nigeria
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Picoli FF, Mundim-Picoli MBV, Alves AM, Silva MAGS, Franco A, Silva RF. Suicidal tandem bullets to the heart with subsequent embolization - a case report. Forensic Sci Med Pathol 2020; 16:523-527. [PMID: 32557013 DOI: 10.1007/s12024-020-00275-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
A tandem bullet phenomenon is a rare situation in which two bullets travel nose-to-base towards the target. In terminal ballistics, a classic feature of the tandem bullet phenomenon is the presence of a single entrance wound with two or more bullets inside the body. During the autopsy, the phenomenon may result in confusion, especially related to the dynamics of the shooting. The present study reports a case of suicide by tandem bullets to the heart with subsequent bullet embolization into the aorta. A 40-year-old Caucasian woman, with a previous history of suicide, shot herself in the chest with a 0.32 revolver. During the autopsy, a single entrance wound (one centimeter in diameter) was observed in the sternal region. The injury was a close-range shot. Internally, a single wound was detected in the right atrium of the heart. Two 0.32 S&WL lead bullets were found inside the descending abdominal aorta. The bullets fitted each other perfectly in a nose-to-base position. Both bullets were tracked back to a single firearm that belonged to the victim's father using forensic ballistics. The forensic report suggested a suicide. A multidisciplinary approach involving crime scene investigation, forensic pathology and forensic ballistics is necessary to investigate tandem bullet cases. Forensic experts must be aware of this phenomenon and, more importantly, they must be aware of its unusual manifestations, such as embolization, in order to come to optimal conclusions.
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Affiliation(s)
- Fernando Fortes Picoli
- Department of Forensic Anthropology and Forensic Dentistry, Scientific Police of Goiás / Federal University of Goiás, Av. Atílio Correia Lima, n. 1.223, Cidade Jardim, 74425-030, Goiânia, Goiás, Brazil.,School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | - Ademir Franco
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Centro de Pesquisas São Leopoldo Mandic, Campinas, Brazil.,Department of Therapeutic Stomatology, Institute of Dentistry, Sechenov University, Moscow, Russia
| | - Rhonan Ferreira Silva
- Department of Forensic Anthropology and Forensic Dentistry, Scientific Police of Goiás / Federal University of Goiás, Av. Atílio Correia Lima, n. 1.223, Cidade Jardim, 74425-030, Goiânia, Goiás, Brazil. .,School of Dentistry, Federal University of Goiás, Goiânia, Brazil.
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Prahlow SP, Prahlow JA. Hostage Situation Homicide. Acad Forensic Pathol 2020; 9:225-238. [PMID: 32110258 DOI: 10.1177/1925362119895598] [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: 08/28/2019] [Accepted: 11/27/2019] [Indexed: 11/16/2022]
Abstract
Deaths related to hostage situations occur in many forms, as these situations can easily escalate as a result of many confounding variables. When approaching such cases, forensic pathologists and death investigators should be mindful of the many details that should be well-documented at the scene and during autopsy to ensure that the correct conclusions and death certification are determined. This case report highlights a death in a hostage situation and the importance of correlating scene information and autopsy findings. An elderly female hostage was ambulating with a walker away from her ex-husband's home, after police negotiations successfully convinced her ex-husband to release her. The ex-husband then appeared at the door, brandishing a weapon, at which time a police officer shot at the man. Instead of striking the man, the rifle's projectile struck the woman in the chest. Subsequent investigation revealed that, although the police officer had a "clear shot" via the rifle sights, the muzzle end of the rifle was obstructed by the back corner of an automobile, behind which the officer was positioned during the hostage situation standoff. The case highlights a rarely discussed safety rule related to firearms: recognition that the line of sight via a weapon's sights (or scope) is not identical to the barrel/bore axis.
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