The legal impact of forensic medical life-threatening danger assessment conclusions in cases of violent offense.

OBJECTIVE: The aim of this study was to examine the association between the legal outcome for suspected perpetrators and the forensic life-threatening danger assessments conducted as part of the clinical forensic medical examinations of victims with penetrating injuries. METHOD: From the Danish Central Crime Register, we retrieved the legal outcomes for suspected perpetrators linked to victims with penetrating injuries in a six-year period and compared the proportional distribution of forensic life-threatening danger assessment conclusions - no life-threatening danger (NLD), could have been in life-threatening danger (CLD), and life-threatening danger (LD) - with the legal outcomes. RESULTS: 326 victims were related to at least one identified suspected perpetrator with a legal outcome. When the forensic life-threatening danger assessments were more severe, an increased proportion of cases resulted in formal charges and, subsequently, conviction, than when the forensic life-threatening danger assessments were less severe. The percentage point differences between NLD, CLD, and LD were almost equal. CONCLUSION: Our results indicate that the forensic life-threatening danger assessments are associated with the legal outcome, as both the proportion of cases with formal charges and the proportion of cases with a conviction increased with the severity of the forensic life-threatening danger assessment conclusions.

Life-threatening danger assessments of penetrating injuries in Eastern Danish clinical forensic medicine.

Clinical forensic assessments of injuries' life-threatening danger may have an impact on the legal aftermath following a violent assault. The pursuit of evidence-based guidelines should ensure a user-independent and reproducible forensic practice. However, does it? The aim of this study was to evaluate the forensic life-threatening danger assessments after a protocol implementation in 2016. The evaluation concerned usability and reproducibility of the protocol, and its influence on assessment severity. We analyzed the level of inter- and intra-rater agreement using 169 blinded, prior-protocol cases that were reassessed by two forensic specialists. We compared assessment made the year before and after protocol implementation (n = 262), and the forensic specialists' reassessments with the prior-protocol cases' original assessments (n = 169). Whether to make an assessment, the levels of agreement varied between weak agreement (inter-rater, Κ = 0.43; assessor 1, Κ = 0.57) and strong agreement (assessor 2, Κ = 0.90). Regarding severity, the levels of agreement varied between strong agreement (inter-rater, Κ = 0.87; assessor 1: Κ = 0.90) and almost perfect agreement (assessor 2: Κ = 0.94). The assessments were statistically significant redistributed after the implementation (chi-square test: p < 0.0001). The proportion of cases assessed as having not been in life-threatening danger increased from 9 to 43%, and moderate severity assessments decreased from 55 to 23%. Of the moderate severity assessments, 55% were reassessed as having not been in life-threatening danger. The protocol ensured independent and reproducible assessments when the forensic specialists agreed on making one. The protocol resulted in less severe assessments. Future studies should examine the reliability of the protocol and its consequences for legal aftermaths.

The usefulness of a trauma probability of survival model for forensic life-threatening danger assessments.

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.

Forensic postmortem computed tomography: volumetric measurement of the heart and liver.

PURPOSE: The purpose of this study was to investigate the utility of postmortem computed tomography (PMCT) images in estimating organ sizes and to examine the use of the cardiothoracic ratio (CTR). METHODS: We included 45 individuals (19 females), who underwent a medico-legal autopsy. Using the computer software program Mimics®, we determined in situ heart and liver volumes derived from linear measurements (width, height and depth) on a whole body PMCT-scan, and compared the volumes with ex vivo volumes derived by CT-scan of the eviscerated heart and liver. The ex vivo volumes were also compared with the organ weights. Further, we compared the CTR with the ex vivo heart volume and a heart weight-ratio (HWR). Intra- and inter-observer analyses were performed. RESULTS: We found no correlation between the in situ and ex vivo volumes of the heart and liver. However, a highly significant correlation was found between the ex vivo volumes and weights of the heart and liver. No correlations between CTR and the ex vivo heart volume nor with HWR was found. Concerning cardiomegaly, we found no agreement between the CTR and HWR. The intra- and inter-observer analyses showed no significant differences. CONCLUSIONS: Noninvasive in situ PMCT methods for organ measuring, as performed in this study, are not useful tools in forensic pathology. The best method to estimate organ volume is a CT-scan of the eviscerated organ. PMCT-determined CTR seems to be useless for ascertaining cardiomegaly, as it neither correlated with the ex vivo heart volume nor with the HWR.

CT imaging vs. traditional radiographic imaging for evaluating Harris Lines in tibiae.

SUMMARY: This paper is the first to systematically investigate computer tomography (CT) images vs. ordinary flat plane radiography for evaluating Harris Lines (HL) on tibiae. Harris Lines are traditionally investigated using radiographic images and recorded as either present or absent, or by counting the number of HL. Seventy-four pairs of human sub-adult and adult archaeological tibiae were used in this study. Both image methods were tested for intra- and inter-observer agreement and the methods were then compared. Analysis was performed with the tibiae divided into younger (n = 19) and older sub-adults (n = 26) and adults (n = 29), as well as all tibiae combined (n = 74). This study found that the intra- and inter-observer agreement was very similar for each method, but both image methods performed less well for counting the number of HL. Direct comparison between CT images and radiographic images showed good agreement for presence or absence of HL and less agreement for counting HL. There appeared to be no systematic pattern for dividing the material according to bone length (and thereby age). Overall, this paper concludes that the performance of CT images is comparable to traditional flat plane radiography for evaluating HL on archaeological dry bone specimens of tibiae. Further, due to the lower performance of counting the number of HL, it appears advisable to only record the presence or absence of HL rather than counting the number of HL.