Is the visibility of standardized inflicted bruises improved by using an alternate ('forensic') light source?

AIM: To study the visibility of standardized inflicted bruises by using an alternate ('forensic') light source compared to a white light source. METHODS: Bruises were inflicted on the flexor site of the forearm (halfway in the middle) in 76 adults, by suddenly allowing a cylindrical metal object (400g) with rounded edges to drop for 1m in a vertically positioned tube. At 0.25, 1, 2, 7 and 14days after this blunt force impact, the impact site on the forearm was photographed with a white light source and subsequently with an alternate light source at 415nm. Visibility of bruises on 170 randomized photographs was assessed on a calibrated monitor by 10 forensic medical specialists (physicians and pathologists) independently in two sessions: (1) with white light source photographs, and (2) after a mean of 11days with greyscale converted alternate light source photographs. Bruise visibility was expressed as a report mark between 1 (very bad) and 10 (excellent), or as 'no visible bruise'. To determine intra-rater agreement, 10 of 170 photographs were assessed twice (untold to the assessors). In total 3600 (180×10×2) photographs were assessed. RESULTS: 39 of 73 (53%) participants who completed the study, developed a visible bruise (women more often than men, p<0.001). Inter-rater agreement between assessors was high (mean inter-class coefficient, ICC, for white light source 0.66 (SD 0.14) and for alternate light source ICC 0.73 (0.09)). Intra-rater agreement was excellent (mean ICC 0.88 (SD 0.09)). Mean report marks for bruise visibility, recorded independently by 10 assessors on 170 unique photographs per light source, were significantly higher with an alternate light source than with a white light source, at 1 and 2days after impact: 4.4 (SD 2.0) vs 3.8 (1.8) (p<0.01) and 4.9 (2.1) vs 4.5 (2.0) (p<0.05), respectively. However, these differences were small, as the mean difference (effect size) in report marks were 0.6 (0.5) and 0.4 (0.3), at 1 and 2days after impact, respectively. The other time points showed no statistical significant differences in report marks. CONCLUSIONS: Bruises after standardized blunt force impact were slightly better visible with an alternate light source than with a white light source after 1 and 2 days, but not after 0.25, 7 and 14 days. The value of using an alternate light source at 415nm to improve bruise visibility was limited in this study.

Pediatric constrictive asphyxia a rare form of child abuse: A report of two cases.

We present two cases of infants who died under suspicious circumstances. After clinical and legal investigations, non-accidental constrictive asphyxia inflicted by one of the parents was established. The first case presents a to date not yet reported, unique mechanism of trauma. In order to stop his daughter from crying, the father admitted that he sometimes sat on his baby while she was lying on the bed. Occasionally increasing his force by pulling with his hands on the bottom of the bed. In the second case tight swaddling and encircling chest compression was the causative mechanism. In both cases the father was sentenced to imprisonment with mandate psychiatric care. Only two previous reports of this uncommon and relatively unknown cause of child abuse, called constrictive asphyxia, are known. In all reported cases static loading of the chest resulted in rib fractures and demise of the child. This rare abusive mechanism should be known to pediatric radiologists and pathologists.

Radiology in suspected non-accidental injury: theory and practice in The Netherlands.

INTRODUCTION: This study evaluates radiological imaging in suspected non accidental injury (NAI) in children below the age of 2 years in the Netherlands. MATERIAL AND METHODS: The study consisted of two parts; first an on-line questionnaire on suspected NAI, amongst radiological practices within the Netherlands. The second part of the study was a retrospective analysis of skeletal surveys in children under the age of 2 years, which were reviewed in an expert centre of forensic medicine on request of the public prosecutor. RESULTS: Out of 116 hospitals 45 (39%) radiologists completed the on-line questionnaire; 8 (8%) of the proposed skeletal surveys complied with the ACR criteria. A total of 29 skeletal surveys in 26 children were reviewed. The median age at the time of the radiographic exam was 3 months for both boys and girls. Only 2 (7%) studies complied with the ACR criteria. DISCUSSION: The results of our study show that, in theory as well as in practice, Dutch radiological practices show a large variation in imaging protocols for suspected NAI.

[Psychiatric patients at the police station in the southern South Holland region: assessment by the District Health Service forensic doctor]. / Psychiatrische patiënten op het politiebureau in de regio Zuid-Holland Zuid: beoordeling door de wachtdienstarts van de Gemeenschappelijke Gezondheidsdienst.

OBJECTIVE: To describe the epidemiological characteristics of ambulant psychiatric patients who were either brought to the police station or who came by themselves, but who were not kept in a cell, as a basis for the development of a reception protocol. DESIGN: Descriptive. METHOD: The data from the medical records from 2000 kept by the forensic doctors employed by the district health services for the Southern South Holland region were inventoried. RESULTS: On request by the police, the forensic doctors examined 203 clients. The majority of these were middle-aged men who did have a place of residence. The reason for police involvement was bizarre or confused behaviour in public. Half of the patients had received or were receiving some form of psychiatric treatment from the mental health service. In approximately half of the cases the forensic doctor found a solution together with the police. In the other half of the cases the forensic doctor asked the crisis intervention team at the mental health service for an evaluation. Two thirds of these patients were hospitalised and one third was sent away. Because examination by both the forensic doctor and the mental health service psychiatrist and other procedures were lengthy (up to 6 hours), patients had to spend a long time in a holding cell at the police station that was not designed for stays of this length of time, and often lacked toilet facilities. CONCLUSION: The forensic doctor treated about half the clients without the need of assistance from the crisis intervention psychiatrist. The temporary accommodation for these confused clients was inadequate.