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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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Accidentes , Médicos Forenses , Niño , Humanos , Causas de Muerte , Homicidio , Certificación , Certificado de DefunciónRESUMEN
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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Ahogamiento , Lactante , Niño , Humanos , Médicos Forenses , Fiebre , Encuestas y Cuestionarios , Causas de Muerte , Certificado de DefunciónRESUMEN
While diabetes mellitus (DM) has historically accounted for substantial worldwide morbidity and mortality, new and evolving epidemiologic trends are forcing the scientific community to view it as a type of emerging disease. This review will summarize the pathophysiology of the disease, present an update of current national statistics and changing epidemiologic patterns, discuss how DM might specifically lead to acute deaths falling under the jurisdiction of the medical examiner/coroner, and suggest a medicolegal standard of practice to maximize their capture and reporting.
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Hyperglycemia and new onset diabetes have been described with certain antipsychotic medications and some of the initial presentations are fatal diabetic ketoacidosis (DKA). We report 17 deaths due to DKA in psychiatric patients treated with second generation antipsychotic medications. Death certificates and toxicology data were searched for DKA and hyperglycemia. We reviewed the medical examiner records which included the autopsy, toxicology, police, and medical examiner investigators' reports. The decedents ranged in age from 32 to 57 years (average 48 years). There were 15 men and two women. The immediate cause of death was DKA in all. The psychiatric disorders included: 10 schizophrenia, three bipolar/schizophrenia, two bipolar, and two major depression. The most frequent atypical antipsychotic medications found were quetiapine and olanzapine followed by risperidone. In 16 deaths, we considered the medication as primary or contributory to the cause of death.
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Antipsicóticos/efectos adversos , Cetoacidosis Diabética/inducido químicamente , Cetoacidosis Diabética/mortalidad , 2-Propanol/sangre , Adulto , Femenino , Toxicología Forense , Humanos , Hiperglucemia/inducido químicamente , Masculino , Trastornos Mentales/tratamiento farmacológico , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
CONTEXT: In March 2009, a novel swine-origin influenza A/H1N1 virus was identified. After global spread, the World Health Organization in June declared the first influenza pandemic in 41 years. OBJECTIVE: To describe the clinicopathologic characteristics of 34 people who died following confirmed A/H1N1 infection with emphasis on the pulmonary pathology findings. DESIGN: We reviewed medical records, autopsy reports, microbiologic studies, and microscopic slides of 34 people who died between May 15 and July 9, 2009, and were investigated either by the New York City Office of Chief Medical Examiner (32 deaths) or through the consultation service of a coauthor (2 deaths). RESULTS: Most of the 34 decedents (62%) were between 25 and 49 years old (median, 41.5 years). Tracheitis, bronchiolitis, and diffuse alveolar damage were noted in most cases. Influenza viral antigen was observed most commonly in the epithelium of the tracheobronchial tree but also in alveolar epithelial cells and macrophages. Most cases were reverse transcription-polymerase chain reaction positive for influenza. Histologic and microbiologic autopsy evidence of bacterial pneumonia was detected in 55% of cases. Underlying medical conditions including cardiorespiratory diseases and immunosuppression were present in 91% of cases. Obesity (body mass index, >30) was noted in 72% of adult and adolescent cases. CONCLUSIONS: The pulmonary pathologic findings in fatal disease caused by the novel pandemic influenza virus are similar to findings identified in past pandemics. Superimposed bacterial infections of the respiratory tract were common. Preexisting obesity, cardiorespiratory diseases, and other comorbidities also were prominent findings among the decedents.
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Brotes de Enfermedades , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/patología , Pulmón/patología , Adolescente , Adulto , Anciano , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Lactante , Recién Nacido , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/microbiología , Radiografía , Factores de TiempoRESUMEN
Artifacts due to decomposition can be mistaken for antemortem injury leading to an incorrect suspicion of foul play. We describe an instance of postmortem wound dehiscence that mimicked antemortem stab wounds. A man with a history of colon cancer and substance abuse was found dead. There were advanced putrefactive changes and multiple defects of the anterior torso that resembled stab wounds. Subsequent investigation revealed that 11 months earlier, he had a laparoscopic-assisted colon resection that involved surgical incisions corresponding in location and size to the above defects. Putrefactive gases may cause bloating of the body. This distension may cause recent and remote healed incisions to dehisce. Correlation of these "defects" at autopsy with the antemortem clinical history is crucial in determining their etiology.
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Cambios Post Mortem , Dehiscencia de la Herida Operatoria/patología , Analgésicos Opioides/envenenamiento , Artefactos , Colon/cirugía , Diagnóstico Diferencial , Patologia Forense , Gases , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Heridas Punzantes/patologíaRESUMEN
The words, "you have breast cancer," is possibly one of the most devastating statements an individual could image hearing from his or her physician even though breast cancer is the most common cancer among women. The diagnosis bears a significant amount of anxiety and fear in regards to treatment and overall survival. However, research has increased healthcare professionals' knowledge on the benefits of early screening, diagnosis, and treatments, which has steadily reduced the death rate from breast cancer over the past 20 years. Physicians are better able to predict how particular breast cancers will react to treatment; therefore, they are able to choose more effective treatment options based on these findings. The goal of this article is to highlight the incidence, staging and diagnostic studies, types, treatments, and follow-up of breast cancer dispelling some of the common societal stigmas and unfounded fears surrounding this diagnosis.
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Neoplasias de la Mama , Cuidados Posteriores , Antineoplásicos/uso terapéutico , Actitud Frente a la Salud , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/psicología , Neoplasias de la Mama/terapia , Autoexamen de Mamas , Quimioterapia Adyuvante , Sistemas de Liberación de Medicamentos , Miedo , Femenino , Humanos , Incidencia , Imagen por Resonancia Magnética , Mamografía , Tamizaje Masivo , Mastectomía , Estadificación de Neoplasias , Rol de la Enfermera , Enfermería Oncológica , Cuidados Paliativos , Radioterapia Adyuvante , Estereotipo , Estados Unidos/epidemiologíaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Quimioterapia Adyuvante/efectos adversos , Trombofilia/genética , Ciclofosfamida/efectos adversos , Resultado Fatal , Femenino , Fluorouracilo/efectos adversos , Homocisteína/sangre , Homocisteína/genética , Humanos , Metotrexato/efectos adversos , Persona de Mediana Edad , Mutación , RiesgoRESUMEN
Pulmonary thromboembolism (PE) is found commonly in forensic pathology practice, as it typically causes sudden death. It is attributed to a wide variety of predominantly acquired etiologies. Although likely etiologically multifactorial, some common proximate causes include: surgery, pregnancy, injury, inactivity of any cause, cancer, obesity, or serum hyperviscosity. On occasion, no apparent predisposing condition is identified. In these instances, occult hereditary thrombophilias may play a causal role. Deaths referred to the Office of Chief Medical Examiner (OCME) of New York City between December, 2000 and September, 2003 and due to PE were retrospectively reviewed. Molecular analysis (FRET) was performed on selected cases for three common hereditary thrombophilias: mutations in factor V Leiden (FVL), prothrombin G20210A (PT), and methylenetetrahydrofolate reductase (MTHFR). During the study period, 124 of 15,280 deaths were primarily attributable to PE. Of those, 34 were selected for molecular analysis. One or more mutations were detected in 35% of those, five of which were clearly causally related to death. Given the potential benefits to surviving family members, our data indicate that postmortem molecular testing for the common hereditary thrombophilias is warranted in at least selected cases.
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Causas de Muerte , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Embolia Pulmonar/etiología , Trombofilia/genética , Adulto , Autopsia , Factor V/genética , Femenino , Asesoramiento Genético , Humanos , Lactante , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Protrombina/genética , Estudios Retrospectivos , Trombofilia/complicacionesRESUMEN
The authors describe three accidental deaths resulting from occupational hazards involving environmental gas alterations. One involved the displacement of oxygen caused by leakage of liquid nitrogen during the installation of a magnetic resonance imaging system. Two involved elevated environmental carbon dioxide concentrations: dry ice sublimation in a walk-in refrigerator in a research laboratory, and activation of a carbon dioxide fire alarm-extinguisher system by a woman locked in a bank vault. The autopsy findings, scene investigations, and certifications of these deaths, as related to the mechanisms of death, are discussed.