Forensic cardiac device analysis at the Los Angeles County Department of the Coroner: A 20-year experience.

Cardiac implantable electronic devices (CIEDs) store information continuously; however, the log of these devices is rarely analyzed in forensic practice. We retrospectively reviewed all cases referred for CIED interrogation by the Los Angeles County Department of Medical Examiner-Coroner between 2001 and 2020. According to the Department's practice, CIED interrogation may be requested for decedents in which details or cause of death are not clear from autopsy and clinical history. The CIED analysis was considered informative for the coroner's investigation either if it detected an arrhythmia or malfunction likely related to decedent's terminal event or if it was essential to determine time of death or identity of decedent. A total of 57 CIEDs were evaluated during the 20-year period. In almost half of cases (26/57: 45.6%), device analysis was informative for coroner's investigation. Arrhythmias likely related to terminal event were commonly detected (21/57: 36.8%). Device malfunction was identified as the likely cause of death in almost 10% of decedents (5/57: 8.8%), including three cases of battery depletion (3/57: 5.3%), one case of misclassification of ventricular tachycardia as supraventricular tachycardia with failure to deliver therapy (1/57: 1.7%), and one case of lead failure due to a broken pacing wire (1/57: 1.7%). Not infrequently, CIED interrogation was essential for determination of time of death (9/57: 15.8%), and there was one case (1/57: 1.7%) in which interrogation was essential for identifying the decedent. Our study shows that postmortem CIED interrogation can provide unique information regarding mechanism and time of death, and decedent's identity.

The Forensic Pathology of Liver Trauma.

The forensic pathologist is an integral part of the trauma surgery team. Trauma surgeons depend on autopsy descriptions for accurate measurement of the severity of trauma and determination of the chance of mortality. The outcome of liver injury improved greatly during the 20th century, primarily due to improved diagnostic and management techniques. In many trauma cases, survival depends on injuries to areas other than the liver. Measurement of the severity of liver trauma often uses the TRISS (Trauma and Injury Severity Score) method, which depends on the nature, location, and size of injuries. Injuries produced by blunt trauma depend on the direction of the force and its interaction with the anatomic structures that surround the liver. Sharp force and gunshot injuries depend on the portions of the liver involved and the amount of kinetic energy transmitted to the tissue. The liver is susceptible to injury from resuscitation, although these injuries are usually not severe. Acad Forensic Pathol. 2018 8(2): 184-191.

Familicide-suicide: a cluster of 3 cases in Los Angeles County.

Familicide and familicide-suicide have not been extensively documented or adequately defined in forensic and psychiatric literature. Such incidents occupy a distinct epidemiological niche and are often precipitated by financial stressors. We present a cluster of 3 such cases, all of which occurred within a 4-month period in Los Angeles County, Calif. The dynamics of these cases are evaluated relative to the literature.

Investigation of homicides interred in concrete--the Los Angeles experience.

Decedents interred in concrete present unique problems and investigation of these deaths necessitates a team of forensic specialists. The Los Angeles County Department of Coroner has had five such deaths in the past 18 years. The buried cases needed layer-by-layer excavation to establish the time and cause of death. Metal detectors are often used in this process. X-rays of the interred remains were completed to help with locating the decedent's position in the concrete. The breaking of concrete in some of the cases required the use of a sledgehammer and later a chisel in a manner that would not damage the remains. Postmortem dismemberment was frequent in our cases. The decedents were all female or prepubescent children, and the perpetrators were closely related to the decedents. While concrete can interfere with determination of postmortem interval, it can also preserve the remains and assist with identification.