Abstract
In-custody deaths have several causes, and these include homicide, suicide, natural death from chronic diseases, and unexplained death possibly related to acute stress, asphyxia, excited delirium, and drug intoxication. In some instances, these deaths are attributed to undefined accidents and natural causes even though there is no obvious natural cause apparent after investigation. Understanding these deaths requires a comprehensive investigation, including documentation of circumstances surrounding the death, review of past medical history, drug and toxicology screens, and a forensic autopsy. These autopsies may not always clearly explain the death and reveal only nonspecific terminal events, such as pulmonary edema or cerebral edema. There are useful histologic and biochemical signatures which identify asphyxia, stress cardiomyopathy, and excited delirium. Identifying these causes of death requires semiquantitative morphologic and biochemical studies. We have reviewed recent Bureau of Justice Statistics on in-custody death, case series, and morphological and biochemical studies relevant to asphyxia, stress cardiomyopathy, and excited delirium and have summarized this information. We suggest that regional centers should manage the investigation of these deaths to provide more comprehensive studies and to enhance the expertise of forensic pathologists who would routinely manage potentially complex and difficult cases.
Highlights
In-custody deaths represent an important problem to the judicial system and to the decedent’s family members [1, 2]
60% of these deaths were classified as homicides by law enforcement personnel, and 40% were attributed to suicide (11%), intoxication (11%), accidental injury (6%), and natural causes (5%) [10]
There were a disproportionate number of deaths secondary to suicide in one case series [8]
Summary
In-custody deaths represent an important problem to the judicial system and to the decedent’s family members [1, 2] These cases often occur without an obvious cause for the deaths and are labeled death by natural causes. In younger decedents, underlying medical disorders are unlikely to contribute to death, in contrast to older individuals with chronic medical conditions. The evaluation of these cases requires a comprehensive approach, but there is a frequent concern that the forensic pathology is casual and biased towards the judicial system [3]. We consider histological studies and molecular studies which could contribute to the identification of death associated with excited delirium, stress cardiomyopathy, drowning, asphyxia, and possibly seizures
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