Forensic Traumatology Research Articles

Forensic medical evaluation of penetrating abdominal injuries.

This study aims to discuss the characteristics, origins, degree of injury, results, reporting, and forensic medical aspects of penetrating abdominal injuries. In this study, 28,619 cases who applied to the emergency department of Kutahya Health Sciences University Evliya Celebi Training and Research Hospital between January 1, 2016 and December 31, 2020 were reviewed. The forensic reports and medical documents of 85 cases with penetrating abdominal injuries were evaluated retrospectively, with the approval of the ethics committee. Among the patients included in the study, 87.1% were male and 12.9% were female. The mean age was found to be 31±13 years. When the origins of the cases were analyzed, 87.1% were found to have developed as a result of intentional injury. The incidents predominantly occurred between 20: 00 and 04: 00 hours. As a result of the examinations performed at the hospital after the incident, alcohol was detected in 36.5% of the cases, while 30.6% of the individuals did not consume alcohol. It was observed that 32.9% of the cases were not tested for alcohol. The most common injuries identified were sharp injuries, accounting for 69.4% of cases, and firearm injuries, comprising 27.1%. Organ damage was noted in 68.2% of the cases, with the small intestine being the most frequently damaged organ. The average number of wounds present was 3.6. Intra-abdominal hemorrhage was detected in 61.2% of the cases, and intra-abdominal artery injuries were found in 8.2%. The mortality rate for penetrating abdominal injuries was 8.2%. In forensic traumatology, penetrating abdominal injuries commonly lead to life-threatening conditions and loss of organ function, which represent the most severe category in trauma severity assessment. Penetrating abdominal injuries most often result from violent incidents, as observed in our study and in the literature.

Artificial intelligence in forensic medicine and related sciences – selected issues = Sztuczna inteligencja w medycynie sądowej i naukach pokrewnych – wybrane zagadnienia

Aim. The aim of the work is to provide an overview of the potential application of artificial intelligence in forensic medicine and related sciences, and to identify concerns related to providing medico-legal opinions and legal liability in cases in which possible harm in terms of diagnosis and/or treatment is likely to occur when using an advanced system of computer-based information processing and analysis. Materials and methods. The material for the study comprised scientific literature related to the issue of artificial intelligence in forensic medicine and related sciences. For this purpose, Google Scholar, PubMed and ScienceDirect databases were searched. To identify useful articles, such terms as „artificial intelligence,” „deep learning,” „machine learning,” „forensic medicine,” „legal medicine,” „forensic pathology” and „medicine” were used. In some cases, articles were identified based on the semantic proximity of the introduced terms. Conclusions. Dynamic development of the computing power and the ability of artificial intelligence to analyze vast data volumes made it possible to transfer artificial intelligence methods to forensic medicine and related sciences. Artificial intelligence has numerous applications in forensic medicine and related sciences and can be helpful in thanatology, forensic traumatology, post-mortem identification examinations, as well as post-mortem microscopic and toxicological diagnostics. Analyzing the legal and medico-legal aspects, artificial intelligence in medicine should be treated as an auxiliary tool, whereas the final diagnostic and therapeutic decisions and the extent to which they are implemented should be the responsibility of humans.

Artificial intelligence in forensic medicine and related sciences - selected issues.

The aim of the work is to provide an overview of the potential application of artificial intelligence in forensic medicine and related sciences, and to identify concerns related to providing medico-legal opinions and legal liability in cases in which possible harm in terms of diagnosis and/or treatment is likely to occur when using an advanced system of computer-based information processing and analysis. The material for the study comprised scientific literature related to the issue of artificial intelligence in forensic medicine and related sciences. For this purpose, Google Scholar, PubMed and ScienceDirect databases were searched. To identify useful articles, such terms as "artificial intelligence," "deep learning," "machine learning," "forensic medicine," "legal medicine," "forensic pathology" and "medicine" were used. In some cases, articles were identified based on the semantic proximity of the introduced terms. Dynamic development of the computing power and the ability of artificial intelligence to analyze vast data volumes made it possible to transfer artificial intelligence methods to forensic medicine and related sciences. Artificial intelligence has numerous applications in forensic medicine and related sciences and can be helpful in thanatology, forensic traumatology, post-mortem identification examinations, as well as post-mortem microscopic and toxicological diagnostics. Analyzing the legal and medico-legal aspects, artificial intelligence in medicine should be treated as an auxiliary tool, whereas the final diagnostic and therapeutic decisions and the extent to which they are implemented should be the responsibility of humans.

Traumatic Brain Injury: Current Trends Towards the Increase of the Number of Cases and Its Diagnosis

Introduction The global medical community calls traumatic brain injury (TBI) a "silent epidemic" because the latter causes a significant increase in mortality and disability more than any other mechanical injury. Although today's world achievements demonstrate powerful technical capabilities for accurate diagnosis of the time of occurrence and mechanism of TBI, however, the commission examination departments of the forensic medical examination bureau are considering more and more cases of diagnostic errors made by forensic medical experts during autopsies , which later caused protracted legal proceedings.
 Aim. In this study, we aimed to evaluate the modern diagnostic possibilities of methods for verifying the diagnosis and the time formation of TBI.
 Methods. Literary data on the prevalence and methods of diagnosing TBI at the present time were analyzed.
 Results. The degree and severity of TBI, as well as its course, after the initial mechanical injury depends on many factors. In the last decade, there has been an intensification of research on protein biomarkers based on biofluids (blood, cerebrospinal fluid) for intravitality diagnosis. However, not all markers provide reliable information that would correlate with the presence of TBI. Until now, the "gold standard" of diagnosis is an autopsy, next to which radiological studies are effectively used.
 Conclusion.
 Taking into account the global statistical data, postmortem diagnosis of TBI is an important issue of forensic traumatology, which requires a careful approach.

FORENSIC-MEDICAL EVALUATION OF INJURIES RECEIVED DURING OPERATION OF PERSONAL MOBILITY DEVICES: THE STATE OF THE PROBLEM (REVIEW)

The article analyzes literature data on modern aspects of traffic injury. Some factor criteria for traffic injury are singled out and identified how they have changed with the modernization of modern vehicles. Тhe data concerning injuries associated with the use of modern personal mobility devices, such as kick-scooters, electric scooters, electric unicycles, electric hover boards, skateboards, roller skates and similar devices were analyzed. Prospects for studying this problem and its value for modern forensic traumatology are outlined. Traffic injury is one of the most common problems today, as it is one of the main causes of death of the young population and ranks first among the causes of death due to injury. In particular, on the territory of Ukraine, the number of killed in car accidents each year reaches 400,000. Тhis scientific research was carried out with the aim of conducting an analysis of literary assets on the problem of studying car injuries associated with the operation of modern electric means of personal mobility. Due to new technological features of modern vehicles, the appearance of new types of transportation facilities, such as kick-scooters, electric scooters, electric unicycles, electric hover boards, skateboards, roller skates and similar devices, except for traditional issues, answers to which are widely covered in the fundamental works of the last century, new questions are posed to the experts, conditioned new, previously undescribed signs of traffic injury the requirements to the level of the scientific validity of the expert's conclusions are growing, which require appropriate methods of expert research. However, despite the full range of data provided, the problem associated with the study of injuries received on kick-scooters, electric scooters, electric unicycles, electric hover boards, skateboards, roller skates and similar devices is little studied. This type of vehicle was first introduced in November 2017 and become quite common today. The main task of this type of vehicle is to facilitate travel in large cities. Despite the ease and accessibility of operation, this type of transport is quite fast and can pose a danger to drivers and other road users. Therefore, forensic experts received new challenges today related to the study of the complex of injuries in drivers and pedestrians resulting from the operation of electric scooters, the mechanism of their formation, the study of signs of characteristic injuries to the driver and pedestrians’ data. However, despite all the work done, its results in most cases are statistical in nature and do not provide a comprehensive picture of the mechanism of injury and forensic-medical evaluation of the consequences of injury. There is also an open question related to the study of the characteristic’s injuries of drivers and pedestrians, the establishment of differential traumatic criteria specific to the driver and pedestrians. There is also an open question related to the study of the feature of injuries and establishment of differential traumatic criteria specific to drivers and pedestrians. Despite the availability of literature on this issue, the rapid spread of personal mobility devices on the roads, as well as the increasing number of related injuries, initiates the arising of new expert tasks that arise during forensic-medical examinations of this injury and outlines new prospects for studying this problem in the context of forensic medicine.

Evaluation of Non-fatal Forensic Vascular Injuries

In the forensic report, whether the injury includes "vascular injury" or not, the life-threatening situation is important for the investigation. In this study, it was aimed to evaluate the vascular injury status and share the data with the literature in cases related to forensic traumatology, which were reflected in the Forensic Medicine Department of Eskişehir Osmangazi University Faculty of Medicine. In the 5-year period between 2015 and 2019, the cases with vascular injury, who applied to the Eskişehir Osmangazi University Faculty of Medicine, Department of Forensic Medicine, were retrospectively analyzed. Report contents and demographic data of the cases were evaluated. It was determined that 52 (1.2%) of 4378 forensic cases evaluated within the scope of the study had vascular injury. 90.3% of the patients with vascular injury were male, they were most frequently in the 19-29 age group, 69.3% of the cases were stab wounds, and the most commonly injured vessel was a.femoralis and its branches (n=11, %21.2). The data obtained in the study were found to be compatible with the literature. It was thought that in-service trainings on this subject were important, especially for emergency room doctors to be more attentive in issuing forensic reports, to take necessary measures to prevent them from being held responsible in cases of vascular injury and other forensic cases, to protect the legal rights of victims.

CURRENT ISSUES OF FORENSIC MEDICINE IN THE CONDITIONS OF MILITARY ACTIONS

Forensic medicine is a science that uses medical and general biological knowledge to solve issues that arise in the practice of law enforcement agencies. Therefore, the range of issues studied by forensic doctors is quite wide. This includes the study of death and cadaveric changes (forensic thanatology), the study of injuries (forensic traumatology), forensic medical examination of living persons regarding bodily injuries, sexual crimes, etc., forensic medical examination of material evidence, identification of a person, forensic medical examination in cases of medical errors and offenses and many others. The fact of military operations on the territory of Ukraine requires that in the training of medical students and interns in the field of «forensic medical examination», special attention should be paid to the issues that a doctor may encounter both in the combat zone and in rear health care facilities. After all, in the conditions of martial law, not only military personnel, but also medical workers are on the front line in the fight against military aggression. Therefore, it is important to pay great attention to the training of medical personnel at a high level, regardless of the difficulties faced by medical education institutions under martial law. That is why this article highlights the key points and problematic issues that must be paid attention in the course of training students and interns at the Department of Forensic Medicine and Medical Law. Algorithms for solving problematic practical tasks that arise before the forensic medical expert in the conditions of martial law are also proposed to ensure high professionalism and reliability of the performed forensic medical examinations. Thus, focusing the attention of forensic medics on the main principles and algorithms, highlighting and discussing problematic issues related to the actions of forensic medics in wartime, namely those issues related to the order of dissection of corpses, their identification and description of bodily injuries have the priority place and are able to significantly facilitate the work of forensic medical experts in such a difficult time. After all, every forensic medic who competently performs his work before conducting active military operations must be familiar with a clear algorithm of actions, which does not contradict the main provisions of Resolution No. 205 dated 03.05.2022 "On approval of the procedure for ensuring the collection of bodies (remains) of fallen military personnel of the state- of the aggressor (the Russian Federation), as well as illegal armed formations, in particular from the temporarily occupied territories in certain areas of the Donetsk and Luhansk regions", which was approved by the Cabinet of Ministers of Ukraine with the beginning of a full-scale military invasion of the territory of Ukraine by the aggressor state. This resolution regulates the actions of military administrations, the territorial defense forces of the Armed Forces, the National Guard, the National Police, the State Emergency Service, representatives of the relevant expert (medical) services, interested bodies and public organizations (associations), which are aimed at ensuring collection in the territories of military operations (armed confrontation) unburied bodies (remains) of fallen servicemen of the aggressor state (Russian Federation), as well as illegal armed formations, in particular from temporarily occupied territories in certain areas of Donetsk and Luhansk regions (hereinafter - bodies), in order to prevent the deterioration of the sanitary and epidemic situations, the occurrence of dangerous infectious diseases on the territory of Ukraine.

Assessment of Maltreatment In Forensic Traumatology Through A Case Report

Assessment of Maltreatment In Forensic Traumatology Through A Case Report

Slow and Steady Wins the Race: A Comparative Analysis of Standing Electric Scooters’ European Regulations Integrated with the Aspect of Forensic Traumatology

Fuel-driven cars are widely considered unsustainable and contrary to the new paradigm of smart growth planning. The need to reform transport behavior, policies, and infrastructure is among the priorities in urban policies around the world. Electric vehicles are an emerging technology that could advance sustainability programs. In the past year, there has been a rapid increase in the diffusion of electric scooters in several European cities, but various states have been unprepared for the rapid spread of green micro-mobility from a regulatory point of view. In addition, in parallel with the spread, there have been numerous road collisions involving standing electric scooters. The aim of this study was to obtain a detailed view of this phenomenon. We focused on the current legislation on electric micro-mobility at the European level to study and summarize the different attitudes adopted by various states whose regulations are present on the web. (It was not possible to evaluate the regulations of all European countries because they are not all available on online platforms.) The elements assessed in the various regulation were age limits, speed limits, compulsory use of helmets, administrative penalties, and the obligation to insure the new e-vehicle (standing scooter). In this study, we analyze the state of the art in electric micro-mobility, highlight the current situation’s limits, and propose new strategies to adequately integrate this new smart vehicle into the urban transport network.

Veterinary forensic necropsies: a look through an aspect of forensic traumatology

Forensic veterinary pathology is essential to identify the cause of death of animals with suspicion of abuse, neglect, exogenous intoxication, medical errors, if the lesions were accidental or ante-mortem or in cases where the animal’s identity is needed. It involves several areas that can be used to determine the cause of death in animals, such as traumatology, entomology and toxicology. This work aims to determine the main lesions found in judicial necropsies of animals from the metropolitan region of Belém, qualifying the most prevalent lesions according to the classification in forensic traumatology. The necropsy was performed according to the animal species and using the method of Ghon. The animals were grouping by specie, sex, race and age and it was made a segmentation by vulnerable energy. 33 judicial necropsies (9.06%) were performed between January 2018 and December 2019, including 22 canines (66.7%), seven felines (21.2%), two farm animals (6.1%) and two wild animals (6.1%). Regarding the sex of the animals, in general, 51.51% were males and 45.45% were females. Young dogs and cats represented the highest percentage of cases. Mixed breed dogs were the most prevalent, with 31.8%. In all species, the most prevalent energy was chemical energy, totalling 18 cases. Second, with six cases, mechanical trauma with only canines and felines, in which, only in three were evident the blunt injury. In only one case, the suspicion was of biodynamic energy, with suggestive findings. In conclusion, the forensic necropsy associated with the animal’s history is capable of providing relevant information which assists the pathologist in the search for injuries, its identification and interpretation.

Non-fatal posttraumatic cerebrovascular diseases not attributable to direct cranial trauma and their role in forensic traumatology

Non-fatal posttraumatic cerebrovascular diseases not attributable to direct cranial trauma and their role in forensic traumatology

Adli Raporların Yaşamsal Tehlike Kriteri Açısından Değerlendirilmesi

In the forensic report, it is important for the judgment whether the injury is "life-threatening" or not. In this study, it is aimed to evaluate the life-threatening situation in events related to forensic traumatology that reflected in the Department of Forensic Medicine, Eskişehir Osmangazi University Faculty of Medicine and to share the data with the literature. In the 5-year period between 2013 and 2017, among the cases who applied to Eskişehir Osmangazi University Faculty of Medicine Department of Forensic Medicine, life-threatening cases were analyzed retrospectively. Report contents and demographic data of the cases were evaluated.It was determined that 355 (12%) of the 3009 forensic cases evaluated within the scope of the study were life-threatening. 79.7% of the life-threatening cases were male, they were mostly in the 21-30 age group, 45.1% of the cases were injured due to a traffic accident, and the most life-threatening injury (n = 130, 36.6% ) was determined to be in the head area.The data obtained in the study were found to be compatible with the literature. It was thought that especially emergency physicians should be more attentive in preparing forensic reports and in-service trainings on this issue were important.

METHODS TO DETERMINE COMPLEX DEGREES OF MUTUAL ANISOTROPY FOR THE DIFFERENTIATION OF HEMORRHAGES IN THE HUMAN BRAIN SUBSTANCE RESULTING FROM TRAUMATIC AND NON-TRAUMATIC GENESIS

An issue that is often debated in forensic traumatology is the differential diagnosis of hemorrhages into the human brain substance (HBS) of traumatic and non-traumatic genesis.
 Objectives. This study aims to identify new criteria for objective forensic differentiation of hemorrhages of traumatic origin, cerebral infarction of ischemic and hemorrhagic genesis by using the method of complex degree of mutual anisotropy. For this study native sections of HBS from 125 corpses were used in the case of: death from coronary heart disease - 35 (28%) of native sections (Group 1 - control); hemorrhages of traumatic genesis - 30 (24%) sections (Group 2); ischemic cerebral infarction - 30 (24%) native sections(Group 3); and hemorrhages of non-traumatic genesis - 30 (24%) native sections (Group 4).
 Results. The statistical moments of the third and fourth orders, which characterize the asymmetry and excess of the complex degree of mutual anisotropy module size distributions, the strength of the method of polarization-correlation microscopy in the differentiation of the samples of the histological sections of the brain of control and experimental groups reached a good level — 87%-90%.
 Conclusion. The method of complex degree of mutual anisotropy allows differentiating with great precision the genesis of hemorrhage into the substance of the brain.

MODERN POSSIBILITIES OF DIAGNOSIS AND DIFFERENTIATION OF HEMORRHAGES IN THE BRAIN OF TRAUMATIC AND NON-TRAUMATIC GENESIS (LITERATURE REVIEW)

Forensic traumatology is one of the most extensive, complex and important sections of forensic science and practice. Traumatic brain injury, as it is one of the most common injuries, occupies a prominent place in it. For a forensic expert the objective differential diagnosis of hemorrhage into the substance of the human brain of traumatic and non-traumatic genesis is especially important.Aim of the work. To review the literature on modern possibilities of diagnosis and differentiation of hemorrhages in the brain of traumatic and non-traumatic genesis.Conclusions. Computed tomography and general clinical picture are usually used for differential diagnosis within the group of acute cerebrovascular disorders, but there is very little data on the differentiation of strokes of ischemic and hemorrhagic genesis and hemorrhage into the brain substance of traumatic origin.Immunohistochemistry is widely used in forensic histology to diagnose pathological processes that preceded or caused death.In forensic practice, to verify the cause of death, physical and optical methods are successfully used, which are based on laser irradiation of biological tissues, followed by mathematical and statistical processing of the obtained data. Previous studies on the possibility of differentiating the genesis of hemorrhage into the brain by thin-layer polarization tomography have given positive results, which suggests the possibility of verifying its cause and traditional polarization methods.

Forensic medical assessment of a craniocerebral trauma arising from the action of solid blunt objects

The article highlights the relevance of the study of the mechanisms of the skull fracture formation from the action of solid blunt objects, as an expert study of craniocerebral trauma is one of the key issues of forensic traumatology. The urgency of the study of the mechanism of the such an injury occurrence is confirmed by the number of investigated corpses with this diagnosis in the evaluation of statistical data. For the establishing of mechanism of causing damages leading to fractures of the skull , it is necessary to determine the nature of the traumatic subject, its constructive characteristics, the number of injurious actions, their direction and the circumstances of the formation of these damages, and also take into account the anatomical and geometric properties of the skull.

Correlações presentes entre danos bucomaxilofaciais e lesões corporais em mulheres: uma revisão de literatura

<span style="font-family: HelveticaLTStd-Roman; font-size: xx-small;"><span style="font-family: HelveticaLTStd-Roman; font-size: xx-small;"><p>A violência contra a mulher é um fenômeno social de alta complexidade e graves paradoxos, seja no aspecto ético, no cultural, no político, no religioso, como também nas tentativas de explicação pelas mais variadas correntes e tendências. É algo que a sociedade e a comunidade científica não podem desconsiderar. A presença da Odontologia Legal, no que tange às lesões do complexo maxilo-mandibular em mulheres, torna-se indispensável na constatação e reparação dos danos. O presente trabalho objetiva demonstrar, através de uma revisão da literatura, as diversas correlações existentes entre as lesões corporais, mais especificamente as relacionadas aos danos bucomaxilofaciais, em mulheres, dando embasamento teórico aos profissionais que atuam na prática pericial em Traumatologia Forense.</p></span></span>

Forensic medicine in Tunisia

Tunisia is an Arab northern African country which counts 10 millions citizens. In Tunisia, there is a small number of forensic practitioners (20) distributed over four University and two regional Hospitals. Forensic activity is under the supervision of Tunisian Ministry of Public Health. The first forensic medicine department was set up in the Faculty of Medicine of Tunis (the capital) in the sixties, after which three other departments were founded in medical faculties and in their respective university hospitals (Sfax, Sousse and Monastir). These Departments provide forensic medical education and research beside their daily practice. Forensic medical practice is divided in forensic pathology and clinical forensic medicine. In forensic pathology, we have to deal with violent or suspected deaths beside natural deaths. The clinical forensic medicine activity covers mainly forensic traumatology. Other fields of forensic sciences are in progress and ought to be developed all over the country. A forensic medical curriculum is provided in the four Tunisian Faculties of Medicine and in their University Hospitals. Nevertheless, the number of trainees remains small and could not currently satisfy the country needs.

Virtopsy: Forensic Traumatology of the Subcutaneous Fatty Tissue; Multislice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI) as Diagnostic Tools

Traumatic lesions of the subcutaneous fatty tissue provide important clues for forensic reconstruction. The interpretation of these patterns requires a precise description and recording of the position and extent of each lesion. During conventional autopsy, this evaluation is performed by dissecting the skin and subcutaneous tissues in successive layers. In this way, depending on the force and type of impact (right angle or tangent), several morphologically distinct stages of fatty tissue damage can be differentiated: perilobular hemorrhage (I), contusion (II), or disintegration (III) of the fat lobuli, and disintegration with development of a subcutaneous cavity (IV). In examples of virtopsy cases showing blunt trauma to the skin and fatty tissue, we analyzed whether these lesions can also be recorded and classified using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). MSCT has proven to be a valuable screening method to detect the lesions, but MRI is necessary in order to properly differentiate and classify the grade of damage. These noninvasive radiological diagnostic tools can be further developed to play an important role in forensic examinations, in particular when it comes to evaluating living trauma victims.

SEM study of dermal surface. A new approach to forensic traumatology.

We describe a method of enzymatic digestion of the dermo-epidermal junction, that allows an observation with a SEM of the finest details of the dermal surface covered by the reticular fibrils of the basement membrane. By means of this technique, we have made a panoramic review of the traumatology and have observed typical characteristics in all types of examined lesions. It seems that the method can constitute a new approach for medicolegal study, in all those cutaneous lesions that involve, even superficially, the dermis.