Lethal Injuries Research Articles

The effect of age on injury patterns in pedestrian deaths.

Although it is known that elderly pedestrians are at increased risk of injury and death from vehicle crashes the specific pattern of lethal injuries related to age has not been extensively studied. Data on the numbers of pedestrian fatalities and ages were obtained from 1990 to 2020 from the Traffic Accident Reporting System, The University of Adelaide, Adelaide, South Australia and detailed autopsy data on fatal pedestrian crashes from the pathology database at Forensic Science SA, Adelaide, South Australia from 2000 to 2020. Fatal injuries were separated into the following regions: head/face, spine, chest, abdomen and limbs/skeleton. Analysis of 634 cases of pedestrian fatalities (1990-2020) showed a significant decline in numbers over the years (p < 0.001). Analysis of fatal injuries in 219 cases (2000-2020) showed a significant reduction in the proportion of fatal head injuries with increasing age (p < 0.05), a significant increase in the proportion of fatal chest injuries with increasing age (p < 0.01) and a significant increase in the proportion of fatal limb/skeletal injuries with increasing age (p < 0.05). Older pedestrians are, therefore, more likely to sustain lethal chest and limb/skeletal injuries than head injuries compared to those who are younger, presumably due to greater physical fragility that occurs with age, with loss of protective muscle bulk and bone density.

A review of open pelvic fractures with concurrent genitourinary injuries.

Open pelvic fractures (OPFs) are uncommon but potentially lethal traumatic injuries. Often caused by high energy blunt trauma, they can cause severe injury to abdominal and pelvic structures. We sought to conduct a review of the literature in order to ascertain the rates of genitourinary injury and vaginal laceration after OPF and the rates of resulting infection and mortality. A review of PubMed was conducted to identify studies reporting the rates of genitourinary injury from OPF. Study characteristics, patient characteristics, and outcomes were collected. The data were pooled, and descriptive statistics were obtained. Eight studies encompassing 343 patients were included. Average age was 35.1years (10-85.9), 28% were female, and the average Injury Severity Score was 26.5 (4-75). 95.5% of patients had a blunt mechanism of injury. Motor vehicle collision (23.9%), motorcycle accident (19.7%), and pedestrian struck (19.3%) were the most common etiologies. Overall mortality and infection rates were 31.2% and 18.7%, respectively. 19.7% of patients suffered an injury to the genitourinary system, and 32.4% of females sustained a vaginal laceration. OPFs have the potential for extremely high morbidity and mortality. While much research has been done to prevent early mortality from hemorrhage, there is comparatively little research into late mortality stemming from infection and sepsis. Intravenous antibiotics are the mainstay of treatment, and local antibiotics usage has been encouraged. In patients with a vaginal laceration, it is important to provide antibiotic coverage for vaginal flora.

The Surgical Timing and Complications of Rib Fixation for Rib Fractures in Geriatric Patients.

Rib fractures (RF) are a common injury that cause significant morbidity and mortality, especially in geriatric patients. RF fixation could shorten hospital stay and improve survival. The aim of this retrospective study was to evaluate the clinical impact and proper surgical timing of RF fixation in geriatric patients. We reviewed all the medical data of patients older than 16 years old with RF from the trauma registry database between January 2017 and December 2019 in Chang Gung Memorial Hospital. A total of 1078 patients with RF were enrolled, and 87 patients received RF fixation. The geriatric patients had a higher chest abbreviated injury scale than the non-geriatric group (p = 0.037). Univariate analysis showed that the RF fixation complication rates were significantly related to the injury severity scores (Odds ratio 1.10, 95% CI 1.03–1.20, p = 0.009) but not associated with age (OR 0.99, 95% CI 0.25–3.33, p = 0.988) or the surgical timing (OR 2.94, 95% CI 0.77–12.68, p = 0.122). Multivariate analysis proved that only bilateral RF was an independent risk factor of complications (OR 6.60, 95% CI 1.38–35.54, p = 0.02). RF fixation can be postponed for geriatric patients after they are stabilized and other lethal traumatic injuries are managed as a priority.

Hemostatic efficacy of composite polysaccharide powder (starch-chitosan) for emergency bleeding control: An animal model study

BackgroundBlood clot formation or hemostasis is vital to minimize blood loss and mitigate the risk of death from severe bleeding. This study investigates the characteristics of a novel hemostatic composite containing chemically modified chitosan and starch for emergency bleeding control. The performance of this novel hemostatic powder was compared with commercially available starch-based (Arista AH) and chitosan-based (Celox) hemostats. MethodsHemostatic composite was prepared according to the patent registered by the authors (Patent No. 100865, Iranian Intellectual Property Organization) in Bani Zist Baspar Healda, Inc. (Shiraz, Iran). The properties of the product were surveyed by Fourier-transform infrared spectroscopy and compared with Arista-AH and Celox as commercial counterparts. The cytocompatibility, hemolysis, platelet and red blood cells (RBCs) adhesion, biocompatibility, and biodegradability attributes were evaluated in in vivo and in vitro studies. Hemostatic efficacy was evaluated in 24 healthy 6-month-old male New Zealand white rabbits in lethal and sublethal injuries of femoral artery and veins, respectively. ResultsModification and composition led to a fundamental development in physicochemical characteristics including swelling properties, water absorption, and platelet and RBC adhesion due to improved electrostatic and hydrophilic attributes. The significant superiority in clotting efficiency was confirmed after the application of the composite in 2 models of venous and arterial injury in comparison with common commercial hemostats. ConclusionSimultaneous use of water-absorbing compounds and introducing positively charged functional groups to hemostatic material led to a considerable control of femoral bleeding in emergency conditions. The introduced composite was biodegradable and biocompatible and prompts RBC aggregation and platelet adhesion.

Particularities of Lethal Head Injuries in Children

Particularities of Lethal Head Injuries in Children

Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality-A multicenter observational study.

Thoracic trauma is a major cause of death in trauma patients and road traffic accident (RTA)-related thoracic injuries have different characteristics than those with non-RTA related thoracic traumas, but this have been poorly described. The main objective was to investigate the epidemiology, injury pattern and outcome of patients suffering a significant RTA-related thoracic injury. Secondary objective was to investigate the influence of serious thoracic injuries on mortality, compared to other serious injuries. We performed a multicenter observational study including patients of the Rhône RTA registry between 1997 and 2016 sustaining a moderate to lethal (Abbreviated Injury Scale, AIS≥2) injury in any body region. A subgroup (AISThorax≥2 group) included those with one or more AIS≥2 thoracic injury. Descriptive statistics were performed for the main outcome and a multivariate logistic regression was computed for our secondary outcome. A total of 176,346 patients were included in the registry and 6,382 (3.6%) sustained a thoracic injury. Among those, median age [IQR] was 41 [25-58] years, and 68.9% were male. The highest incidence of thoracic injuries in female patients was in the 70-79 years age group, while this was observed in the 20-29 years age group among males. Most patients were car occupants (52.3%). Chest wall injuries were the most frequent thoracic injuries (62.1%), 52.4% of which were multiple rib fractures. Trauma brain injuries (TBI) were the most frequent concomitant injuries (29.1%). The frequency of MAISThorax = 2 injuries increased with age while that of MAISThorax = 3 injuries decreased. A total of 16.2% patients died. Serious (AIS≥3) thoracic injuries (OR = 12.4, 95%CI [8.6;18.0]) were strongly associated with mortality but less than were TBI (OR = 27.9, 95%CI [21.3;36.7]). Moderate to lethal RTA-related thoracic injuries were rare. Multiple ribs fractures, pulmonary contusions, and sternal fractures were the most frequent anatomical injuries. The incidence, injury pattern and mechanisms greatly vary across age groups.

Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South Africa

Background: Penetrating cardiac injuries are rare in South African and international literature. Penetrating cardiac injuries are regarded as one of the most lethal injuries in trauma patients. The mechanism of injury varies across the world. In developing countries, stab wounds cause the majority of penetrating cardiac injuries. These injuries remain clinically challenging and are associated with high mortalities. Aim: To describe our experience with penetrating cardiac injuries and the outcome of their management at a level 1 trauma unit in Johannesburg, South Africa. Materials and methods: We retrospectively reviewed all patients who presented with penetrating cardiac injuries over a period of four years (1 January 2016 to 31 December 2019). The patients were identified using the hospital database. The patient’s demographics, mechanism of injury, injury severity score, vital signs, investigation findings, final diagnosis, type of operation, length of hospital stay, morbidities, and mortalities were recorded. Results: There was a total of 167 patients with penetrating cardiac injuries identified. There were 151 (90.4%) males, with an overall median age of 29 years (IQR 24–34). Stab wounds accounted for 77.8% of the injuries, while gunshot wounds (GSW) accounted for 22.2%. The median injury severity score (ISS) and revised trauma score (RTS) were 25 and 7.1, respectively. The right ventricle was the most injured chamber (34.7%), followed by the left ventricle (29.3%), right auricle (13.2%), right atrium (10.2%), and combined injuries accounted for 7% of injuries. A commonly used incision was a sternotomy (51.5%), left anterior-lateral thoracotomy (26.9%), emergency room thoracotomy (19.2%), and clamshell thoracotomy (2.4%). The overall mortality rate was 40.7%, with a 29.2% mortality in the stab wounds. Twenty-four (14.4%) patients died in the emergency department, sixteen (9.6%) patients died on the table in theatre, and the remaining twenty-eight (16.7%) died in the intensive care unit or wards. Gunshot wounds, other associated injuries, right ventricle injuries, a high ISS, low RTS, and low Glasgow coma scale were all significantly more likely to result in death (p &lt; 0.001). Conclusions: Penetrating cardiac injuries are often fatal, but the mortality can be improved with appropriate resuscitation and a work-up. The injuries to the heart can be safely managed by trauma/general surgeons in our setting. The physiology in presentation and other associated injuries determines outcomes in patients with penetrating cardiac injury.

An Injury Investigation of a Bus-Train Collision, Chachoengsao, Thailand, October 2020

On October 2020, there was a bus-train collision at Chachoengsao Province with 18 fatalities. The Division of Epidemiology conducted a joint investigation during October 2020 to describe characteristics of the event and deaths, and identify factors associated with fatalities. A descriptive study was conducted by interviewing officers, witnesses, policemen, rescuers and survivors. We also reviewed medical records and closed-circuit television and performed environmental survey of the roads and bus wreckage. A retrospective cohort study was performed with multiple logistic regression and Haddon matrix analyses. The bus collided with a cargo train at an illegal road-railway crossing intersection. Eighteen people died (25.4%). Most deaths were caused by lethal injuries to the head and neck (17/18, 94.4%). The bus was overloaded and turning on loud music. The intersection did not have crossing gates and the warning signal was broken. This bus-train collision resulted in high fatality. Standing on the overloaded bus was the significant risk of death. Regulations of noise limits, number of passengers, limit standing on the buses, and improvement of safety controls for all road-railway intersections should be strictly implemented for injury prevention.

Sledding while towed behind motorized vehicles associates with more severe and lethal injuries☆

IntroductionOur institution has recently experienced an increase in sledding-related injuries, particularly when towed behind motorized vehicles. The purpose of this study was to characterize injury severity and clinical outcomes between pediatric patients who sustain injuries owing to motorized sledding accidents to aid in injury prevention messaging. MethodsThis retrospective study queried all patients who presented with a sledding-related injury to a single ACS-verified Level 1 Pediatric Trauma Center located in the Southeastern United States between 01/2015 and 01/2022. Demographics, injury details, and clinical outcomes were compared between two groups: patients towed behind a motorized vehicle (MOTOR) and those who were not (GRAVITY). ResultsOf the 67 patients included in our analysis, 15 (22%) were in the MOTOR group. Patients in the MOTOR group presented with significantly higher injury severity (ISS) and lower Glasgow coma scale (GCS) scores. Additionally, patients in this MOTOR group more often received a blood transfusion and intubation, had longer intensive care and overall hospital lengths of stay, and incurred higher hospital costs. In a multivariate analysis, the use of a motorized vehicle to sled was independently associated with increased ISS (OR: 9.7, 95% CI 1.9–17.5; p = 0.02). Two deaths occurred after sledding while being towed behind a motorized vehicle. ConclusionChildren experiencing sledding accidents while being towed by motorized vehicles sustain significantly more severe injuries and require more intensive treatments that together lead to increased hospital costs. These findings provide the framework for community educational initiatives and injury prevention measures to mitigate risk among children engaged in sledding. Level of evidenceIV retrospective cohort study.

The Microwave Auditory Effect

The microwave auditory effect has been widely recognized as one of the most interesting and significant biological phenomena from microwave exposure. The hearing of pulsed microwaves is a unique exception to sound waves encountered in human auditory perception. The hearing of microwave pulses involves electromagnetic waves. This paper reviews the research in humans and animals leading to scientific documentations that absorption of a single microwave pulse impinging on the head may be perceived as an acoustic zip, click, or knocking sound. A train of microwave pulses may be sensed as buzz, chirp, or tune by humans. It describes neurophysiological, psychophysical, and behavioral observations from laboratory studies involving humans and animals. Mechanistic studies show that the microwave pulse, upon absorption by tissues in the head, launches a pressure wave that travels by bone conduction to the inner ear, where it activates the cochlear receptors via the same process involved for normal sound hearing. Depending on the impinging microwave pulse powers, the level of induced sound pressure could be considerably above the threshold of auditory perception to cause tissue injury. The microwave auditory effects and associated pressures could potentially render damage to brain tissue to cause lethal or nonlethal injuries.

Wildlife is imperiled in peri-urban landscapes: threats to arboreal mammals

Urbanization and deforestation impose severe challenges to wildlife, particularly for forest-living vertebrates. Understanding how the peri-urban matrix impacts their survival is critical for designing strategies to promote their conservation. We investigated the threats faced by brown howler monkeys (Alouatta guariba clamitans) in peri-urban regions of Rio Grande do Sul (RS) and Santa Catarina (SC) states, southern Brazil, by compiling negative interaction events (hereafter NIE) reported over more than two decades. We assessed the major NIEs, their distribution among age-sex classes, and the predictors of NIE-related mortality. After 20+ years of monitoring, we compiled 540 NIEs (RS = 248 and SC = 292). Electrocution by power lines was the most frequent cause of death or injury (37%), followed by dog attack (34%), vehicle collision (17%), and human mistreatment (12%). The occurrence of lethal injuries ranged from 5% to 69% depending on the type of NIE and on which state it occurred in. The overall post-NIE mortality was 56%. Adults of both sexes were the most affected individuals in both study regions. The minimal adequate GLM model explained 83% of the variation in NIE-related mortality. State, NIE type, and age-sex class were the main predictors of mortality. Overall, mortality was lower in SC and higher among adult females than in the other classes. We found that the survival of brown howler monkeys in the forest-urban interface is constrained by both the urban infrastructure and the growing interactions with humans and domestic and stray dogs (Canis familiaris). We propose the placement of aerial bridges, road signs and speed bumps in areas of frequent animal crossing, the sterilization of stray dogs, and the sensitization of local inhabitants on the importance of respecting and protecting wildlife to reduce their NIEs with humans and domestic animals in the forest-urban interface.

Forensic determination of shark species as predators and scavengers of sea turtles in Florida and Alabama, USA

Sharks are the primary predator of large immature and mature sea turtles, yet the shark species responsible for both lethal and non-lethal injuries are rarely identified. Forensic analysis of bite wounds can be used to accurately assess size and potential shark species when combined with observations on species-specific feeding behavior, geographic distribution, and habitat preference. The objective of this study was to use forensic analysis of bite damage on sea turtles to infer shark size and species. Photographs from 13 cases of documented shark predation (n = 10) and scavenging (n = 3) attempts on sea turtles were retrospectively analyzed, including nesting, free-ranging, and/or dead stranded loggerhead Caretta caretta, green Chelonia mydas, Kemp’s ridley Lepidochelys kempii, and leatherback Dermochelys coriacea sea turtles in Florida and Alabama, USA, from 2010-2020. Mean interdental distance (IDD) and bite circumference (BC) of wound marks on sea turtles suggest that wounds were generated by white sharks Carcharodon carcharias in 3 cases, tiger sharks Galeocerdo cuvier in 3 cases, and bull shark(s) Carcharhinus leucas in one case. For 3 cases with less distinct wound patterns, 2 likely shark species were identified and thereafter narrowed down to a single species based on bite mark characteristics (e.g. punctures). Due to indistinct IDD and BC ranges of the bite patterns, a single shark species was not identified in 3 cases. Forensic analysis enables more accurate evaluations of which shark species prey on and scavenge sea turtles and is a useful technique for studying the behavioral interactions of sharks and turtles.

A narrative review of traumatic mediastinal injuries and their management: the thoracic surgeon perspective.

ObjectiveMediastinal injuries are uncommon, rarely encountered and depending on the institution, can be managed by various sub-specialties. The purpose of this narrative review is to present an overview of traumatic mediastinal injuries, their presentation, and management options from the perspective of a thoracic surgeon.BackgroundAlthough infrequent, traumatic mediastinal injuries can pose significant morbidity and mortality. The infrequency of these injuries limits operative exposure for thoracic surgeons and trainees. A concise overview of common presentations and management options is warranted to further solidify important concepts.MethodsA search of the literature was conducted using MEDLINE, PubMed, and Embase for relevant articles pertaining to anatomic injuries of the mediastinum. The presentation of mediastinal injuries along with indications for non-operative versus operative management in cardiac injuries, thoracic esophageal injuries, tracheobronchial injuries, and injuries to the lungs and pleura was conducted and literature summarized.ConclusionsIn providing this review it is hopeful to enhance knowledge and comfort in recognition and management of these uncommon yet potentially lethal injuries. Early involvement of thoracic surgery is recommended to ensure effective and efficient treatment.

Assessing Protein Biomarkers to Detect Lethal Acute Traumatic Brain Injuries in Cerebrospinal Fluid.

Diagnosing traumatic brain injury (TBI) from body fluids in cases where there are no obvious external signs of impact would be useful for emergency physicians and forensic pathologists alike. None of the previous attempts has so far succeeded in establishing a single biomarker to reliably detect TBI with regards to the sensitivity: specificity ratio in a post mortem setting. This study investigated a combination of body fluid biomarkers (obtained post mortem), which may be a step towards increasing the accuracy of biochemical TBI detection. In this study, serum and cerebrospinal fluid (CSF) samples from 30 acute lethal TBI cases and 70 controls without a TBI-related cause of death were evaluated for the following eight TBI-related biomarkers: brain-derived neurotrophic factor (BDNF), ferritin, glial fibrillary acidic protein (GFAP), interleukin 6 (IL-6), lactate dehydrogenase, neutrophil gelatinase-associated lipocalin (NGAL), neuron-specific enolase and S100 calcium-binding protein B. Correlations among the individual TBI biomarkers were assessed, and a specificity-accentuated threshold value analysis was conducted for all biomarkers. Based on these values, a decision tree modelling approach was performed to assess the most accurate biomarker combination to detect acute lethal TBIs. The results showed that 92.45% of acute lethal TBIs were able to be diagnosed using a combination of IL-6 and GFAP in CSF. The probability of detecting an acute lethal TBI was moderately increased by GFAP alone and considerably increased by the remaining biomarkers. BDNF and NGAL were almost perfectly correlated (p = 0.002; R2 = 0.944). This study provides evidence that acute lethal TBIs can be detected to a high degree of statistical accuracy using forensic biochemistry. The high inter-individual correlations of biomarkers may help to estimate the CSF concentration of an unknown biomarker, using extrapolation techniques.

Characteristics of Prehospital Death in Trauma Victims.

Background: Using Injury Severity Score (ISS) data, this study aimed to give an overview of trauma mechanisms, causes of death, injury patterns, and potential survivability in prehospital trauma victims. Methods: Age, gender, trauma mechanism, cause of death, and ISS data were recorded regarding forensic autopsies and whole-body postmortem CT. Characteristics were analyzed for injuries considered potentially survivable at cutoffs of (I) ISS ≤ 75 vs. ISS = 75, (II) ISS ≤ 49 vs. ISS ≥ 50, and (III) ISS < lethal dose 50% (LD50) vs. ISS > LD50 according to Bull’s probit model. Results: In n = 130 prehospital trauma victims (45.3 ± 19.5 years), median ISS was 66. Severity of injuries to the head/neck and chest was greater compared to other regions (p < 0.001). 52% died from central nervous system (CNS) injury. Increasing injury severity in head/neck region was associated with CNS-injury related death (odds ratio (OR) 2.7, confidence interval (CI) 1.8–4.4). Potentially survivable trauma was identified in (I) 56%, (II) 22%, and (III) 9%. Victims with ISS ≤ 75, ISS ≤ 49, and ISS < LD50 had lower injury severity across most ISS body regions compared to their respective counterparts (p < 0.05). Conclusion: In prehospital trauma victims, injury severity is high. Lethal injuries predominate in the head/neck and chest regions and are associated with CNS-related death. The appreciable amount (9–56%) of victims dying at presumably survivable injury severity encourages perpetual efforts for improvement in the rescue of highly traumatized patients.

Delayed diagnosed trauma in severely injured patients despite guidelines-oriented emergency room treatment: there is still a risk

PurposeEmergency trauma room treatment follows established algorithms such as ATLS®. Nevertheless, there are injuries that are not immediately recognized here. The aim of this study was to evaluate the residual risk for manifesting life-threatening injuries despite strict adherence to trauma room guidelines, which is different to missed injuries that describe recognizable injuries.MethodsIn a retrospective study, we included 2694 consecutive patients admitted to the emergency trauma room of one single level I trauma center between 2016 and 2019. In accordance with the trauma room algorithm, primary and secondary survey, trauma whole-body CT scan, eFAST, and tertiary survey were performed. Patients who needed emergency surgery during their hospital stay for additional injury found after guidelines-oriented emergency trauma room treatment were analyzed.ResultsIn seven patients (0.26%; mean age 50.4 years, range 18–90; mean ISS 39.7, range 34–50), a life-threatening injury occurred in the further course: one epidural bleeding (13 h after tertiary survey) and six abdominal hollow organ injuries (range 5.5 h–4 days after tertiary survey). Two patients (0.07% overall) with abdominal injury died. The “number needed to fail” was 385 (95%–CI 0.0010–0.0053).ConclusionOur study reveals a remaining risk for delayed diagnosis of potentially lethal injuries despite accurate emergency trauma room algorithms. In other words, there were missed injuries that could have been identified using this algorithm but were missed due to other reasons. Continuous clinical and instrument-based examinations should, therefore, not be neglected after completion of the tertiary survey.Level of evidenceLevel II: Development of diagnostic criteria on the basis of consecutive patients (with universally applied reference “gold” standard).

EVALUATING COMPOSITIONAL FIDELITY AND SOURCES OF MORTALITY OF SHORELINE FISH CARCASSES IN A FRESHWATER LAKE COMMUNITY IN WESTERN CANADA

ABSTRACT Taxonomic comparisons of death assemblages with extant communities continue to provide insight for ecological studies but whether demographic aspects such as age structure, sex ratio, and causes of mortality are accurately captured by the former remains little studied. At a 110 ha dystropic lake in western Canada, seasonal shoreline accumulations of fish carcasses were collected annually for 12 years (N=4499) during 95 full lake-circuits and analyzed for taxa, body size frequencies, sex ratio relative to live-captures and sources of mortality. Rank order of the four fish species (Gasterosteus aculeatus, Oncorhynchus clarki, O. keta, Salvelinus malma) was similar for live-captures and carcasses. Of the dominant species (G. aculeatus), modal adult body length (∼80 mm SL) was the same for carcasses and live-captures and shifted by about 10% over 30 years with parallel trends between the groups for both sexes. Age-specific body size was about 5% larger (P&amp;lt;0.001) in carcasses than live-captures. Carcasses were significantly female-biased (2:1) each year relative to a population sex ratio of 1:1 in the lake. There was a complete absence of juvenile fish (&amp;lt;30 mm) among carcasses but these constituted 70% of the live population. Estimated relative contributions to mortality for the carcasses include starvation (&amp;lt;1%), parasitism (3%), senescence (4%) and lethal injuries from predator attack (70–80%). If these carcasses are representative of a fossil series in freshwater lake sediments, then several demographic parameters including age-specific body size, age-class frequencies and sex ratio depart substantially from the live population. As well, the virtual absence of avian piscivores in the carcass assemblage, the major source of predation on the fish population, warrants additional attention in paleoecological studies.

Ammonia Exposure: A Review of Six Cases.

Exposure to high doses of ammonia gas can result in lethal injuries to humans. This case series presents 5 fatalities and an injured individual, caused by acute ammonia exposure, which occurred in the rubber industry. One of the fatalities and the survivor were reported in an incident of ammonia gas cylinder explosion, whereas the other 4 fatalities were accidentally exposed to gaseous ammonia, where they had started working at a reopened rubber factory that had been abandoned for a long time. Autopsy, scene investigation, and the toxicological findings of the deceased and the clinical forensic examination of the survivor revealed corrosive burns on the skin and the oropharynx, diffuse alveolar damage, and high level of ammonia in blood and the scene. These cases highlight how the comprehensive death investigation helps the forensic practitioner to conclude ammonia exposure as the cause of death/injury where there is a possibility of gas inhalation.

Hemopneumothorax detection through the process of artificial evolution - a feasibility study

BackgroundTension pneumothorax is one of the leading causes of preventable death on the battlefield. Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination. These techniques are not fully applicable in field conditions and on the battlefield, where situational and environmental factors may impair clinical capabilities. We aimed to assemble a device able to sample, analyze, and classify the unique acoustic signatures of pneumothorax and hemothorax.MethodsAcoustic data was obtained with simultaneous use of two sensitive digital stethoscopes from the chest wall of an ex-vivo porcine model. Twelve second samples of acoustic data were obtained from the in-house assembled digital stethoscope system during mechanical ventilation. The thoracic cavity was injected with increasing volumes of 200, 400, 600, 800, and 1000 ml of air or saline to simulate pneumothorax and hemothorax, respectively. The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution, a cutting-edge approach in the artificial intelligence discipline.ResultsThe in-house assembled dual digital stethoscope system and developed genetic algorithm achieved an accuracy, sensitivity and specificity ranging from 64 to 100%, 63 to 100%, and 63 to 100%, respectively, in classifying acoustic signal as associated with pneumothorax or hemothorax at fluid injection levels of 400 ml or more, and regardless of background noise.ConclusionsWe present a novel, objective device for rapid diagnosis of potentially lethal thoracic injuries. With further optimization, such a device could provide real-time detection and monitoring of pneumothorax and hemothorax in battlefield conditions.

Abdominal and pelvic vascular trauma in Queensland, Australia: institutional experience at a level one trauma centre

Background: Abdominal and pelvic vascular injuries are amongst the most lethal injuries sustained by trauma patients. Unlike internationally, the epidemiology is not well documented in Australia. Gold Coast University Hospital (GCUH) is a level one trauma centre in Queensland, Australia. This study aims to identify the epidemiological patterns of abdominal and pelvic vascular traumatic injuries, their interventions and outcomes, and compare these with national and international data. Methods: All individuals who presented to GCUH between January 2014 and December 2019 with abdominal or pelvic vascular injuries were retrieved from the GCUH prospective trauma database. A descriptive analysis was undertaken on this cohort. Results: The study reviewed 5452 trauma admissions to GCUH, of which 68 patients sustained abdominal or pelvic vascular injuries. The number of blunt and penetrating trauma cases were 53 (77.9%) and 15 (22.1%) respectively, and 51 (75%) of the patients were male. Interventions were required in 57 patients (83.8%). Of these interventions, 28 were open (41.2%), 27 were endovascular (39.7%) and 2 required both open and endovascular interventions (2.9%). The most commonly injured vessels were the visceral arteries (51.9%) and iliac arteries (22.7%). The mortality rate was 8.8% which were all as a result of blunt trauma. Conclusions: Abdominal and pelvic vascular trauma causes significant injuries with a higher mortality than general trauma. Given the majority of cases occurred secondary to road accidents, motor vehicle safety interventions and prevention programmes are likely to have the greatest effect on reducing the abdominal and pelvic vascular injury rate in Australia.