Postmortem computed tomography findings as evidence of traffic accident-related fatal injury

PURPOSE: Most traumatic deaths in Japan are due to nonpenetrating injuries, especially those that result from traffic accidents; however, the autopsy rate of traffic accident-related deaths is only about 5%. We investigated the diagnostic ability of postmortem computed tomography (PMCT) in cases of fatal trauma after traffic accidents. MATERIALS AND METHODS: Our subjects were 78 subjects (59 males, 19 females; mean age 50 years, range 15-87 years) who were brought to our institution in cardiopulmonary arrest on arrival after traffic accidents and died despite resuscitation attempts. PMCT findings of damage to the head, neck, thorax, abdomen, and pelvis were classified into three grades according to the Abbreviated Injury Scale (AIS) severity: A: 1 (minor), 2 (moderate); B: 3 (serious), 4 (severe), 5 (critical); C: 6 (maximum). RESULTS: The percentage ratio of A/B/C in 78 head injuries was 32/60/8, in 41 neck injuries 83/5/12, in 76 thorax injuries 5/38/57, in 76 abdominal injuries 70/24/7, and in 76 pelvic injuries 79/21/0, respectively. CONCLUSION: PMCT can detect or presume fatal trauma when diagnosing the cause of death after traffic accidents.     

Analysis of inflammable substances to determine whether death has occurred before or after burning

Summary In two murder cases involving burning, both victims had been set on fire in the open air after being drenched with kerosene. In the first case, carbon monoxide hemoglobin (COHb) saturation was found to be 2.1% in the left heart blood and 0.8% in the right heart blood, a ratio of 2.6 for left to right heart blood. Paraffin hydrocarbons were also detected in the left heart blood. It was determined that the victim had been set on fire before death and that burning had been the cause of death. In the second case, the COHb saturation was 0.21% in the left heart blood and 0.24% in the right heart blood, giving a left-to-right ratio of 0.9. Paraffin hydrocarbons were detected in the hair sample, but not in the left heart blood. It was determined that the victim had been set on fire after death, and the cause of death was suspected to be asphyxia due to compression of the neck.Paper presented at the 67th Annual Meeting of the Deutsche Gesellschaft für Rechtsmedizin, Kloster Banz, D-8623 Staffelstein, FRG, September 20–24, 1988     

Prospective study of coroner's autopsies in Benin City,Nigeria

A prospective study of 726 cases of coroner's autopsies carried out over a period of two years (1st January, 1996 - 31st December, 1997) was reviewed. The causes and circumstances of death are defined and classified into natural and unnatural deaths. Fifty cases (6.3%) were children while the remaining 676 cases (93.1%) were adults in a male to female ratio of 2.6 to 1. The most common indications for coroner's autopsies were sudden unnatural deaths (SUDs) accounting for 485 cases (66.8%) and also sudden unexpected natural deaths (SUNDs) (241 cases) accounting for 33.2%. In the first category, road traffic accidents accounted for 86.7% of cases with deaths involving motor vehicle drivers and their passengers (41.8%); pedestrians (37.1%); and motorcyclists and their passengers (18.6%). The commonest causes of death in all road traffic accidents were craniocerebral injuries and haemorrhagic shock. In the second category the most common causes of sudden unexpected natural death were cardiovascular diseases resulting from complications of hypertension (54.7%) occurring in apparently healthy individuals. Other causes of death were pneumonia, pulmonary tuberculosis, typhoid fever and neoplastic diseases. This study showed that in Nigeria, with an increasing acquisition of dietary and life style habits of the developed western world, there is becoming a concomitant risk of deaths from road traffic accidents and sudden unexpected natural deaths from hypertensive cardiovascular disease.     

Immunohistochemical investigation of pulmonary surfactant-associated protein A in fire victims

To evaluate the forensic pathological significance of the immunohistochemical distribution of pulmonary surfactant-associated protein A (SP-A) in determining the cause of death in fires, 57 fire victims were examined by scoring the staining intensity. The highest SP-A score with dense granular deposits (aggregates) in the intra-alveolar space was frequently observed in cases with a lower blood carboxyhemoglobin (COHb) level (<60%). The SP-A score was relatively low in carbon monoxide intoxication due to causes other than fires. High SP-A scores showed a relation to the serum level and in part related to the bloody exudate in the lower airway. These observations suggested that the increase in SP-A in fire victims may be mainly related to pulmonary alveolar injury due to the inhalation of hot air and/or irritant gases rather than hypoxia.     

车祸所致的颅脑损伤（附426例分析）

本文报告由车祸引起的颅脑损伤426例，并与同期非车祸所致的496例进行对比分析。分析表明，车祸所致颅脑损伤多较严重。且多为合并份，并发症亦多。随着交通事业的发展其发生率有逐渐增高的趋势，文章对其损伤的机理，临床特点以及诊断处理等问题进行了讨论。     

The pattern of injury in fatal pedal cycle accidents and the possible benefits of cycle helmets.

OBJECTIVE: To establish the number of fatal pedal cycle accidents occurring in the Sheffield and Barnsley area, UK, and to investigate the possible benefits of helmet wearing by cyclists. DESIGN: All medicolegal investigations into fatal road traffic accidents in the areas of Sheffield and Barnsley (total population 757,300) were reviewed to identify cases in which pedal cyclists had died. The necropsy reports of the cases were compared with those of an equal number of controls (pedestrians and motor vehicle occupants) which were matched by sex, age and year of death. RESULTS: 28 deaths occurred in the last 15 years giving a mortality of 0.25/100,000 per annum, which is lower than the rate for the UK as a whole (0.43/100,000), but in five cases the accidents which eventually led to death occurred outside the area under study. These deaths represented 3.3% of road traffic deaths between 1979 and 1993. Over 80% of both cases and controls had severe head injuries, but the controls had suffered more fatal injuries to other parts of the body. None of the cyclists had worn helmets and, in order to assess the maximum possible benefit of helmet wearing, it was assumed that a helmet would have saved all those who only had head injuries. It was found that helmets might have saved 14 lives in 15 years. A similar calculation based on the controls suggests that if all pedestrians and vehicle occupants had worn helmets, 175 lives might have been saved in the same period. CONCLUSIONS: There is no justification for compelling cyclists to wear helmets without taking steps to improve the safety of all road users.     

Ubiquitin immunoreactivity in the midbrain as a marker of stress to motor nervous systems in fatal injury

Previous studies showed an increase in the ubiquitin (Ub)-immunoreactive structures in the midbrain in acute deaths from asphyxiation and in fires in adult subjects. The present study examined the Ub-immunoreactivity in the midbrain as a marker of stress to motor nervous systems in fatal injury cases (over 35 years of age, n=140: blunt injuries, n=82; sharp injuries, n=58), compared with that in control groups (n=61) including death by strangulation, acute cardiac and cerebrovascular diseases. The intranuclear Ub-immunopositive inclusion of the pigmented dopaminergic neurons of the substantia nigra (inclusion Ub-index) and the granular 'dot-like' Ub-immunoreactivity area ('dot-like' Ub-area) in the crus cerebri were analyzed. In blunt injuries, those markers were high in abdomen and back injuries and low in head and chest injuries. The inclusion Ub-index was higher in the crush/pressure injury group than in those with injuries due to impact traffic accidents and falls. 'Dot-like' Ub-area was also low in falls. In sharp injury cases, cardiac injury with hemopericardium showed a higher inclusion Ub-index. These findings suggested that the stress to the motor nervous system may be very intense in crush/pressure injury and hemopericardium than in impact injury and fatal hemorrhages, respectively, and in abdomen and back injuries than in head and chest injuries.     

The hidden aspect of carotid lesions in traffic accidents: A little-known phenomenon

Vascular injuries that occur during traffic accidents are a commonly neglected aspect that can add more detail to the framework of a case. In this study, we analysed a case series of 150 traffic accidents, 39 of which were marked by microscopically identifiable vascular lesions. The purpose was to identify the presence of carotid injuries in individuals who died due to traffic accidents and had nonpenetrating trauma of the neck. We focused on the discrepancies regarding the macroscopical aspect and the histology and demonstrated how histological analysis of the carotids in cases of trauma can reveal injuries that are attributable to the trauma itself. We conducted a histological analysis of the lesions to describe their distribution and type and investigate potential correlations. The study offers insight on how to examine road accidents that involve traumatic injury of the carotid arteries. Indeed the main task of the forensic pathologist in the case of death is to establish the existence of a causal relationship between the micro- or macroscopic alterations observed in the autopsy and the traumatic event that led to the death of the subject. Thus, further morphological elements were provided to the forensic practitioners that may reveal injuries attributable to the trauma itself and should be evaluated in cases of trauma in traffic accidents.     

Accidental fire deaths

Summary Accidental fire deaths that occurred in Metropolitan Dade County, encompassing Miami, Fla., USA, during the years from 1979 until 1983 were studied. A total of 108 cases were collected, representing 6.1% of the nontraffic-related accidents during this 5-year period, and analyzed as to the age, race, sex, cause of death of the victim along with the blood alcohol content at autopsy, toxicologic analysis, location of the fire, and how the fire started.Essentially, the victims ages cluster in the 0–5 years and does 70 years, although other age groups are evenly distributed. A white male population predominates.The cause of death is listed as either smoke inhalation or thermal injury. Most toxicologic analyses were not performed due to the high rate of fire rescue intervention and at least emergency room hospitalization prior to death. Caboxyhemoglobin levels, when analyzed, ranged from less than 20% to over 80%. In a smaller group of cases, cyanide was analyzed for and was found negative (or none detected) in the majority of the cases. More fires occurred in residences and started due to cigarette smoking or electric malfunction.     

Toddler run-overs – A persistent problem

Trauma accounts for a high percentage of unexpected deaths in toddlers and young children, mostly due to vehicle accidents, drowning and fires. Given recent efforts to publicise the dangers of toddler run-overs a study was undertaken to determine how significant this problem remains in South Australia. Review of coronial files over 7 years from 2000 to 2006 revealed 50 cases of sudden and unexpected death in children aged between 1 and 3 years of which 12 of 28 accidents involved motor vehicles (6 run-overs and 6 passengers). The 6 children who were killed by vehicle run-overs were aged from 12 months to 22 months (ave = 16.8 months) with a male to female ratio of 1:1. Four deaths occurred with reversing vehicles in home driveways and one at a community centre. The remaining death involved a child being run over at the beach by a forward moving vehicle. Vehicles included sedans in four cases and a four-wheel drive in one case (one vehicle was not described), and were driven by the victim’s parent in four cases, a friend of the family in one, and an unrelated person in the final case. Deaths were all due to blunt cranial trauma. Despite initiatives to prevent these deaths, toddler run-overs in South Australia approximate the number of sudden deaths due to homicides, drownings and natural diseases, respectively, for the same age group; deaths are also occurring in places other than home driveways, and sedans were more often involved than four-wheel drive vehicles.     

A case of carbon monoxide poisoning before a vehicle fire: Availability of volatile hydrocarbons analysis

Benzene is one of volatile hydrocarbons contained in fire smoke, and the concentrations in the blood are known to be positively correlated with that of carbon monoxide-hemoglobin (CO-Hb) in fire-related deaths. In this report, we present a vehicle fire case in which CO and benzene concentration is atypically un-correlated. The car driven by the vehicle dweller ran into an oncoming lane at high speed, hitting a traffic signal pole. A vehicle fire started when the rescuer opened the car door. A burned body and briquette stove were found when the fire was extinguished. An autopsy revealed a small amount of soot deposit in the airways. The CO-Hb concentration in the heart blood was 63%. Volatile hydrocarbon analysis of the blood was performed; compared with the CO-Hb concentration, the benzene concentration was significantly lower than expected. High CO-Hb concentration without a hydrocarbon component indicated that the deceased inhaled CO that was not related to fire smoke. Thus, we concluded that the cause of death was CO poisoning caused by the briquette stove before the vehicle fire started. Comparing volatile hydrocarbon concentrations with CO-Hb concentrations could provide more information about the circumstances surrounding a vehicle fire-related death.     

陕西省高速公路交通事故伤亡特点

目的 研究陕西省高速公路交通事故伤亡的基本特点。方法 采用流行病学调查方法对陕西省1994-1999年西安-铜川，西安-渭南，西安-宝鸡三条高速公路交通事故1168起。伤亡1691人的基本资料进行回顾性分析。结果 高速公路交通事故的主要原因是驾驶员肇事，交通事故伤类型以机械性创伤为主，合并烧伤也较为常见，受伤人员以乘客最多；但车外人员有较高的死亡率；车内人员中驾驶员多发伤死亡率最高，为42.3%(180/426)。随着受伤部位增加，死亡率增高，院前死亡率高达69.5%(314/452)，死亡原因前三位依次是颅脑伤44.7%（320/716），胸部伤25.4%(182/716)，腹部伤16.5%(118/716)。结论 高速公路交通伤中多发伤多，致死性损伤多，死亡率高。     

澳门镜湖医院救治道路交通伤3648例分析

目的 探讨澳门地区道路交通伤的一些流行病学特点。方法 回顾性统计分析澳门镜湖医院１９９４年１月～１９９８年１２月救治３６４８例道路交通伤病案。结果 道路交通意外致伤３６４２例，死亡６例；轿车和摩托车是造成人员伤亡的主要车型，分别占机动车所致交通伤的４９．８％和３９．１％；机动车与行人碰撞是道路交通伤的主要类型，占５１．８％，儿童组占爱伤行人的４６．４％；大部分交通伤造成的人员损伤较轻微，擦伤、挫裂     

Sudden unexpected infant deaths associated with car seats

The purpose of this study was to investigate the frequency, circumstances, demographics, and causes of death of infants dying while seated in car safety seats. A retrospective review of a pediatric autopsy database at a specialist center over a 16-year period was undertaken to identify any infant deaths (aged <1 year), in whom death occurred while seated in a car safety seat. Fourteen car seat-associated deaths were identified from a total of 1,465 coronial infant autopsies (0.96 %). Four involved infants were being appropriately transported in the car seat, all of whom had a medical underlying cause of death (one infection and three congenital heart disease). The majority (10 cases; 70 %) occurred while car seats were being inappropriately used, outside of the car, including as an alternative to a cot or high-chair. Five of these infants died of explained causes, but four deaths remained unexplained after autopsy, and in one no cause of death was available. There were no cases of previously healthy infants dying unexpectedly in a car seat when it was being used appropriately, and in this series there were no cases of traumatic death associated with car seats, either during road traffic accidents, or from falling or being suspended from a car seat. Infant deaths in car seats are rare. These data support the recommendation that car seats be used only for transport and not as alternatives for cots or high-chairs. More research is required to investigate the effect of travel in car seats on infants with underlying conditions. There appears to be no increased risk of unexpected deaths of healthy infants transported appropriately in car seats.     

Spectrum of unnatural fatalities in the Chandigarh zone of north-west India--a 25 year autopsy study from a tertiary care hospital

A 25 year (1977-2002) autopsy study of 5933 unnatural fatalities from a tertiary care hospital of north-west India revealed an abrupt rise in unnatural deaths (3050; 51.4%) since 1997. 84.2% subjects were between the age group of 16 and 45. Accidental deaths (79.3%) constituted the majority of unnatural fatalities followed by suicidal (13.9%) and homicidal (6%) deaths. Road traffic accidents (RTAs), burn, poisoning, accidental falls from height and firearm injury were responsible for 94.5% of the total unnatural deaths. A male preponderance (73.4%) was seen in all causes of deaths except for burns where females (61%) outnumbered males (39%). The incidence of fatalities due to poisoning and burns had increased from 5.7% and 22.6% to 12% and 24.3%, respectively, whereas due to fire arms and machinery accidents decreased from 4.5% and 1.2% to 1.2% and 0.4%, respectively. The proportion of mortality due to road traffic accidents (50.3%) and accidental fall from height (6.9%) remained almost static. Two-wheeler occupants (motor cycles, etc. 33.3%) were the main victims in road traffic accidents. Pouring of kerosene oil (36% dowry death), malfunctioning and bursting of kerosene oil stove (43.5%) were the most common factors in burn deaths. Between 1977 and 1987 barbiturates (33.3%), organophosphates (23.8%) and copper sulphate (14.3%) and in 1987-1997 organophosphates (45%) and aluminium phosphide (26.5%) were the major fatal poisons. Since 1992 aluminium phosphide (80%), a fumigant pesticide used for wheat preservation was the most common poison. The incidence of suicidal deaths increased from 10.9% (1987-1992) to 15.7% (1997-2002) with a peak incidence of 18.2% in 1992-1997, when this pesticide with no effective antidote was made freely available in the market.     

Trends in early and late deaths due to motor vehicle accidents in Japan

To clarify trends and urban-rural differences in the early death rate (deaths within 24 h divided by the deaths within 1 year after motor vehicle accident x100 [%]) due to motor vehicle accidents (MVAs) in Japan. Mortality data were collected from the annual statistics of traffic accident research and vital statistics in Japan from 1980 through 1998 and analyzed. Early death rates were nearly constant (73.9-78.0%) from 1980 through 1998. Early death rates were lower in younger and elderly groups. As regards to geographic variations, early death rates and 1-year death rates per 100,000 vehicles were significantly higher in rural areas (population density <1000/km(2)) than in urban areas. To investigate MVA deaths, both early and late deaths should be examined. Decreasing the early death rate, a new index for MVA death, which reflects the reduction of injury severity is important for preventing MVA deaths.     

Reduction and mitigation of thermal injuries: what can be done?

Soon after the introduction of the crashworthy fuel system and Nomex flight apparel, morbidity and mortality rates from thermal injuries in aviation were reduced to zero. Although the incidence of aircraft mishaps involving postcrash fires have remained the same, there has been a recent increase in thermal injury morbidity. These case reports describe three different aircraft accidents in which fire was caused by factors other than the crashworthy fuel system. They also describe sustained thermal injuries and compare them to personal protection equipment. We found that the condition of the personal protective equipment and unauthorized use of unapproved apparel were responsible for the sustained injuries. We maintain that personal protection equipment is effective if worn in the manner for which it was designed. We believe that the lessons learned apply to all military operations where the risk of fire is high, not solely aviation. A proactive program focused on education would reduce the thermal injury morbidity.     

重庆市高速公路部分交通事故死亡案例的特点分析

目的 对重庆市2006年～2010年高速公路部分致死性交通事故的资料进行收集和分析,探讨其事故特征.方法 对重庆法医验伤所2006年1月～2010年6月高速公路部分致死性事故死亡人员尸检报告及重庆市交通行政执法总队高速公路支队所提供的事故情况报告进行分类、归纳、整理与统计.结果 (1)共693起致死性交通事故,死亡人数...     

爆胎与高速公路交通事故的相关性分析

目的探讨爆胎与高速公路交通事故的相关性。方法对1998—2000年3年间广州-深圳高速公路(以下简称广深高速公路)爆胎交通事故进行回顾性分析。结果1998—2000年3年间广深高速公路共发生交通事故2484起，其中848起交通事故出现爆胎，发生率为34．14％(848／2484)。时间因素以10：00～16：00为高发段，占55．54％(471／848)，其中14：00最高，占9．67％(82／848)；每年4～9月份为高发期，占56．84％(482／848)。爆胎部位以单个右后胎高发，共398起，占46．93％(398／848)；左后胎次之，共295起，占34．79％(295／848)。848起爆胎事故中，死亡12例，受伤200例，占同期2484起事故总伤亡人数的22．55％(212／940)。其中颅脑损伤58例，胸部损伤32例，腹部损伤7例，脊柱损伤25例，骨盆损伤4例，四肢损伤52例，全身软组织挫伤127例；多发伤106例。结论爆胎是南方高速公路交通事故的重要因素，防止超速驾驶、加强轮胎质检和规范化管理是减少高速公路交通事故的有效措施。     

Industrial accidental deaths in the Niger delta region of Nigeria: a study of 32 autopsies in Port Harcourt

Accidents in the oil industry in the Niger delta region of Nigera raise concerns about safety measures and the management of industrial sites. A total of 32 autopsies were performed after coroners' inquest forms were served on the authors by the State, which serve as consent and request. Standard procedures were adopted in all the cases and the reports were appropriately issued. Death from industrial accidents accounted for 2.5% and 6.1% of total autopsies and accidental death autopsies respectively. The youngest victim was a 19 year old male while the oldest was a 55 year old male. The age group 30-39 years was the most vulnerable. There was a male dominance; (male:female ratio = 9.7:1). The commonest accidents in their order of frequency were: falling from a height, explosion/fire, motor vehicle accidents and falling objects. Multiple injuries, head and neck trauma and drowning were the commonest cause of death at autopsy. Accidental deaths were commoner in the small-scale industries (81%) than in the large-scale industries (19%). This is the first time such a study has been carried out locally. The proportion of accidental deaths in the small scale industries relative to that of the large ones may be attributed to the poor enforcement of safety measures in the smaller industries