Age estimation from sternebral fusion in an Indian population – A computed tomographic evaluation

Forensic age estimation is a crucial aspect of the human identification process. Sternebral fusion is one of the skeletal indicators of age that has not been thoroughly researched for the purpose of age estimation. The present study was conducted with the aim of assessing the utility of each of the sternebral fusion in age estimation, and to ascertain if these fusion stages can help in identifying whether an individual has attained the medicolegally significant ages of 16 and 18 years. Thoracic CT images of 148 study participants (74 females, 74 males) were analysed to evaluate the fusion of sternebrae 1–2, sternebrae 2–3, and sternebrae 3–4. The fusion scores for these were found to be statistically significant (P < 0.001) with sternebrae 1–2 fusion showing the highest coefficient of correlation at R = 0.900. Linear regression models were generated using each of the sternebral fusions separately and together for estimation of age. The standard error of estimate for the regression models ranged from 1.51 to 2.86 years. Box and Whisker plots were constructed to see the fusion score wise age distribution of the study population, and it was observed that sternebral fusion has the ability to indicate whether an individual has attained the age of 16 and 18 years. Our study concludes that sternebral fusion can act as an accurate method of forensic age estimation of juveniles and young adults.     

The applicability of Willems’ and Lee’s dental age estimation methods for Japanese children and the comparison with the Korean population

This study aimed to examine the applicability of Willems’ and Lee’s methods in a Japanese population and to find the differences in teeth development between Japanese and Korean children by comparing the accuracy of their estimated age using the two methods. The developmental status of the lower left permanent teeth in 1,475 orthopantomograms of Japanese children were evaluated based on Demirjian’s criteria, and the ages were estimated using Willems’ and Lee’s methods. The errors in estimated ages were calculated and compared with equivalent Korean population data. The accuracy of both methods for estimating the age of the Japanese population was similar to that in the Korean population except for that of Lee’s method used in Japanese males. The results showed that there might be differences in teeth development between the Japanese and Korean boys. To increase the accuracy of the dental age estimation, the method that is derived from their own population data should be applied in forensic practice.     

Accuracy and repeatability of two methods of gait analysis – GaitRite™ und Mobility Lab™ – in subjects with cerebellar ataxia

Instrumental gait analysis is increasingly recognized as a useful tool for the evaluation of movement disorders. The various assessment devices available to date have mostly been evaluated in healthy populations only. We aimed to explore whether reliability and validity seen in healthy subjects can also be assumed in subjects with cerebellar ataxic gait. Gait was recorded simultaneously with two devices – a sensor-embedded walkway and an inertial sensor based system – to explore test accuracy in two groups of subjects: one with mild to moderate cerebellar ataxia due to a subtype of autosomal-dominantly inherited neurodegenerative disorder (SCA14), the other were healthy subjects matched for age and height (CTR). Test precision was assessed by retest within session for each device. In conclusion, accuracy and repeatability of gait measurements were not compromised by ataxic gait disorder. The accuracy of spatial measures was speed-dependent and a direct comparison of stride length from both devices will be most reliably made at comfortable speed. Measures of stride variability had low agreement between methods in CTR and at retest in both groups. However, the marked increase of stride variability in ataxia outweighs the observed amount of imprecision.     

Accuracy in certification of cause of death in a tertiary care hospital – A retrospective analysis

Every physician is duty bound to issue a “Cause of Death” certificate in the unfortunate event death of his/her patient. Incomplete and inaccurate entry in these certificates poses difficulty in obtaining reliable information pertaining to causes of mortality, leads to faulty public health surveillance, and causes hindrance in research. This study intends to evaluate the completeness and accuracy of Medical Certification of Cause of Death in our Institute and to formulate strategy to improve the quality of reporting of cause of death. During the period from January 2012 to December 2012, a total of 151 certificates of cause of death were issued by the faculty members of various departments. Maximum number of death certificates were issued for patients in the extremes of the age <10 years (n = 42, 27.82%) and in >60 years (n = 46, 30.46%). The various inadequacies observed by us are as follows: 40 (26.49%) cases had inaccurate cause of death, interval between onset and terminal event was missing in 94 (62.25%) cases, in 68 (45.03%)cases the seal with registration number of the physician was not available on the certificate, incomplete antecedent & underlying cause of death was found in 35 (23.18%) & 84 (55.63%) cases, in 66 (43.71%) cases there was use of abbreviations and the handwriting was illegible in 79(52.32%) cases.     

A comparison of the validity of the Demirjian,Willems, Nolla and Häävikko methods in determination of chronological age of 5–15 year-old Indian children

BackgroundDemirjian's method has been the most popular and extensively tested radiographic method of age estimation. More recently, Willems' method has been reported to be a better predictor of age. Nolla's and Häävikko's methods have been used to a lesser extent. Very few studies have compared all four methods in non-Indian and Indian populations. Most Indian research is limited by inadequate sample sizes, age structures and grouping and different approaches to statistical analysis.AimThe present study aimed to evaluate and compare the validity of the Demirjian, Willems, Nolla and Häävikko methods in determination of chronological age of 5 to 15 year-old Indian children.DesignIn this cross-sectional observational study, four methods were compared for validity in estimating the age of 1200 Indian children aged 5-15 years.ResultsDemirjian's method overestimated age by +0.24 ± 0.80, +0.11 ± 0.81 and +0.19 ± 0.80 years in boys, girls and the total sample, respectively. With Willems' method, overestimations of +0.09 ± 0.80, +0.08 ± 0.80 and +0.09 ± 0.80 years were obtained in boys, girls and the total sample, respectively. Nolla's method underestimated age by -0.13 ± 0.80, -0.30 ± 0.82 and -0.20 ± 0.81 years in boys, girls and the total sample, respectively. Häävikko's method underestimated age by -0.17 ± 0.80, -0.29 ± 0.83 and -0.22 ± 0.82 years in boys, girls and the total sample, respectively. Statistically significant differences were observed between dental and chronological ages with all methods (p < 0.001). Significant gender-based differences were observed with all methods except Willems' (p < 0.05). Gender-specific regression formulae were derived for all methods.ConclusionWillems' method most accurately estimated age, followed by Demirjian's, Nolla's and Häävikko's methods. All four methods could be applicable for estimating age in the present population, mean prediction errors being lower than 0.30 years (3.6 months).     

Accuracy of the London Atlas,Haavikko’s Method and Cameriere’s European Formula of dental age estimation in Turkish children

Age estimation is a mandatory procedure when the chronological age is unknown or uncertain. Dental development is the preferred characteristic for estimating a child's age. There are many methods for dental age estimation, but their reliability can differ between populations. This study compared the accuracy of three of these methods—the London Atlas (LA), Haavikko's method (HM), and Cameriere's European formula (CF)—in Turkish children living in northwestern Turkey. Panoramic radiographs of 980 children from northwestern Turkey aged between 6.00 and 14.99 years were examined for the whole study group and separately for different ages and sexes by all three methods. Statistical differences between chronological age and dental age were tested using the paired sample t-test and the Wilcoxon signed-rank test. The LA, HM, and CF accuracies were determined based on the mean absolute error. Spearman's rank correlation coefficient showed that the correlation between chronological age and dental age for both sexes was linear for all methods. The LA overestimated the chronological age by 0.09 years, while HM and CF underestimated it by 0.49 and 0.11 years, respectively. The difference between dental age and chronological age was significant in all samples, for all methods, except for the LA in boys. When boys, girls, and the total sample were evaluated, values with the lowest mean absolute error were obtained by HM and were statistically significant in all three groups. Therefore, HM is more accurate than the LA and CF for dental age estimation in Turkish children living in northwestern Turkey.     

Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT – A pooled analysis of two randomized trials

The incidence of contrast-medium-induced nephropathy (CIN) following intravenous (IV) CM administration of contrast media to renally impaired patients undergoing multidetector computed tomography (MDCT) is not well characterized. Our objective was to investigate the incidence of CIN in patients with glomerular filtration rate (GFR) <60 ml/min undergoing contrast-enhanced MDCT examinations and to compare the rates of CIN following the IV administration of low-osmolar contrast media (LOCM, iopamidol and iomeprol) and an iso-osmolar contrast medium (IOCM, iodixanol). A total of 301 adult patients with moderate-to-severe renal failure received a similar IV contrast dose (40 gI). Serum creatinine (SCr) was measured at screening, baseline and 48–72?±?6 h after the MDCT examination. Primary CIN outcome was an increase in SCr ≥0.5 mg/dl (≥44.2 μmol/l) from baseline. The CIN rates were 2.3% in the total population, 0.6% when GFR >40 ml/min, 4.6% when GFR <40 ml/min and 7.8% in patients with GFR <30 ml/min. The incidence of CIN was significantly higher after iodixanol than after LOCM (seven patients, 4.7% following IOCM, no CIN cases following the LOCM; p?=?0.007). Significant differences in favor of the LOCM were also observed in patients with GFR <40 ml/min and GFR <30 ml/min. Following the IV administration of nonionic contrast agents in patients with moderate-to-severe renal insufficiency, the risk of significant CIN seems to be low. The IOCM iodixanol caused a higher rate of CIN than the LOCM iopamidol and iomeprol, especially in high-risk patients. Differences in osmolality between these LOCM and iodixanol do not play a role in the genesis of CIN.     

Efficiency analysis of VersaPlex™ 27PY system in Central Indian Population: First report from Indian population

In the current scenario, DNA typing is the need of forensic science field due to its ability to provide results in much shorter time. In view of advancement of forensic DNA typing and incensement in the number of STRs markers, Promega offered a new VersaPlex™ 27PY system with 27 loci (23 autosomal STR loci, Amelogenin, DYS391 and two rapidly mutating Y-STR loci (DYS570 and DYS576)). In this study, the efficacy of “23 autosomal STR loci” for paternity testing and personal identification was demonstrated in Indian population. For this, 217 central Indians were tested and all the statistical parameters of forensic and population genetic interest were calculated. In addition, sensitivity of the kit was also tested for forensic casework. During investigation with VersaPlex™ 27PY system, allele 11 at locus TPOX was observed to be most frequent with the highest allelic frequency 0.432. Studied 23 loci showed valuable together with highest value of combined power of discrimination (CPD = 1), combined power of exclusion (CPI = 0.9999999989) and lowest value of combined matching probability (CPM = 7.92x10^-28).     

Validation methods of Fazekas and Kósa and Molleson and Cox for age estimation of the ilium in Western Mediterranean non-adult population: proposal of new regression formulas

The purpose of this study is to test the applicability of the age estimation methods of Fazekas and Kósa [1] and Molleson and Cox [2] in Western Mediterranean non-adults and to develop accurate and rapidly applied formulas for their age estimation, using a sample of 149 non-adults of known sex and age from the cemetery of San José in Granada (Spain). Measurements have been taken of the maximum length and width of each ilium for application of the formulas of Fazekas and Kósa [1] and Molleson and Cox [2]. There has been no significant intra- or inter-examiner variation in measurements. The documented age of the individuals has been underestimated with the Fazekas and Kósa method and overestimated with Molleson and Cox. Based on these findings, new formulas are proposed for the age estimation of non-adults in Western Mediterranean populations.

     

Radiographic assessment of facial soft tissue thickness in South Indian population – An anthropologic study

Facial reconstruction is a technique used in forensic anthropology to identify an unknown person. Various methods used for facial reconstruction are drawings, sculpture and computer aided image building which is mainly based on facial soft tissue thickness measurement. Several methods have been established for measuring facial soft tissue thickness (FSTT) with each one having certain limitations. There is limited data available on FSTT among South Indian population. Hence the present study was ventured to determine the FSTT among South Indian adults and also to find FSTT difference between male and female.308 subjects of South Indian origin (18–27years) having full set of permanent dentition who require orthodontic treatment were included in the study. Subjects were assessed for Body Mass Index (BMI) and diagnostic digital x-ray of lateral cephalogram (LC), Lateral oblique (LO) view and posterior-anterior (PA) view was obtained. The digital image was transferred to Adobe Photoshop CS4 software and 23 different soft tissue points were measured.Mean FSTT was more in males compared to females except for three landmarks. Statistically significant difference was observed in 20 landmarks when height and weight was compared in males, whereas in females only 12 landmarks showed significant difference. BMI showed good correlation with FSTT in both males and females, which was confirmed by linear regression. The best regressor in terms of estimating FSTT in association with age/sex/BMI were nasion, sub nasale, labial superioris, labrale inferius, gnathion, inferior border of zygomatic, right and left gonion. Stepwise discriminant analysis using all variables showed 94.8% of overall accuracy in sex determination.The observation of present study suggests that LO and PA view along with LC gives information regarding mean FSTT among South Indian population. Even though BMI plays a dominant role in determining FSTT, but age, sex, height and weight should also be considered with care while facial reconstruction. Additionally the present regression equation contributes towards increase in the specificity of the tissue depths and can be used in real cases by allowing the practitioners to calculate individual tissue depth.     

Effect of fusion status of sternum in stature estimation – A study from South India

Forensic anthropologists examine and identify skeletal, dismembered and commingled remains in a legal context to establish the biological profile of the deceased. Stature estimation is one of the important parameters in establishing the biological profile. The present study is planned to derive regression models for stature estimation from sternal measurements. Various factors are likely to affect stature estimation in forensic investigations. Since, none of the previous researchers have studied the effect of fusion status on stature estimation from sternum and its segments, the present study attempts to find if the fusion status of the sternum affect its reliability and accuracy in stature estimation. The sample of the present study consisted of 117 sterna that were obtained from autopsied bodies. Five measurements i.e. Length of manubrium (M), length of mesosternum (B), combined length of manusbrium and mesosternum and the (M + B), width at first sternabrae (S1) and width of 3rd sternabrae (S3) were taken on the autopsied sterna. The sterna were classified as fused (both manubriosternal and xiphisternal joints were fused), partly fused (only one of the manubriosternal or xiphisternal joints was fused) and not fused (both manubriosternal and xiphisternal joints were not fused). Regression models were derived using statistical methods. All the sternal measurements show a positive however, a weak correlation with stature. Thus, it can be concluded that the accuracy and reliability of stature estimation from sternum and its segments is quite low in practical situations. Among the sterna classified based on the fusion status, the length measurements of completely fused sterna show significant correlation with the stature. None of the other sternal measurements on the non-fused or partly fused sterna show statistically significant correlation with stature. The present study concludes that the fusion status of the sternum is likely to affect the reliability and accuracy in estimation of stature. The findings of this study however, should be considered 'preliminary' until they are corroborated by similar studies based on larger samples from different populations.     

Comparative analysis of the applicability of the skeletal age determination methods of Greulich–Pyle and Thiemann–Nitz for forensic age estimation in living subjects

Evaluation of hand ossification is a main pillar of radiological age diagnosis in living subjects. In the present study, we comparatively assessed the Greulich–Pyle and Thiemann–Nitz methods for accuracy of age estimation and degree of acceleration in the respective reference populations. For this, the skeletal age of 649 hand X-rays from German subjects aged 1–18 years was determined by both methods. Accuracy of the age estimates was determined based on regression and measures of certainty. In terms of accuracy, both methods seem to be equally well suited for forensic age diagnostics. The degree of acceleration in the reference populations for the two methods was calculated as the mean difference between the estimated skeletal age and the actual age of a test subject. Compared to the Greulich–Pyle population, the Thiemann–Nitz population was accelerated by 0.44 years in both male and female subjects. When an expert opinion is required and one cannot exclude the possibility that the investigated subject may come from a population with a high acceleration status, the Thiemann–Nitz method should preferably be used to prevent overestimation of age.     

Bone age assessment: comparison of children from two different regions with the Greulich–Pyle method In Turkey

The aim of this study was to identify and compare bone age assessments of Turkish children in regions of Central Anatolia and Eastern Anatolia using the Greulich-Pyle (GP) method. Evaluation was made of 849 (375 boys, 514 girls) adolescents aged between 9 and 17 years, who lived in two geographically different regions of Turkey. The selection criteria included normal growth and development, a state of good physical and mental health with no previous history of chronic or acute illnesses, no past trauma or injury to the hand-wrist region, no congenital or acquired malformations of the hand-wrist area, no hormonal disorders, and good quality hand-wrist radiographs. Bone age (BA) was evaluated using the GP method from definitive radiographs of the left hand-wrist. The total mean differences between BA and chronological age (CA) for girls and boys were found to be 1.19 ± 1.2 (p < 0.05) and 0.90 ± 1.2 (p < 0.05) years in the Eastern Anatolia region and 0.28 ± 0.6 (p > 0.05) and –0.10 ± 0.3 (p > 0.05) years in the Central Anatolia region. There were significant differences between BA and CA in all age groups for girls and boys in Malatya (a city in the Eastern Anatolia region) and in 10 and 13 year olds for girls and 12, 13, 15, and 16 year olds for boys in Sivas (a city in the Central Anatolia region). Statistically significant differences were determined between the BA and CA of the subjects living in Malatya and Sivas (p < 0.05). The results of this study using the Greulich–Pyle atlas indicate that bone development is completed earlier in adolescents living in Malatya compared with those in Sivas.     

Comparison of the accuracy of the London atlas and Smith method in dental age estimation in 5–15.99-year-old Iranians using the panoramic view

International Journal of Legal Medicine - Tooth development is widely used for age estimation and staging physical maturity. It is of great importance in dental age estimation in forensic...     

Accuracy of predicting 18 years of age from mandibular third molar development in an Indian sample using Demirjian’s ten-stage criteria

Predicting 18 years of age can be crucial in forensic contexts. The third molar is the only tooth developing during this chronological period and has been used to estimate minority/majority status (</≥18 years). Conventionally, Demirjian’s grading has been used to assess third molar development although the method was not originally intended for evaluating this tooth. Demirjian incorporated third molar assessment in a recent modification and replaced the alphabetical grading (A to H) with a numerical scale (0 to 9). The new grading system is untested on third molars and this study assessed the tooth’s development on orthopantomograms of 221 Indian subjects (68 males, 153 females; age range 15–21 years). The tendency to correctly determine majority/minority status was assessed using three different statistical approaches, viz. traditional regression analysis, logistic regression analysis and Bayesian prediction. The sample was divided in to a reference sample of 180 cases and a test group of 41 subjects. All three statistical methods correctly predicted an individual as being </≥18 years in 73.2% of test subjects. Their ability to correctly identify a minor/juvenile was higher (85.7%) than their capacity to properly identify a major/adult (60%). Using the revised grading system, and irrespective of the statistical method applied, over one quarter of Indian subjects requiring identification as a major/minor were categorised in to the wrong age group. This level of accuracy may be inadequate for courts of law to rule with sufficient levels of certainty about the juvenile/adult status of an individual using third molar development.     

The comparison between measurement of open apices of third molars and Demirjian stages to test chronological age of over 18 year olds in living subjects

This paper concerns a method for assessing adult age based on the relationship between age and the third molar maturity index (I_3M), which is related to the measurement of the open apices of the third molar. Furthermore, this method was compared to those based on Demirjian’s stages G and H. The sample consisted of 906 Caucasian individuals aged between 14 and 23 years (53.6% females and 46.4% males). Orthopantomographs were analyzed by two observers and calibrated by means of the concordance correlation coefficient for the reproducibility of the third molar maturity index (I_3M) and κ statistics for reproducibility of the Demirjian stages. Probabilities for an individual to be older than 18 years of age (adult age) were derived using the measurements of the third molar maturity index (I_3M). These results were exploited to set out a threshold value to assign an individual to juvenile or adult age. A cutoff value of I_3M = 0.08 was taken. The sensitivity of this test was 70% and specificity was 98%. Furthermore, the proportion of individuals with a correct classification was 83%. The results of the test showed a better specificity when compared to the choice of stage G and a better sensitivity when compared to the choice of stage H for adult age.     

Validity of a modified Demirjian system based on an Australian dataset – simple maturity score in age estimation

This pilot study is a validation of a modified Demirjian’s System developed for the Australian population by Blenkin and Evans. The study sample comprised orthopantomographs of 230 individuals aged 2.5 to 14.5 years. Seven right mandibular teeth (excluding the wisdom tooth) were assessed and graded according to the Demirjian’s stages of tooth development. Corresponding modified numeric scores for the stages were summed to form a simple maturity score from which age estimates were derived. The mean difference between the estimated and chronological age for girls was 0.02 years, 95% CI [-0.13, 0.17]. Paired-sample t-test results found this difference not to be statistically significant p = 0.81, <0.05. For boys, the method underestimated the age with a mean difference of –0.24 years 95% CI [–0.4, –0.08]. Paired t-test found this to be significantly different (p = 0.003). This study found that the modified Demirjian’s System of Blenkin and Evans is valid for use in the Australian population.     

Statistical analysis and verification of forensic age estimation of living persons in the Institute of Legal Medicine of the Berlin University Hospital Charité

In recent years, the increase in international migration movements has led to a greater demand for forensic age estimation of foreigners without valid identification documents in numerous countries. The growing importance of forensic age determination is underlined by a rapid rise in the number of expert reports by the Institute of Legal Medicine of the Berlin University Hospital Charité. A total of 247 expert opinions on estimated age were given between 1992 and 31 December 2000. Subject to formal court ruling, age is estimated based on the physical inspection, in combination with an X-ray of the left hand and the clavicles as well as dental assessment. However, the statistical proof of the range of scatter for the summarized age diagnosis still remains to be clarified in the context of this assessment procedure. The age estimations made by the Institute of Legal Medicine of the Berlin University Hospital Charité were statistically analyzed with respect to the validity of the different methods. For verification of the age diagnoses, the age estimates were compared with the court records and the age determined in the course of legal proceedings. In 45 cases, the age diagnoses could be verified. In all cases where the age could be verified beyond doubt, deviations from the actual age did not exceed +/-12 months. From this, it can be concluded that the combined application of the above-mentioned methods allows forensic age estimations with a sufficiently high degree of reliability.     

The fusion of ossification centers – A comparative review of radiographic and other imaging modalities of age assessment in living groups of children,adolescents, and young adults

A total of 227 articles published within the last twenty years, indexed in the PUBMED and Researchgate databases, were reviewed for the purpose of comparing medical imaging-based methods of age estimation. The evaluated studies were analyzed in terms of the assessed parts of the body, age, and epiphyseal fusion ages in children, adolescents, and young adults. Our analysis showed that an overwhelming majority of studies had been based on computed tomography and magnetic resonance imaging. A comparison of the studies showed that, irrespective of the imaging modality and the nationality of study population cohorts, the rates of development and the ages at which the process of ossification begins and ends show certain trends.     

Postmortem age estimation via DNA methylation analysis in buccal swabs from corpses in different stages of decomposition—a “proof of principle” study

International Journal of Legal Medicine - Age estimation based on the analysis of DNA methylation patterns has become a focus of forensic research within the past few years. However, there is...