Diagnostic accuracy of post-mortem computed tomography for fractures of the hyoid-larynx complex.

Post-mortem computed tomography (PMCT) is routinely used at many forensic institutions to guide the following autopsy and is especially useful for diagnosing fractures. This systematic review aims to investigate the sensitivity and specificity of a PMCT scan in fracture diagnosis of the hyoid-larynx complex (HLC) compared to traditional autopsy in cases involving traumatic neck injuries. We searched PubMed, SCOPUS and Web of Science and included papers with cases n ≥ 3 published between January 2000 and April 2023 reporting on PMCT and autopsy findings of fractures of the HLC. The search provided 259 results of which 10 were included. Overall sensitivity and specificity were 0.70 [0.59; 0.79] and 0.92 [0.80; 0.97] for hyoid bone fractures and 0.80 [0.62; 0.91] and 0.76 [0.63; 0.85] for the thyroid cartilage. The results show great variation, and a large range between studies. These results indicate that PMCT cannot replace autopsy in cases with HLC fractures. Future larger prospective studies are needed, examining fracture details, scan protocols and different slice thicknesses using uniform reporting.

Forensic age estimation of the knee by post-mortem DR, CT, and MR imaging: a comparative study.

It is believed by many that reference data for age estimation purposes must be imaging-modality specific. A study from our department has however proven otherwise. We therefore found it interesting to investigate this further by looking at the level of agreement between different imaging modalities. The aim of this study was to investigate the level of agreement between the three radiological modalities, computed tomography (CT), magnetic resonance imaging (MRI), and digital radiography (DR), in assessing the ossification of the epiphyses of the knee. A total of 34 deceased individuals of 10-25 years of age, brought in for a medicolegal autopsy at our department, were scanned by CT, MRI, and DR. The ossification stages of the three bones of the right knee, distal femoral, proximal tibial, and proximal fibular epiphysis were assessed using the established combined staging method by Schmeling et al. and Kellinghaus et al. Analysis of the results by Cohen's weighted kappa showed a good agreement between CT and DR (K = 0.61-0.70), and MRI and DR (K = 0.68-0.79) but only moderate agreement between CT and MRI (K = 0.55-0.57). This leads us to conclude that different radiological images cannot be used interchangeably for age estimation purposes, so reference material needs to be imaging-modality specific. However, to make a more general conclusion research on a larger population is needed.

Sensitivity and specificity of post-mortem computed tomography in skull fracture detection-a systematic review and meta-analysis.

Post-mortem computed tomography (PMCT) has been increasingly used as routine examination in forensic pathology. No recent review of the growing number of papers on the ability of PMCT to detect skull fracture exists, and original papers report sensitivities from 0.85 to 1.00. This systematic review (PROSPERO: CRD42021233264) aims to provide a meta-analysis of sensitivity and specificity of PMCT in skull fracture detection. We searched PubMed, MEDLINE and Embase for papers published between January 2000 and August 2021 reporting raw numbers, sensitivity and specificity or Abbreviated Injury Score for PMCT compared to autopsy. Papers without both PMCT and autopsy, no separate reporting of the neuro-cranium, exclusively on children, sharp trauma, gunshot or natural death as well as case reports and reviews were excluded. Two authors independently performed inclusion, bias assessment and data extraction. QUADAS-2 was used for bias assessment and a random effects models used for meta-analysis. From 4.284 hits, 18 studies were eligible and 13 included in the meta-analysis for a total of 1538 cases. All deceased were scanned on multi-slice scanners with comparable parameters. Images were evaluated by radiologists or pathologists. Intra- and inter-observer analyses were rarely reported. In summary, sensitivity of PMCT for detection of fractures in the skull base was 0.87 [0.80; 0.92] with specificity 0.96 [0.90; 0.98], and sensitivity for the vault was 0.89 [0.80; 0.94] with specificity 0.96 [0.91; 0.98]. The mixed samples are a limitation of the review.

The Danish approach to forensic age estimation in the living: how, how many and what's new? A review of cases performed in 2012.

BACKGROUND: The resulting statement of forensic age estimations in the living is of great consequence for the examinees in question. Concerns have been raised about the nature of these examinations, e.g. the potentially harmful radiographic exposures, as well as the accuracy of the estimated age. AIM: This manuscript investigates the reported age estimates performed at the Section of Forensic Pathology, Institute of Forensic Medicine, Copenhagen, in 2012. SUBJECTS AND METHODS: The results of the individual assessments, i.e. the physical examination, and the radiographic examinations of bone age and dental age, were investigated as well as the correlation between the age estimates of the two latter examinations. RESULTS: In 139 out of the 174 statements, a conclusive chronological age estimate of at least 18 years was given. Although bone age was assessed within the dental age-range in a total of 152 out of 162 cases, some variations in the combined assessments were seen. CONCLUSION: The current procedure is not mathematically or statistically satisfactory. Instead, the most likely age including the variation and error of the age estimate should be reported in statements. The introduction of a Bayesian approach and the use of post-mortem-imaging-based databases may be used for this purpose.

Medico-legal autopsies in Denmark.

INTRODUCTION: At 2.7% in 1970, the Danish medico-legal autopsy frequency was lower than recent frequencies observed in the Nordic countries (4-24%). The aim of this study was to analyse trends in the number and frequency of Danish medico-legal autopsies. MATERIAL AND METHODS: Data were collected from the computerized archives in the Danish departments of forensic medicine, Statistics Denmark and the Danish National Board of Health. RESULTS: During the 1996-2005 study period, a total of 14,990 medico-legal autopsies were performed. This yielded a medico-legal autopsy frequency of between 2.4% and 2.8%. Our results revealed a certain constancy in the number of medico-legal autopsies and frequency of autopsy with regard to manner of death, sex and number, but we also observed changes in the age composition which involved a decrease in the proportion of young (20-39 years) and an increase in the proportion of middle-aged persons (40-59 years). CONCLUSION: Denmark has a lower autopsy frequency than other Nordic countries and this may constitute a problem for quality of death-statistics and research based on autopsy results. If the patterns in medico-legal autopsy frequencies continue, a decrease in the number of medico-legal autopsies is to be expected. As a consequence, education and training of forensic pathologists may be impaired.