Physical assessment of tortures: Interobserver analysis of medico-legal degrees of consistency based on the Istanbul protocol.

The Istanbul Protocol section on medicolegal evaluation delineates the guidelines for the correct management of the physical examination and the methods of assigning the degrees of consistency. Considering that most cases exhibit highly heterogeneous lesions, the examiner is forced to rely on his own experience, and their evaluation may be very subjective. The purpose of this work is to understand how subjective such an evaluation may be and whether the "experience" factor, interpreted as years dedicated to this profession and the number of cases evaluated, is statistically significant. To this end, a survey containing eleven cases of pre-evaluated asylum seekers was sent to thirty Italian clinical forensic practitioners. The participants were invited to assign a degree of consistency to each case according to the Istanbul Protocol guidelines, besides answering a few questions regarding their professional record. The doctors were divided into groups based on the number of cases evaluated and the experience collected expressed in years, and then interobserver analysis was performed. Results showed that the Fleiss' Kappa coefficient acquired significant values when attention was turned to the sub-samples composed of more experienced participants. Therefore, the introduction of appropriately trained health professionals - "experts in migrations and torture" - could lower the risks of misinterpretation and make the assessment as reproducible as possible.

Assessment of Cervical Skeletal Trauma: The Synergistic Contribution of Forensic and Clinical Medicine to a Case of Corpse Concealment.

Fatal neck injuries represent a major challenge in forensic pathology because the anatomical complexity and high variability of neck structures make it often extremely difficult to differentiate true pathological findings from artifacts at autopsy. This topic becomes even more relevant when the forensic pathologist is required to make a pathophysiological evaluation of bone fractures in the absence of soft tissue to support the diagnosis. We report a case of unidentified, stone-covered, skeletonized human remains found within a pit below an abandoned building with bony lesions of the cervical spine and ribs, including a full-thickness fracture of the right lateral mass of the atlas (C1). After a careful study of the fractures was carried out by screening forensic literature and anthropological studies, clinical neurosurgical expertise was called upon to provide a reliable explanation. A rapid and violent twisting of the neck in the opposite direction from the fracture site by an attacker who pinned the victim's torso is the scenario that most likely occurred in our case. This case report shows that the diagnosis of cervical spine injuries in skeletal remains should be the result of a multidisciplinary approach that integrates forensic, anthropological, and clinical expertise.

Analysis of interrater reliability in age assessment of minors: how does expertise influence the evaluation?

Nowadays, the clinical forensic medical management of migration flows comprises the age assessment of unaccompanied minors. The process of age estimation is a fundamental pillar for legally ensuring the minors' rights and their protection needs. The procedure is complex and involves different phases and actors, from medical doctors to law enforcement officers. The present study aimed to investigate the performance of Greulich and Pyle, Demirjian, and Mincer methods when performed by raters both trained and without training. Also, the interrater reliability within groups of raters from different areas of expertise was evaluated. A total of 36 participants were enrolled for this study, divided in two groups according to their level of experience with age estimation methods. Each rater was asked to allocate stages and standards for age assessment, evaluating ten orthopantomograms and ten hand-wrist roentgenograms. The interrater reliability expressed through the Fleiss Kappa coefficient and the agreement with the reference standard were calculated. The results showed that none of the categories analyzed could reach a good interrater reliability (ĸ > 0.8) for both methods. The study results highlighted variation and disagreement in the interpretation of the sample among raters and in the subsequent stages and standards allocation. In conclusion, the results of this study highlight that expertise does influence the reliability of the most utilized methods of age estimation of living individuals and stress the importance of proper training and practice, which could greatly increase the accuracy of age assessments.

The medico-legal assessment of asylum seeker victims in Italy.

INTRODUCTION: Changing patterns of migration has required states and governments to respond to the specific medical and legal needs of asylum seekers. Based on medical assessments undertaken at the University Institute of Legal Medicine, the present study aims to describe the cases of asylum applicants who have suffered from physical violence, including torture, and the variables involved. METHODS: Over a 10-year period, 225 survivors were examined by clinical forensic professionals from the University Institute of Legal Medicine. RESULTS: 85% of asylum applicants came from Africa, 87% were male, and the most common age group was 26-40 years old. 46% of applicants fled their country for political reasons. Blunt force injuries were reported in 45% of cases, the trunk was the most affected area of the body (40%), and applicants presented with an average of two different mechanisms of lesions and an average of four lesions each. DISCUSSION/CONCLUSION: Assessment of physical violence on asylum seekers requires the cooperation of professionals with different skillsets and training.