Liability and Medico-Legal Implications in Estimating the Likelihood of Having Attained 14 Years of Age in Pediatric Clinical Practice: A Pilot Study.

Accurate methods of age estimation are more essential than ever due to the rise in undocumented individuals without proper identification, often linked to illegal immigration and criminal activities. This absence of reliable records presents challenges within the legal systems, where age thresholds in the context of children's rights vary across countries. Age 14 has global significance, as established by the UN Convention on the Rights of the Child and the EU for administrative purposes. Accurate age estimation is crucial in medical decisions, reproductive health, and forensics. This study focuses on age estimation via dental radiographs, proposing a method for estimating the likelihood of having attained the age of 14. Orthopantomograms were analyzed from two samples, 191 Italian children (aged 5-15) and 822 Chilean subjects (aged 11-22), using dental maturity indices. These indices evaluated open tooth apices and complete root development. Statistical analysis confirmed the method's reliability in identifying individuals aged 14 or older, with sex-specific cut-offs. The proposed method particularly advocates an approach based on dental mineralization, which could surpass those relying on bone growth. The collaboration between medical experts, including pediatricians and diagnostic imaging specialists, is vital for standardized age estimation strategies. Ethical concerns regarding radiation exposure and accountability are recognized, although the method's low radiation doses are deemed acceptable. The proposed method will help health professionals to accurately predict whether or not the 14-year threshold has been reached, opening up new avenues of medico-legal interest and laying the foundations for a legal framework that would allow the pediatrician, when involved, to use a valid and recognized diagnostic approach.

Medico-legal indicators and cut-offs in different age classes through quantitative analysis of epiphyseal fusion segments on knee CT scans.

Scientists are interested in determining age in subadults for several forensic purposes. High- resolution instrumental techniques are being increasingly used for age estimation, driven by the need to minimize errors; in this context, several studies have focused on the knee joint, recognized as a potential site for age examination in late adolescence. We analyzed 200 CT scans performed on Russian subjects (106 males and 94 females) between 13 and 20 years, without growth diseases, endocrine disorders, or osteodystrophy. Each subject underwent two scans, one for each leg. Two indicators were measured for each bone (femur, tibia and fibula): the entire length of the epiphyseal scar and the length of the part/s that is/are fused with metaphysis. Intra class Correlation Coefficient (ICC) was performed to evaluate the intra-operator reproducibility. The ratio between the two lengths was calculated for each bone (FemurR, TibiaR and FibulaR). The first aim was to evaluate a correlation between the ratios of the three bones and the three bones treated as a single parameter (given by the sum of the ratios) versus age. The results showed good correlations in both cases (τ a = 0.74, 0.64, 0.57 and 0.67). The second aim was to estimate the cut-offs derived from the sum of the three ratios respect to four age classes (14-15 years: cut-off ≤ 0.63, 15-16 years: cut-off ≤ 1.19, 16-17 years: cut-off ≥ 0.68 and 17-18 years: cut-off ≥ 1.49. The results from this research encourage further studies of the knee joint as an indicator of legal adult age.

Leading Pathogens Involved in Co-Infection and Super-Infection with COVID-19: Forensic Medicine Considerations after a Systematic Review and Meta-Analysis.

The COVID-19 pandemic raised concerns about the potential for co-infection or over-infection with other respiratory infections, as they can complicate the diagnosis, treatment and prognosis of the disease. This is also a challenge for forensic pathologists, who may come across cases where the presence of co-infection or over-infection is suspected or confirmed, and it is important that they take this into account when determining the cause of death. The aim of this systematic review is to analyse the prevalence of each specific pathogen co-infecting or over-infecting patients with SARS-CoV-2 infection. In total, 575 studies were selected from the Scopus and Pub-Med online databases and 8 studies were included in a meta-analysis. Male gender, advanced age and nursing home care are risk factors associated with the development of co-infection, whereas age, tachypnoea, hypoxaemia and bacterial infection are predictors of mortality. Overall, however, having a SARS-CoV-2 infection does not represent a real risk for the development of co-infections/super-infections.

Anthropometric analysis of orbital and nasal parameters for sexual dimorphism: New anatomical evidences in the field of personal identification through a retrospective observational study.

Orbital and nasal parameters among modern humans show considerable variation, which affects facial shape, and these characteristics vary according to race, region, and period in evolution. The aim of the study was to ascertain whether there are sex differences in the orbital and/or nasal indexes and/or the single measurements used to calculate these in a Kosovar population. The following parameters were taken into consideration: orbital height (OH), orbital width (OW), nasal height (NH), and nasal width (NW). The ratios between orbital index/nasal index (RONI) were calculated. All measurements were obtained from a population sample comprising 408 individuals. The accuracy in sex prediction was 52.86% (CI95% = 45.05%-60.67%) for NW and 64.96% for NH (CI95% = 57.50%- 72.42%). The difference between male and female indexes was statistically significant (P < 0.05). The anthropometric study revealed that only NW and NH are configured as predictors of sexual dimorphism. It could be useful to increase the number of samples to test the discriminant function in other population groups.

An Effective Model for Estimating Age in Unaccompanied Minors under the Italian Legal System.

This article presents an effective model for estimating the age of subjects without identification documents, in accordance with Italian legislation covering unaccompanied minors, using instrumental methods recognized by the scientific community for age estimation. A decision-making tree has been developed, in which the first step is a physical examination. If secondary sexual characteristics are fully developed and there are no obvious signs of abnormal growth, dental X-rays are the next step. If the roots of the seven left mandibular teeth between the central incisor and the second molar are completely developed, the focus then moves to the third molar. If the index of the third molar (I3M) value is less than 0.08, or if third molars are not assessable, the following step is to study the clavicle which, if fully formed, indicates that the subject is an adult with 99.9% probability; otherwise, the probability is 96%. In all other cases (where the I3M is over 0.08), the probability that the subject has reached 18 years is less than 60%. The research, carried out initially on x-rays of the wrist, teeth and clavicle, highlighted the uselessness of the x-ray of the wrist for determining the age of majority, because in our sample, all subjects with incomplete maturity of hand/wrist bones were under 16 years of age; thus, OPT was necessary anyway. What we propose is a practical, easily feasible, fast, economical, and extremely reliable method, which can be used on Caucasian populations and beyond for multiple forensic purposes.

Combining Bayesian Calibration and Copula Models for Age Estimation.

Accurately estimating and predicting chronological age from some anthropometric characteristics of an individual without an identity document can be crucial in the context of a growing number of forced migrants. In the related literature, the prediction of chronological age mostly relies upon the use of a single predictor, which is usually represented by a dental/skeletal maturity index, or multiple independent ordinal predictor (stage of maturation). This paper is the first attempt to combine a robust method to predict chronological age, such as Bayesian calibration, and the use of multiple continuous indices as predictors. The combination of these two aspects becomes possible due to the implementation of a complex statistical tool as the copula. Comparing the forecasts from our copula-based method with predictions from an independent model and two single predictor models, we showed that the accuracy increased.

Third molar maturity index (I3M) assessment according to different geographical zones: a large multi-ethnic study sample.

Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (> 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18 years old which is the goal of the forensic methods used for justice.

Quantitative and Qualitative Approaches for Dental Age Assessment in Sub Adult Portuguese Population: European Regression Formula and Demirjian Stages.

Introduction: Over the last decade, the criminal justice system among the European countries deals with a new group of people, the undocumented people. In the criminal field, most of the suspected claimed to be under the minor legal age according to the type of crime. The government of each European country is committed to protecting the children and vulnerable people. There are serious safety concerns since adults falsely claim to be minors and legal systems oppose to such claims. In this study, we have used different age assessment methods and some of them without accuracy. Objective: To meet the general considerations we developed a study using the current dental age assessment methods. Hence, for the Portuguese population, this study aims to validate the European regression formula between the ages of 6 and 15 years of age; to estimate the cut-off point for the age of 12 years, and to compare the quantitative approach of European regression formula with Demirjian's qualitative approach for age estimation. Material and Methods: 483 orthopantomograms were analysed using the European formula and Demirjian scoring stages. A new method, Model 2, was designed to better suit the Portuguese population. Results: The European formula: average age underestimation of 4.88 for the third quadrant and 4.04 months for the fourth quadrant; and a mean absolute error (MAE) of 10.93 and 10.68 months respectively. Demirjian method: average overestimation of 8.70 months, MAE of 12.85 months. In Model 2: MAE of 9.37 months for the third quadrant, and 9.28 months for the fourth quadrant. Both European formula and Demirjian method had an area under ROC curves results above 0.93. Discrepancy of sensitivity between methods for the specific cut-off point: 11.48. The results obtained in this study can be extrapolated to 87.33% of the Portuguese population. Conclusions: The European regression formula can be applied for the Portuguese population, and seems to be more accurate than Demirjian's methodology in this population. Nevertheless, both European regression formula and Demirjian method present similarly suitable results in the classification of 12 years of age, although there is a noticeable discrepancy favouring the European regression formula. The European Formula when applied for criminal age assessment, independently of population, is mandatory to indicate to the judicial institutions, the sensitivity of the results.

Vaccines as a preventive tool for substance use disorder: A systematic review including a meta-analysis on nicotine vaccines' immunogenicity.

The research on substance use disorders is ongoing in the quest to find anti-addiction vaccines to treat drug abuse. This article provides a systematic review of clinical trials that have been conducted on humans to evaluate the efficacy, safety, and abstinence rates of anti-addiction vaccines for different drugs, with useful results regarding cocaine and nicotine vaccines in particular; this study includes also a meta-analysis to establish the antibody-titer production following the nicotine vaccination, while a meta-analysis of cocaine vaccines was not performed due to the small number of included trials. The articles taken into consideration were published between 2002 and 2015, including searches through 2022. Overall, 13 articles were selected with 2,266 participants from different ethnic groups. The meta-analysis of nicotine vaccines showed that vaccinated groups were 50 times more likely to create specific antibodies compared to the non-vaccinated. These results demonstrated how the nicotine vaccine has good immunogenicity.

Validation of the Italian, European, North German, Malaysian, and South African black formulas on Cameriere method using panoramic radiographs in Kenyan children.

This study aimed to validate the accuracy of five different formulas based on the Cameriere method for age estimation in Kenyan children. We analyzed panoramic radiographs of 350 Kenyan children (184 males and 166 females) aged between 6 and 13 years. The dental development of each child was estimated by the analysis of the first seven left permanent teeth in the left mandible. Dental age was calculated by the Italian, European, North German, Malaysian, and South African black formulas previously published in peer-review journals. The children's mean chronological age (CA) was 9.34 ± 2.02 years and 9.26 ± 2.01 years for males and females. In males, the South-African formula overestimated CA least, by 0.12 years, followed by the Italian formula by 0.22 years, the European formula by 0.37 years, the Malaysian formula by 0.48 years, and the North-German formula overestimated the most, by 0.57 years. In females, the South-African formula underestimated CA by - 0.12 years. The Italian overestimated by 0.12 years, followed by the North-German formula by 0.29 years, the European formula by 0.31 years, and the Malaysian formula by 0.40 years. The Italian formula provided the best accuracy in the absolute difference within ± 1 year, by 75.72% and 75%, following the North-German formula by 66.47% and 70.27% for males and females, respectively. Therefore, the findings suggest that the Italian formula best estimates dental age in Kenyan children.

Age Assessment in Children and Adolescents by Measuring the Open Apices in Teeth: A New Sardinian Formula.

Age estimation in children is fundamental in both clinical and forensic fields. The aim of this study was to evaluate the accuracy of the Cameriere's European and Italian formulae for age estimation in Sardinian children and adolescents, a genetically isolated population. A sample of 202 orthopantomograms of healthy Sardinian children and adolescents (100 females and 102 males) aged between 6 and 17 years was retrospectively evaluated. The seven left mandibular teeth were assessed with the Cameriere's European and Italian formulae. The teeth with closed apex (N0) were counted and, in the teeth with open apex, the distance between the inner sides was calculated. All variables showed a significant and negative correlation with age except N0 and g. Sex (g), the variables s, N0, and the first-order interaction between them, contributed substantially to the age measurement (p < 0.001). Although the value of x5 had a low prediction level, it generated the following multiple linear regression formula, specific for the Sardinian sample: Age = 10.372 + 0.469 g + 0.810 N0 − 1.079 s − 0.398 s ∙ N0 − 0.326 × 5. Only the Sardinian and European formulae allowed to obtain an acceptable interclass agreement (both the lower and upper >0.7). The results showed that the European formula could be accurate for assessing age in this sample of children and adolescents.

A new analytical cut-off point for determining 18 years of age using MRI on medial clavicular epiphysis.

Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation. The purpose of the present study was to assess a new numerical cut-off at the age of 18 years, taking into consideration Magnetic Resonance (MR) images of the medial clavicular epiphysis. We analyzed 163 MR scans of Italian subjects aged between 14 and 25 years. Using the data obtained we calculated two ratios: REM-1 (ratio between the length of the whole epiphysis and the length of the metaphysis) and REM-2 (ratio between the length of epiphyseal-metaphyseal fusion and the length of the metaphysis). In 68 out of 163 cases it was not possible to measure REM-2. The reproducibility was demonstrated using the Intraclass Correlation Coefficient (ICC) (Cronbach's alpha > 0.80). REM-1 and REM-2 were compared in each category of age (adult and minor) by the Wilcoxon signed-rank test. The cut-off points for measurements of REM-1 and REM-2 were determined by logistic regression. For REM-1, the cut-off scores were 0.83 for all individuals (accuracy = 94.77%) and males (accuracy = 96.05%), and 0.86 for females (accuracy = 92.30%). For REM-2, the cut-off values were 0.40 for all individuals and males (accuracy = 100.00%), and 0.41 for females (accuracy = 100.00%). Finally, receiver operating characteristic (ROC) curves for age classification based on REM-1 and REM-2 were constructed, showing that REM-2 had the highest discriminative power. Thus, a new cut-off model for predicting the age of majority has been introduced, conducting a quantitative analysis thanks to the use of a high-resolution imaging tool.

Dental Age Assessment by I2M and I3M: Portuguese Legal Age Thresholds of 12 and 14 Year Olds.

OBJECTIVE: Better understanding of dental age assessment may help in cases of age estimation in Forensic Clinics. The first aim was to provide essential information on method reliability for upcoming studies using dental age assessment by second molar index (I2M), and third molar index (I3M) for age estimation on legal ages of 12 - 14 years. The second aim was to document forensic method outcomes of the Demirjian method which has already been used in forensic clinic. MATERIAL AND METHODS: Two samples were used for this purpose: for I2M, 633 orthopantomographs (270 females / 363 males), the age range from 7 to 17 years and for I3M, 471 orthopantomographs (253 females / 218 males), the age range from 10 to 23 years, from the database population of Lisbon North University Hospital Center, approved by the Ethic Committee. RESULTS: The I3M cut-off point (1.133) for 12- year- olds obtained better results than the cut-off point stated by the I2M (0.135). Besides, I2M cut-off point (0.001) for 14- year- olds showed better results when compared with the cut-off point (0.705) established by the I3M. Both methods are reliable for the legal age thresholds of 12 and 14 years. However, using I2M and I3M allows us to vary the cut-off value to privilege sensitivities or specificity, depending on which is more appropriate to the intended application. CONCLUSIONS: The accuracy (88.94%) of I3M obtained better results for the 12- year- old cut-off point (1.133) and the accuracy (90.21%) of the I2M performed better for the 14- year- old cut-off point (0.001).

Cut-off for the legal ages in the Portuguese Population by Third Maturity Index: Measures of Accuracy.

OBJECTIVES: The aim of this study is to estimate the cut-off points for the Portuguese legal ages through the I3M, and to compare them with the methods of Demirjian, Nolla and Moorrees. DESIGN: The lower third molars were analyzed on 348 orthopantomography's aged between 12 and 23 years in a Portuguese Population. The images were analyzed by ImageJ and the cut-off points were calculated for the respective legal ages of 14, 16, 18 and 21 years old. RESULTS: The correlation between age and the I3M was 0.862, whereas with Demirjian's stadiums, Nolla's stages, and Moorrees' stages the correlation coefficients were 0.863, 0.842 and 0.844, respectively. For the cut-off point of 0.08 for the age of 18, a sensitivity of 78.99 %, specificity of 93.48 %, an accuracy of 88.54 %, a positive predictive value of 86.24 % and a posteriori Bayes probability of 92.82 %. The cut-off points established for the ages of 14, 16, 18 and 21 years for the Portuguese population achieved an accuracy of 83.67 %, 85.67 %, 88.54 % and 87.11 %, respectively. CONCLUSION: Demirjian's method and Cameriere's method attain quite similar results. In certain ages, the methods of Nolla and Moorrees show higher sensitivity or higher specificity when compared to Cameriere's method, however this last method is more stable in terms of reliability and more suitable to use in the Portuguese population.

Measurement of the open apices of mandibular first and second premolars to test the chronological age over 14 years: Study on a sample of south Indian children.

Age estimation is an integral part of forensic medical and dental practice. In many countries, the age threshold of 14 years is set to determine the minimum age for criminal responsibility. In the present study, the authors studied the final maturation of the first (IPM1) and second mandibular premolars (IPM2) by Cameriere maturity index and determined cut-offs at the age threshold of 14 years, and validate on the test sample. Orthopantomograms of 960 healthy south Indian children and sub-adults (480 boys and 480 girls) aged between 10 and 18 were analysed, 640 as training sample and 320 as a test sample. The results of logistic regression analysis with age (

Comparison of Frontal Sinuses for Personal Identification in 3 Populations Using Cameriere's Code Number.

ABSTRACT: The identification of unknown individuals is of crucial importance to society, especially in the context of mass disasters involving individuals of different nationalities. The comparison of frontal sinus patterns is an important tool for personal identification. In Cameriere's method, a new personal code number (codC) containing 8 digits was elaborated, based on the measurements of frontal sinus patterns. The present study is an update of this previous work. Digital radiographic images of the skulls of 299 individuals of different nationalities (100 Italians, 99 Kosovars, and 100 Turks) were analyzed, adopting the same maximum-weight dependence tree used in the original work. For comparisons between groups, Fisher exact test and the χ2 test were carried out. The method, applied to different population groups, significantly increases the likelihood of identifying a person by comparison of antemortem and postmortem frontal sinus radiographs. Results demonstrated that the model is more discriminative in identifying individuals of different nationalities.

Forensic Validity of the Third Molar Maturity Index (I 3M) for Age Estimation in a Russian Population.

The aim of this cross-sectional study was to test the accuracy of the third molar maturity index (I 3M) cut-off value (0.08) to distinguish between individuals above and below the adult age of legal responsibility (18 years) in a Russian population. A sample of 571 digital panoramic radiographs of healthy Russian minors and young adults (363 females and 208 males), aged between 14 and 24 years, was evaluated. The lower left third molars were analyzed by applying the cut-off value of 0.08 determined by Cameriere et al. (2008). Lin's concordance correlation coefficient (ρ c) and Cohen's kappa coefficient (κ) showed that repeatability and reproducibility are high for both intra- and interobserver errors. The I 3M value decreased with age in both sexes. Age distribution gradually decreases as I 3M increases in both girls and boys. In the male group, molar maturity stages 0-0.04, 0.04-0.08, 0.08-0.3, 0.3-0.5, and 0.9-1.4 were reached slightly earlier than in the female group. The results demonstrated that sensitivity is 0.96 in boys and 0.93 in girls; associated specificity values were both 0.98. The cut-off value of I 3M is statistically robust and thus valid for forensic application in a Russian population to determine whether or not a subject has reached 18 years of age. Finally, we compared our results with those of other studies in which the same I 3M cut-off value was tested on different populations. The method is novel as it is reliable and easily reproducible, thus ensuring a universal way of comparing the results obtained (based on a cut-off value) among many populations, in order to develop an ever-increasing database.

Validation of the Third Molar Maturation Index (I3M) to assess the legal adult age in the Portuguese population.

Age estimation is a major step in forensic and legal procedures. Its relevance has been increasing due to growing society issues, such as identification of missing people, crimes against minors or lack of valid identification papers from locals or foreigners. Evaluation of the cut-off value of the Third Molar Maturation Index (I3M) = 0.08 for discriminating minors from adults in the Portuguese population. The left lower third molars were analysed by applying a specific cut-off value of 0.08 determined by Cameriere et al. in 2008. A sample of 778 digital panoramic radiographs of a representative Portuguese sample (442 females and 336 males), in the age range of 12-24 years (mean age 17.7 ± 2.98 years in females and 18.1 ± 3.0 years in males), was retrospectively evaluated. I3M decreased as the real age gradually increased in both sexes. The 0.08 cut-off score was valuable in discriminating adults from minors. According to the pooled results, the accuracy, by means of area under the curve, was 92.8% (95% confidence interval (CI) 91.0-94.6%). The proportion of correctly classified subjects (sensitivity) was 90.7% (95% CI 88.7-92.8%) and the specificity was 94.9% (95% CI 93.3-96.4%). The results show that I3M is a valuable method to differentiate minors from adults in the Portuguese population.

Analysis of carpal bones on MR images for age estimation: First results of a new forensic approach.

Current multifactorial age estimation methods are based on radiography, however, in the forensic field there is growing interest in using magnetic resonance imaging (MRI). With regard to the carpal region, MRI provides more information for defining the individual ossification nuclei and the cartilage surrounding single bones. During the phase of bone growth, the progressive reduction of the cartilage layer is accompanied by the development of a cartilage-bone interface. The aim of our study was to create a new model for age estimation, based on the ratio between the area occupied by the nucleus of ossification (NO) and the surface of growth (SG) of each carpal bone, the latter derived by adding NO to the area of cartilage-bone interface. We analyzed 57 MRI scans of Italian subjects aged between 12 and 20 years, without growth diseases, endocrine disorders or osteodystrophy. Measurements of NO and SG areas were extracted using ImageJ software, and the ratio between the NO and SG of each bone (NOSG) was calculated. A multiple linear regression model was used to estimate the individual's age as a function of the variables: gender and wrist bone measurements. The results showed that the best model was obtained with 6 predictors (nvmax=6): Gender, and the NOSG of the Trapezoid, Trapezium, Scaphoid, Pisiform, and Capitate. The median of the residuals (observed age minus predicted age) was -0.025 years, with an IQR of 0.19 years. Thus a new forensic approach to age assessment using MRI is introduced in this paper, which gives the preliminary results.

Age estimation in children based on open apices measurement in the Serbian population: Belgrade Age Formula (BAF).

Background: Cameriere's method has been tested in many populations and is widely accepted for dental age estimation.Aim: To establish a new formula for age estimation by measurement of open apices of mandibular teeth based on Cameriere's European formula.Subjects and methods: Panoramic radiographs of 333 healthy Serbian children aged 5-14 years were analysed by two independent researchers. The new formula - Belgrade Age Formula (BAF) - was created and tested on the same Serbian sample. Furthermore, BAF was tested on the Serbian validation sample of 126 children and 2115 Italian children aged 5-14 years.Results: In the Serbian sample, the residuals of the BAF and European formula demonstrated that BAF is significantly better in age estimation than the European formula. No significant difference was found in females from the Serbian validation sample between dental and chronological age when BAF was applied. For males, the BAF and European formula had similar accuracy. In the Italian sample, the mean differences between estimated and real age for the European formula were -0.214 ± 0.934 and 0.109 ± 0.773 for females and males, respectively, while for BAF these differences were 0.182 ± 0.951 and -0.195 ± 0.923 for females and males, respectively.Conclusion: BAF was found to be accurate in the Serbian and Italian populations.