An analysis of risk factors for child suicide in three centres from 2008 to 2017.

As a part of a study of suicide in children aged 17 years and under in three centers-Hennepin County in the United States (US), Auckland in New Zealand (NZ), and South Australia in Australia (AUS) from 2008 to 2017 it was decided to characterize potential risk factors and to determine whether these differed by jurisdiction. Reviewed data included a history of psychiatric illness, symptoms prior to suicide, events preceding suicide, previous suicidal ideation or suicide attempts, and communication of suicidal intent. The most common events preceding suicide were arguments with family/friends and relationship issues; in addition depression with or without expressed suicidal ideation, self-harming behavior, sadness, distress, drug/substance abuse, and anorexia were documented. Suicidal intent was on occasion communicated via technological means. In 79.5% of cases in South Australia decedents had a previously diagnosed psychiatric illness, with 62% in Hennepin County. This compared to a much lower proportion of cases in Auckland (23.8%). Whether this reflects more limited access to psychiatric services or a reluctance to seek support and therapy in Auckland is unclear. It does, however, demonstrate that risk factors for child suicide are not uniform among communities and so extrapolation of data from one area to another may not be appropriate. Disturbingly parents/carers were not aware of the decedent's suicidal intent in 84-87.2% of cases.

Lethal septic pulmonary thromboembolism in a repatriated body - a rare complication of prolonged urinary catheterization.

A case of septic pulmonary thromboembolism arising from thrombophlebitis of the prostatic venous plexus associated with long-term urinary catheterisation in a 51-year-old man is reported. Despite a previous autopsy having been conducted in the country where he had been resident overseas, a re-examination showed histological evidence of mild patchy chronic prostatitis with a florid, focally purulent, thrombophlebitis of the periprostatic venous plexus with abscess formation and evidence of bacterial overgrowth. Corresponding microscopy of the lungs showed septic microthromboemboli within small pulmonary arteries with variable degrees of necrotising acute inflammation and thrombosis. Death was not due to 'acute pulmonary oedema' as had been originally certified but to septic thromboembolism. This case demonstrates the need to carefully evaluate the prostatic venous plexus at autopsy, and also the type of problems that may arise at the time of the re-examination of repatriated remains.

Circumstances and Pathological Findings in Civilian Helicopter-Related Fatalities.

ABSTRACT: Helicopters are used worldwide in a range of commercial and private industries and are particularly useful in northern Australia due to the sparse population scattered over large distances with remote regions difficult to access by any other means of transport. Nine civilian helicopter-related fatalities were reported to the Northern Territory coroner between January 2004 and December 2023. The victims were all male (age range, 34-74 years; mean, 52 years). All fatal crashes occurred in remote areas, the majority on cattle stations. Pilots were the sole occupants in 5/9 incidents; in 4 incidents, there were injured survivors. All fatal incidents involved Robinson piston engine helicopters (Robinson R44 models in 2 incidents and Robinson R22 models in the remaining 7). Scene investigations, postmortem examinations, and ancillary investigations were frequently hampered by decomposition of the remains, resulting from difficult search operations and delayed location, retrieval, and storage. Head injuries were present in all cases with chest and spinal injuries in more than half. Integrated assessment of injuries with toxicological and aviation investigations facilitated understanding of the crash dynamics.

Artefacts due to putrefactive gas production - an overview.

Autolytic and putrefactive processes can cause considerable alterations to soft tissues and internal organs that may complicate forensic assessments. An overview was undertaken of the range of taphonomonic changes and processes that may result from postmortem putrefactive gas accumulation. The most commonly encountered phenomenon was purging of putrefactive fluids from the nose and mouth that was on occasion confused with bleeding from antemortem trauma. Much less common was putrefactive 'rigor mortis' where the limbs extend due to the accumulation of soft tissue and subcutaneous gas. This may sometimes be associated with alteration of the position of a body suggesting that it had been deliberately moved. Distension and stretching of the skin and subcutaneous tissues may cause recently sutured surgical incisions to dehisce, raising the possibility of inflicted incised wounds. Raised intra-abdominal pressures may cause diaphragmatic herniation of small intestine and has been associated with so-called 'coffin birth' where a fetus is expelled from the uterus after death due to pressure on the fundus. Gas accumulation on postmortem computed tomography examination may be confused with air embolism or the effects of trauma. All of these changes are the result of anaerobic bacterial action generating gases such as methane, carbon dioxide and hydrogen sulphide resulting in pressure gradients.

Tree failure - A natural phenomenon with forensic implications.

Tree failure, or summer branch drop, refers to situations where large branches or whole trees may unexpectedly drop on unsuspecting victims. On occasion, this involves vehicles impacted by falling overhanging trees or branches. To study this phenomenon further review of the Forensic Science SA, Adelaide, Australia, database and an internet news search were undertaken over a 20 year period from March 2004 to February 2024 for all cases where unexpected accidental deaths in South Australia had been caused by falling branches or trees. There were six cases (age range 12-63 years; average 39 years; M:F 1:2). Three deaths occurred when branches dropped onto vehicles being driven along roads, 2 occurred when entire trees dropped onto the victims (one in windy weather) and 1 was due to a branch drop. Three tree species were identified as a grey box gum tree (Eucalyptus microcarpa), a lemon-scented gum tree (Corymbia citriodora) and a Cottonwood tree (Populus deltoides). The remainder were variants of eucalyptus (gum) trees. Deaths due to tree failures are uncommon and may involve a variety of different tree species with these events not necessarily occurring during high winds or storms. The major findings at autopsy are blunt force injuries.

Tarnished jewellery and skin - a subtle external marker indicating exposure to hydrogen sulfide.

A 39-year-old woman was found lying in the rear of a car at her home address. A smell of rotten eggs was noted and bottles of brick, tile and paver cleaner and lime sulfur were found in the rear of the vehicle. Suicide notes were found in the house. At autopsy there was no evidence of significant trauma with black tarnishing of a silver-coloured ring and a silver-coloured necklace noted with staining of the underlying skin, in keeping with a chemical reaction between hydrogen sulfide and silver. Internally the most significant finding was unusual greenish discolouration of the gray matter of the external and cut surfaces of the cerebral hemispheres, cerebellum and brain stem. No other organs had this discoloration. Death was attributed to hydrogen sulfide poisoning. Skin discoloration from silver jewellery may represent a subtle external marker for lethal or non-lethal hydrogen sulfide exposure.

Increasing age and lethal opiate use.

Opioid abuse is a leading cause of drug-related morbidity and mortality worldwide. It has been suggested that the age of opiate users in Australia is rising. To evaluate this further in a local population, toxicology and pathology case files from Forensic Science SA, Adelaide, South Australia, were examined for all cases with lethal opioid levels from 2000 to 2019 (n = 499; M:F 2.3:1; age range 18-91 years, median age 42 years). The median age of opiate deaths increased significantly by approximately 16 years (p = 0.007, R2 = 0.34) with a significant increase in total deaths in the 45-54 years and 55-64 years age groups (p = 0.009, R2 = 0.32) (p = < 0.001, R2 = 0.54). Deaths due to heroin overdose showed the lowest median age (39 years, n = 184), with deaths from tramadol toxicity having the highest (50.5 years, n = 32). Recent changes in the demographic profile of opioid users in cases of lethal overdose involve an aging population. Forensic and clinical practitioners should be aware of significant opioid abuse in certain individuals at older ages as this raises the possibility that this may exacerbate the effects of age-related chronic diseases in this group and/or contribute to fatalities.

Difficulties associated with the interpretation of postmortem toxicology.

While postmortem (PM) toxicology results provide valuable information towards ascertaining both the cause and manner of death in coronial cases, there are also significant difficulties associated with the interpretation of PM drug levels. Such difficulties are influenced by several pharmacokinetic and pharmacodynamic factors including PM redistribution, diffusion, site-to-site variability in drug levels, different drug properties and metabolism, bacterial activity, genetic polymorphisms, tolerance, resuscitation efforts, underlying conditions, and the toxicity profile of cases (i.e. single- or mixed-drug toxicity). A large body of research has been dedicated for better understanding and even quantifying the influence of these factors on PM drug levels. For example, several investigative matrices have been developed as potential indicators of PM redistribution, but they have limited practical value. Reference tables of clinically relevant therapeutic, toxic, and potentially fatal drug concentrations have also been compiled, but these unfortunately do not provide reliable reference values for PM toxicology. More recent research has focused on developing databases of peripheral PM drug levels for a variety of case-types to increase transferability to real-life cases and improve interpretations. Changes to drug levels after death are inevitable and unavoidable. As such, guidelines and practices will continue to evolve as we further our understanding of such phenomena.

Does citing early SIDS research skew contemporary conclusions?

Research on infants who have allegedly succumbed to sudden infant death syndrome (SIDS) has been of variable quality over the years. Even now peer-reviewed papers are being published on cases termed 'SIDS' without autopsies having been performed, despite this being a requirement of the three major definitions for over five decades. Clearly cases used in earlier research studies could not have complied with the requirements of as-yet unpublished definitions/guidelines. For this reason care must be taken in citing initial papers as their results may have been skewed by the presence of non-SIDS cases. This may have particular relevance for meta analyses. Reviewing the literature on substance P and its relationship to SIDS provides an excellent example of how diametrically opposed conclusions were reached at different time points. Early studies on SIDS, and studies that use cases that were classified before the standard NICHD and San Diego definitions, should, therefore, be approached with a degree of scepticism and not cited in contemporary papers or at meetings as they have the potential to confuse rather than clarify.

Cardiac tamponade - a rare cause of sudden death in autoimmune polyglandular syndrome.

A 27-year-old male died suddenly due to cardiac tamponade arising from pericarditis complicating autoimmune polyglandular syndrome (APS) type 2. He had a history of primary Addison disease and autoimmune hypothyroidism which were corroborated at autopsy. In addition a florid fibrinous pericarditis was associated with 287 g of turbid fluid in the pericardial sac. Although pericarditis with tamponade is a potential complication of APS, it has rarely if ever, been reported as a cause of sudden death. Lethal mechanisms may involve both compressive and restrictive effects.

Domestic violence and chronic traumatic encephalopathy (CTE) - a forensic perspective.

Chronic Traumatic Encephalopathy, or CTE, is an entity characterized by neurological deficits that are thought to arise from repetitive episodes of blunt head trauma. It has gained considerable attention recently in those who have engaged in contact sports. However, given that it is caused by mechanical cerebral strain from nonspecific blunt impact, it seems reasonable to assume that it could arise from a multitude of causes, such as craniocentric domestic violence. While the literature is somewhat contradictory, the possibilities are that CTE may be caused by either the incremental additive effects of less severe trauma, or from more forceful impacts, or from a combination of both of these mechanisms. Another issue to consider is the degree of acceleration/rotation trauma associated with particular events. Careful study of the chronology, nature and dose-relationships of previous head impacts in victims of inflicted lethal head trauma will, therefore, be required. This will help to clarify its significance in cases of domestic violence and also specifically whether it can be additive from more minor impacts, or whether there is a threshold of force required before it occurs.

The role of alcohol in infant cosleeping deaths.

The well-established epidemiological and neuropathological differences between infants who die alone compared to those in shared sleeping environments indicate that these cohorts have differences. Risk factors in both situations depend on both exogenous and endogenous factors. Although parental consumption of alcohol continues to be cited as a risk factor for sudden infant death syndrome (SIDS) it is difficult to understand how a substance which impairs parental consciousness rather than infant arousal could contribute to SIDS. Surely a more logical mechanism to explain these deaths would be suffocation by a sedated adult rather than evoking predisposing factors for SIDS.

Identifying and documenting osseous trauma from shark attacks by post mortem CT examination and autopsy.

A 15-year-old male was attacked by a large white shark while surfing. CT examination revealed an above-knee amputation of the right lower extremity with stripping of soft tissues from the groin distally. 3-dimensional volume rendering did not show any fragments of shark teeth but did reveal linear gouges, areas of shaving of cortical bone and an inverted 'V'-shaped defect at the distal margin of the femoral shaft. At autopsy these injuries were confirmed in addition to areas with fine parallel cross-striations matching the marginal serrations of the teeth of a white shark. Thus, while post mortem CT with 3-dimensional reconstruction at high resolution can show the nature and number of the bony injuries following shark attack, it is complimented by pathological examination which may find fine parallel grooves from teeth serrations. Post mortem 3-dimensional volume rendering may also help to find or exclude fragments of teeth, and silicone casting may provide a permanent record of bone lesions.

Recent trends in an uncommon method of carbon monoxide suicide.

PURPOSE: The most prevalent method of carbon monoxide (CO) suicide is inhalation of vehicle exhaust (VE). However, a new method of CO suicide has recently emerged involving charcoal burning (CB) in a confined space to produce fatal CO levels. This method has been reported from countries in Asia, associated with economic instability and media reporting of high-profile celebrity cases. The current study was undertaken to analyze rates and characteristics of CB suicides in South Australia (SA) for comparison with respect to their characteristics and scene, autopsy and toxicology findings. METHODS: A search was undertaken for all intentional fatal carbon monoxide poisonings in SA between 2000 and 2019. Collected variables included age, sex, cause of death, location of death, decedent histories, scene, autopsy and toxicology findings and manner of death. Statistical analyses were performed using R (version 4.2.3). RESULTS: There was a significant decrease in VE suicides (p < 0.05) and a significant increase in CB suicides (p < 0.001) over the 20-year period. Those who used CB were found to be, on average, between 1.5 and 15.8 years younger than those who used VE (p = 0.017). The risk factors for CB suicide included psychological/psychiatric conditions and financial problems, while VE suicides were associated with a history of physical problems and contact with the legal system. External and internal autopsy findings were consistent with the literature. CONCLUSION: CB suicide is perceived to be widely accessible and painless and is therefore becoming a popular suicide method. Monitoring future trends will be important to determine whether intervention is required.

Acanthosis nigricans - a potentially useful clue to the presence of significant occult disease at autopsy.

A 19-year-old male was found dead in his apartment. At autopsy he was morbidly obese (Body mass index; BMI - 40.5) with multiple areas of velvety pigmented thickening of the skin in folds around the neck, in the axillae, in the inframammary regions, over the anterior waistline and groin regions and over the dorsal aspects of the feet. These had the typical appearance of acanthosis nigricans. Internal examination revealed aspiration of gastric contents into the airways. Vitreous humour biochemistry showed markedly elevated levels of both glucose (62.9 mmol/L) and ß-hydroxybutyrate (13.54 mmol/L). Death was, therefore, due to aspiration pneumonia complicating diabetic ketoacidosis on a background of morbid obesity. The initial indicator of underlying diabetes, in conjunction with obesity had been acanthosis nigricans.

Cardiac amyloid deposition and the forensic autopsy - A review and analysis.

Although amyloid material in the heart is not infrequently encountered at autopsy it may on occasion be difficult to determine the significance in terms of possible contributions to the terminal mechanisms of death. A review was undertaken of the literature and of autopsy cases at Forensic Science SA over a 20-year-period (2003-2022) for all cases where significant amyloid material had been encountered on microscopy of the heart. Sixteen cases were found consisting of 11 cases where cardiac amyloid was involved in the lethal episode, and five where it was considered an incidental feature. Of the 11 lethal cases, there were three where cardiac amyloidosis was the cause of death, and eight where it was a contributing factor, along with ischaemic heart disease (N = 7) and bronchopneumonia (N = 1). The age range was 47-92 years, average 78.6 years, with a male to female ratio of 10:1. The weights of the hearts ranged from 496 to 1059 g - average 648 g. Of the five cases where it was considered an incidental finding, the causes of death were blunt head trauma (N = 2), small intestinal ischaemia (N = 2) and small intestinal obstruction (N = 1). The weights of the hearts ranged from 299 to 487 g, average 369 g. The most relevant types of amyloidosis in forensic cases tend to be light chain amyloidosis, senile cardiac amyloidosis and familial amyloid cardiomyopathy. Other forms of amyloidosis that affect the heart, which include reactive amyloidosis, haemodialysis-related amyloidosis and isolated atrial amyloidosis, either have minimal or no clinical significance, or are of uncertain significance. While it may be difficult to determine the prognostic significance of amyloid material at autopsy clinicopathological correlation may provide useful supportive information.

The death of Rasputin-A forensic evaluation.

Grigori Yefimovich Rasputin, a confidant of Tsar Nicholas and his wife, was murdered by Prince Yussupov and his co-conspirators in the cellar of the prince's Moika Palace in St Petersburg, Russia, on the evening of December 30th, 1916 (December 17th in the Russian calendar). The narrative of his death is largely based on Prince Yussupov's published memoirs and has Rasputin being poisoned with cyanide, shot, bludgeoned, and finally drowned. A review of the available forensic material, however, shows a photograph with a contact gunshot wound to Rasputin's forehead. This would indicate that he was dead prior to being dropped into the Little Nevka River. His distaste for sweet foods and the absence of poison at autopsy would also suggest that the story of cyanide toxicity was fabricated. Yussupov's description of Purishkevich firing at Rasputin from a distance as he ran across the courtyard in an attempt to escape would also not be consistent with the post mortem photograph. The simplest version of the events would be that Rasputin was executed by a contact gunshot wound to the forehead when he visited the Yussupov Palace. While it appears that the events of that fateful evening have been embellished, it is certainly not uncommon for perpetrators of homicides to provide histories that are later shown to be at odds with the truth. Re-evaluation of historic cases may provide compelling evidence for alternative interpretations to the popular historic record.

Concealed Homicides-A Postmortem Study and Review.

ABSTRACT: A study was undertaken at Forensic Science SA, Adelaide, South Australia, of all cases of homicide (January 2003-December 2022) where the victims' bodies had been concealed. Three hundred twenty-six homicides were identified, which included 27 cases where bodies had been deliberately hidden (8%) (age range, 2-82 years; ave, 34.9 years; M:F = 1.5:1). Deaths were due to blunt force trauma (n = 11), sharp force trauma (n = 4), asphyxia (n = 4), gunshot wound (n = 2), and a combination of drowning and asphyxia (n = 1). In 5 cases, the cause of death was not determinable. The methods of concealment (which were sometimes overlapping) included the following: dumping at a hidden/isolated location (n = 8), burial (n = 7), dismembering (n = 3), incinerating (n = 3), hiding in a wheeled garbage bin (n = 2), disposing in garbage resulting in the remains being located at waste disposal facilities (n = 2), hiding in a shed (n = 1), under a concrete floor (n = 1), in a suitcase (n = 1), in a river (n = 1), in a mine shaft (n = 1), and in a septic tank (n = 1). Although it has been asserted that concealed homicides are rarely encountered in forensic practice, the current study has demonstrated that the bodies in at least 8% of victims of homicide in South Australia have undergone some form of concealment.