Estimation of the post-mortem interval; added value of mechanical excitability of human skeletal muscle.

Estimation of the post-mortem interval (PMI) is mainly based on the state of body cooling, post-mortem lividity (livor mortis) and post-mortem muscle stiffness (rigor mortis). However, the time span of development of these post-mortem phenomena are influenced by a variety of factors concerning the body of the deceased and the environment in which the body is found. Subsequently, this leads to a substantial spread in upper and lower limits of PMI based on determination of the state of these phenomena. Moreover, interpretation of post-mortem phenomena like lividity, rigor and interpretation of the correction factor for Henssge's nomogram is subjective. For this reason, PMI estimations are often broad, possibly too broad to be helpful for answering questions which are relevant for the criminal investigation. Therefore, combining the outcome of different methods for estimating the PMI, the so-called compound method, is recommended. Supravital muscle reaction by mechanical stimulation of skeletal muscle is a less known aspect of the compound method. Here we present a series of cases series in which supravital muscle reaction contributed to a more precise estimation of the PMI.

Review: The safe handling of a corpse (suspected) with COVID-19.

INTRODUCTION: Countries around the world are confronted with a rising count of patients that die from COVID-19. Up to this date, there is no scientific evidence that proves that a COVID-19 corpse is still infectious. Different guidelines are being followed worldwide on how to deal with a COVID-19 positive corpse. The aim of this review is to compare different guidelines and literature on best practice for handling a COVID-19 positive corpse. RESULTS: The guidelines vary greatly in the use of PPE's and other safety measures especially during autopsy. There is great variation in the use of disinfectant and its concentration. Also recommended funeral services and contact with relatives vary greatly. CONCLUSION: In conclusion, there is very limited scientific evidence on which the researched guidelines are based. It is unclear why some guidelines propose a "business as usual" attitude and others a "code-red" attitude. More scientific evidence is needed to substantiate the handling of COVID-19 positive corpses to make an educated decision on how to safely handle a COVID-19 positive corpse.

Sudden death during physical restraint by the Dutch police.

BACKGROUND: and goal: The Police is sometimes confronted with the death of a subject during physical restraint. In most of these cases a clear Cause of Death (COD) cannot be determined by the Pathologist. The goal of this research is to find and clarify a pattern and pinpoint a clearer COD. METHOD: The research group is compiled of 38 closed police case files from the NPIID (National Police Internal Investigation Department) between 2005 and 2016. The control group is compiled of cases involving excitation and restraint, without leading to death. 148 cases were included from the NPIID between 2005 and 2016 and the Violence Registration Database of the Dutch National Police between 2014 and 2015. Case files of both the research and the control group were systematically analyzed and compared. RESULTS AND CONCLUSION: The observed patter shows that subjects dying during Physical Restraint are mostly males between 30 and 40 years old with a BMI above 30 kg/m2. Both BMI and age are remarkably lower in the control group. Subjects were encountered in a state of excitation mostly attributed to (multiple) drugs (cocaine, MDMA or cannabis). The physical restraint portrayed a pattern of escalation with restraint being mostly face-down, hands cuffed to the back, receiving thoracic pressure, resulting in a high total amount of force used. In the research group 44.7% (17/38) of subjects were encountered (partially) unclothed versus 4.1% (6/148) in the control group. Cause of death in these cases seems to be multifactorial and is comprised of both personal factors and factors during and after the struggle. The different factors are comingled and augment each other. The end effect is that the subjects end up in a fatal spiral.

Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult "natural deaths".

PURPOSE: The aim of this study was to investigate whether post-mortem computed tomography (PMCT) provides additional information regarding the cause of death and underlying diseases in a general practitioners' (GP), out-of-hospital population. METHODS AND MATERIALS: Bodies donated to our anatomy department between January 2014 and January 2018, who consecutively underwent a total body PMCT and had given permission for retrieval of their medical records during life, were included. PMCT scans were assessed by a radiologist and compared with the cause of death as stated in the medical records. Discrepancies were analyzed with an adjusted Goldman classification. RESULTS: Ninety-three out of the 274 scanned donors during the inclusion period had given consent for the retrieval of their medical records, of which 79 GP's responded to the request thereof (31 men, 48 women, average age 72.8 years, range 36-99). PMCT identified 49 (62%) cases of cancer, 10 (12.7%) cardiovascular diseases, 8 (10.1%) severe organ failures, 5 (6.3%) cases with signs of pneumonia, 2 (2.5%) other causes, and 7 (8.9%) cases without an (underlying) definitive cause of death. Eleven major discrepancies on the Goldman classification scale, with possible relevance to survival between PMCT and GP records, were identified. CONCLUSION: PMCT can have added value for the detection of additional findings regarding the cause of death in an out-of-hospital, GP's population, especially to identify or exclude major (previously non-diagnosed) underlying diseases.

Estimation of the postmortem interval based on the human decomposition process.

Postmortem interval (PMI) estimations which are used as evidence in Dutch court are sometimes solely based on the experience of the forensic physician without a scientific background. The aim of this study was to investigate the degree of agreement between forensic physicians and their PMI estimations. Fifteen cases were selected from 1534 external postmortem investigations. Photographs of the human remains were presented to 89 forensic physicians in the Netherlands with the instruction to estimate the PMI based on their experience, knowing the remains were found indoors and in which season. Data analysis was conducted by using an interclass correlation (ICC) and Spearman's rank correlation coefficient. This study shows a poor correlation (ICC = 0.254) between the PMI estimations of the 89 forensic physicians. It is therefore not advised that PMI estimations based on experience be used as evidence in court.

The development of a post-mortem interval estimation for human remains found on land in the Netherlands.

The decomposition process of human remains can be used to estimate the post-mortem interval (PMI), but decomposition varies due to many factors. Temperature is believed to be the most important and can be connected to decomposition by using the accumulated degree days (ADD). The aim of this research was to develop a decomposition scoring method and to develop a formula to estimate the PMI by using the developed decomposition scoring method and ADD.A decomposition scoring method and a Book of Reference (visual resource) were made. Ninety-one cases were used to develop a method to estimate the PMI. The photographs were scored using the decomposition scoring method. The temperature data was provided by the Royal Netherlands Meteorological Institute. The PMI was estimated using the total decomposition score (TDS) and using the TDS and ADD. The latter required an additional step, namely to calculate the ADD from the finding date back until the predicted day of death.The developed decomposition scoring method had a high interrater reliability. The TDS significantly estimates the PMI (R 2 = 0.67 and 0.80 for indoor and outdoor bodies, respectively). When using the ADD, the R 2 decreased to 0.66 and 0.56.The developed decomposition scoring method is a practical method to measure decomposition for human remains found on land. The PMI can be estimated using this method, but caution is advised in cases with a long PMI. The ADD does not account for all the heat present in a decomposing remain and is therefore a possible bias.