[Drowning mortality in Catalonia (2019-2022)]. / Mortalidad por ahogamientos en Cataluña (2019-2022).

OBJECTIVE: Data on drownings tend to underestimate mortality from this cause. The objective of this study was to describe fatal drownings recorded in Catalonia between 2019 and 2022 through forensic sources, present their characteristics, and assess the utility of this information for monitoring drowning mortality. METHODS: A retrospective observational study based on the register of judicial deaths from the Institute of Legal Medicine and Forensic Sciences of Catalonia was carried out. Data on medicolegal aetiology, aquatic environment, age, gender, date of death, and municipality of origin were analysed. Statistical analysis was based on the comparison of proportions test based on Chi-square for categorical variables and the Mann Whitney U test for the comparison of numerical variables. RESULTS: A total of 310 drownings were recorded, with a mean age of 57.2 years and a male predominance (77.1%). The majority of drownings were unintentional (71.3%), followed by suicides (15.5%), and cases of undetermined intent (12.6%). Compared to intentional drownings, unintentional and undetermined intent drownings had a higher percentage of males than females (81.2% vs. 56%, p<0.001), and fewer cases with Spanish nationality than foreign or undetermined nationality (60% vs. 92%, p<0.001). Middle-aged and older individuals accounted for the majority of deaths, but among unintentional drownings, those recorded in pools included significantly higher percentages of children and adolescents aged zero-fourteen years than those occurring in natural waters. CONCLUSIONS: The results highlight the importance of drowning mortality in Catalonia and the need to strengthen preventive activities, especially for children and during episodes of intense heat. Medicolegal sources are useful for monitoring drowning mortality, but it would be beneficial if they incorporated information on variables such as place of residence and nationality.

OBJETIVO: Los datos sobre ahogamientos tienden a subestimar la mortalidad por esta causa. El objetivo de este estudio fue describir los ahogamientos mortales registrados en Cataluña entre 2019 y 2022 a través de fuentes forenses, mostrar sus características y valorar la utilidad de esta información para monitorizar la mortalidad por ahogamientos. METODOS: Se realizó un estudio observacional retrospectivo basado en el registro de muertes judiciales del Instituto de Medicina Legal y Ciencias Forenses de Cataluña. Se analizaron la etiología médico-legal, entorno acuático, edad, sexo, fecha de defunción y municipio de procedencia. El análisis estadístico se basó en la prueba de comparación de proporciones basada en Chi cuadrado para las variables categóricas y la prueba U de Mann Whitney para la comparación de variables numéricas. RESULTADOS: Se registraron 310 ahogamientos mortales, con una edad media de 57,2 años y predominio masculino (77,1%). La mayoría fueron no intencionales (71,3%), seguidos por suicidios (15,5%) y casos de intencionalidad indeterminada (12,6%). Comparados con los ahogamientos intencionales, los no intencionales y de intencionalidad indeterminada incluyeron más hombres que mujeres (81,2% frente a 56%, p<0,001), y menos casos con nacionalidad española que extranjera o indeterminada (60% frente a 92%, p<0,001). Las personas de mediana y avanzada edad aportaron la mayoría de las defunciones pero, entre los ahogamientos no intencionales, los registrados en piscinas incluyeron más niños y adolescentes de cero-catorce años que los que tuvieron lugar en aguas naturales. CONCLUSIONES: Los resultados prueban la importancia de los ahogamientos mortales en Cataluña y la necesidad de fortalecer las actividades preventivas, especialmente en la infancia y durante episodios de calor intenso. Las fuentes médico-forenses son útiles para monitorizar la mortalidad por ahogamientos, pero convendría que incorporaran variables como el lugar de residencia y la nacionalidad.

Osteonal Microcracking Pattern: A Potential Vitality Marker in Human Bone Trauma.

In forensic anthropology, the differential diagnosis between peri- and postmortem bone fractures is mainly based on macroscopic criteria. In contrast, studies focusing on bone histology are very scarce. In a recent publication, we showed that (perimortem) fractures in fresh human bones exhibit a different osteonal microcracking pattern than (postmortem) damage in dry bones. In the current work, we explored whether this osteonal microcracking pattern is distinctive of the vitality of (perimortem) fresh bone fractures. To this end, we compared the number, length and structural distribution of microcracks in vital humeral fractures from forensic autopsy cases with experimentally reproduced, three point-bending fractures in fresh and dry human humeri. Half of the fresh experimental bones were fractured whilst applying axial compression, i.e., attempting to simulate intra vitam conditions more accurately. The results showed a similar osteonal microcracking pattern between vital fractures and experimental fractures of fresh humeri subjected to axial compression. Interestingly, this pattern was significantly different from the one observed in the experimental fractures of fresh humeri without axial compression and dry humeri. This supports our hypothesis that the osteonal microcracking pattern can potentially be used as a marker for vital perimortem trauma, providing a histomorphometric tool for fracture timing.

Microcracking pattern in fractured bones: new approach for distinguishing between peri- and postmortem fractures.

Timing bone fractures is one of the main tasks of a forensic anthropologist, but still an uncertain diagnostic. In the literature, there are many macroscopic methods to distinguish perimortem from postmortem fractures, based on the distinct structural and mechanical properties of fresh and dry bones. However, this differentiation is still challenging, in particular when the bones are fragmented or still exhibit fresh properties. Although histologic analysis is often used as a complementary diagnostic tool in forensic pathology, its application in the evaluation of bone fractures is uncommon. The aim of this study was to investigate whether fractures of fresh bones reveal a distinct microcracking pattern compared to fractures of dry bones, in order to optimise the fracture timing. To this purpose, we histologically analysed perimortem and postmortem fractures in human humeri. The fresh bones were retrieved from traumatic autopsy cases, and the dry bones from donors which were experimentally fractured. Our results showed that the highest density and length of microcracks (MCKs) were found in the interstitial area of dry fractured bones, which may be considered a marker of postmortem damage. In fresh fractured bones, we generally observed a lower density of MCKs, but a higher proportion of osteonal MCKs, which may be considered a marker of perimortem trauma. In summary, the results of our exploratory study suggest that changes in intrinsic bone factors (mineral/organic components) result in a different microcracking pattern that can be used in fracture timing.

Distinction between perimortem and postmortem fractures in human cranial bone.

Timing of cranial trauma is challenging in forensic cases and literature on the subject is scarce. This study analysed the macroscopic fracture patterns of perimortem cranial fractures and compared them to experimentally reproduced cranial fractures on dry human craniums. The results showed nine traits associated with fresh cranial fractures: undulated margin, flake defects, peels with peel defects, fissures, crushed margins, bridge, bone scales and beveling. All the traits appear on the outer table or on the inner table of the cranium. Although not all characteristics must be present at the same time in all cranial fractures, they do define a new perimortem fracture pattern. Statistical analyses showed that six of these traits (undulated margins, flake defects, crushed margins, bone scales, fissures and peels) are distinctly related with perimortem (fresh) bone conditions. Considering the most discriminant perimortem traits, a decision-making algorithm is developed as a probabilistic approach to distinguish peri- from postmortem cranial fractures with an accuracy of 87%. This algorithm allows the forensic practitioner to incorporate more confidence during cranial trauma evaluation.

Visualization and documentation of perimortem traits in long bone fractures using computed tomography.

Perimortem fracture patterns in long bones, defined in previous publications, include layered breakage, bone scales, crushed margins, flakes with flake defect, wave lines, and plastic deformation. The traits help professionals during trauma analysis to differentiate peri- from post-mortem fractures. This study will therefore investigate whether these traits can be recorded with Computed Tomography (CT) as the non-invasive 3D imaging technique is becoming more popular in forensic science. CT scans of macerated bone samples (n = 15; humerus: n = 1; ulna: n = 1; radius: n = 1; femur: n = 12) were investigated using multi-planar reconstructions (MPRs) and volume renderings. Tension lines and severe plastic deformation were visible on the individual multi-planar reconstructions (MPRs) and the 3D models. Additionally, layered breakage and flake defects were also clearly distinguishable on the volume renderings. Based on the results, CT imaging may be a useful and fast tool to document, visualize, and analyze findings of blunt force trauma.

Intra vitam trauma pattern: changing the paradigm of forensic anthropology?

This study aims to improve a previous study that reported new traits to characterize a perimortem fracture pattern in human long bones. This second study aims to acquire further knowledge about these perimortem traits, specifically by improving the experimental setting-by using a Blunt Force Trauma Simulator-and increasing the sample size with a total of 43 autopsy specimens and 57 reproduced fractures. Additionally, we investigated whether these traits could be related to muscular contractions by adding axial compression in the experimentally fractured specimens. If intra vitam traits can be found, it would consequentially be more valuable for forensic anthropologists to shorten the perimortem period. We demonstrate that all traits are perimortem traits. Furthermore, based on our results, we see the tendency that the combination of traits-instead of the presence of each trait individually-may make it possible to distinguish intra vitam from perimortem fractures. This study confirms these distinct characteristics that can be valuable to utilize in the distinction between peri- and postmortem fractures.

Perimortem fracture pattern in ribs by blunt force trauma.

Literature on timing of rib trauma is scarce but remains challenging during forensic cases. This study analysed the macroscopic fracture patterns of perimortem rib fractures and compared them to experimentally reproduced rib fractures on fresh and dry ribs. Six distinctive macroscopic traits were found in ribs that might provide information about the timing of trauma, fracture mechanism and/or trauma circumstances. These traits are peels, folds, differential fracture edges, incomplete fractures, plastic deformation and longitudinal lines. Peels, folds and plastic deformation might provide information about trauma timing. Folds and different fracture edges might provide information about the fracture mechanism. Statistical analyses showed that longitudinal lines, folds and incomplete fractures might provide information about the trauma circumstances and that age might have an influence on the occurrence of complete fractures, longitudinal lines and peels (p ≤ 0.05). The new insights presented in this study might be valuable for forensic anthropologists in rib trauma analysis.

New insights in the analysis of blunt force trauma in human bones. Preliminary results.

Determining the time of injury is an important but still a challenging task in forensic anthropology. In literature, many descriptions can be found to make a distinction between perimortem and postmortem fractures. Characteristics that are more related to fractures in fresh conditions, however, are not extensively investigated. This study compared 28 perimortem fractures from autopsies and 21 both fresh and dry experimentally reproduced human bone fractures. Preliminary results showed the following five distinct traits that might be related to perimortem conditions: layered breakage, bone scales, crushed margins, wave lines and flakes with matching flake defect. These distinct traits might not only be good estimators of perimortem trauma but also may be an indicator of trauma in intra vitam conditions, especially related with muscular reaction to injury. Furthermore, layered breakage seems to be a good trait to infer the biomechanics of trauma.