Characterization of fatal blunt injuries using postmortem computed tomography

The Role of Autopsy in Diagnosing Fatal Chest Injuries in Road Traffic Accidents: A Literature Review

Road accidents are one of the leading causes of death worldwide, with significant repercussions on public health and the global economy. Fatal accidents can cause injuries in various anatomical areas with different dynamics. The thorax is one of the main sites involved in fatal accidents, due to the presence of vital organs such as the heart and lungs. Protective devices, such as seatbelts and airbags, also play a fundamental role in preventing chest injuries. However, external examination is often insufficient to determine the extent of internal trauma, resulting in significant difficulties in reconstructing the accident dynamics. In particular, in the absence of an autopsy, it is difficult to determine whether the driver or passengers were wearing protective devices, such as seatbelts, at the time of the accident. Diagnosing injuries secondary to protective devices, such as airbags, can also be complex without this assessment. Through a review of the literature, this work analyzes the different types of thoracic trauma that can be found at autopsy, providing indications to the forensic pathologist for the examination of these injuries. This review highlights the importance of the autopsy examination as a gold-standard investigation in the analysis of thoracic trauma from road accidents, in order to evaluate with certainty the injuries that caused death, and to facilitate the reconstruction of the dynamics for judicial purposes. Finally, an analysis of postmortem radiological investigations and of the role of protective measures in these events, such as the seatbelt and airbag, is provided.

[Blunt force trauma in forensic radiology]

OBJECTIVE

Description of the main forensic radiological examination modalities and findings in blunt force trauma in living and deceased adults.

METHODS

Elaboration of the essential points based on the authors' own experiences and relevant literature.

RESULTS AND CONCLUSION

Injury-related consequences of blunt force are frequently observed in forensic radiological diagnostics, especially in the context of accidents and suicides, and less frequently in homicides. The method of choice for radiological imaging of blunt force in deceased persons is native postmortem computed tomography (PMCT). In principle, the radiological effects of blunt force in PMCT do not differ significantly from those in living persons. Postmortem magnetic resonance imaging (PMMRI) is very suitable for imaging blunt soft tissue injuries in the shorter postmortem interval. In the case of living individuals with the consequences of blunt force trauma, imaging is primarily indicated for clinical diagnostic reasons. Common indications are domestic violence, violence against the elderly, and disputes in public spaces. The choice of radiological examination method depends on the clinical history and symptoms, and the radiological examinations can be subjected to a forensic assessment.

The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study

BACKGROUND

Trauma related deaths remain a relevant public health problem, in particular in the younger male population. A significant number of these deaths occur prehospitally without transfer to a hospital. These patients, sometimes termed "the forgotten cohort", are usually not included in clinical registries, resulting in a lack of information about prehospitally trauma deaths. The aim of the present study was to compare patients who died prehospital with those who sustained life-threatening injuries in order to analyze and potentially improve prehospital strategies.

METHODS

This cohort study included all primary operations carried out by Switzerland's largest helicopter emergency medical service (HEMS) between January 1, 2011, and December 31, 2021. We included all adult trauma patients with life-threatening or fatal conditions. The outcome of this study is the vital status of the patient at the end of mission, i.e. fatal or life-threatening. Injury, rescue characteristics, and interventions of the forgotten trauma cohort, defined as patients with a fatal injury (NACA score of VII), were compared with life-threatening injuries (NACA score V and VI).

RESULTS

Of 110,331 HEMS missions, 5534 primary operations were finally analyzed, including 5191 (93.8%) life-threatening and 343 (6.2%) fatal injuries. More than two-thirds of patients (n = 3772, 68.2%) had a traumatic brain injury without a significant difference between the two groups (p > 0.05). Thoracic trauma (44.6% vs. 28.7%, p < 0.001) and abdominal trauma (22.2% vs. 16.1%, p = 0.004) were more frequent in fatal missions whereas pelvic trauma was similar between the two groups (13.4% vs. 12.9%, p = 0.788). Pneumothorax decompression rate (17.2% vs. 3.7%, p < 0.001) was higher in the forgotten cohort group and measures for bleeding control (15.2% vs. 42.7%, p < 0.001) and pelvic belt application (2.9% vs. 13.1% p < 0.001) were more common in the life-threating injury group.

CONCLUSION

Chest decompression rates and measures for early hemorrhage control are areas for potential improvement in prehospital care.