Death scene investigation and autopsy proceedings in identifying the victims of the terror attack on the Breitscheidplatz in Berlin 19th December 2016

Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model

The accurate radiological detection of skeletal trauma is crucial for the investigation of blunt force trauma (BFT) cases. The sensitivities of CTs, X-rays and Lodox in identifying BFT fractures and minimum number of impacts in pigs, used as proxies for adult humans, were assessed. Ten human sized pig carcasses were struck with a mallet and scanned, after which the number of fractures and minimum number of impacts detected radiologically were recorded. Pig carcasses were then macerated, and the defleshed, skeletonized remains were considered the gold standard as far as number and location of fractures were concerned. CTs were most sensitive in identifying fractures and impacts in all body regions, with overall sensitivities of 55.4% and 71.5% respectively, while X-rays and Lodox had sensitivities of 25.8% and 29.3% for fractures, and 43.5% and 41.1% for impacts, respectively. All modalities were highly specific for identifying fractures (CT: 99.1%; X-ray: 98.9%; Lodox: 99.4%). CTs should be used to analyze blunt force trauma when a radiological assessment is required, but an examination of the defleshed bones remains the gold standard for the deceased whenever feasible. X-rays and Lodox have limited diagnostic value in these cases and relying on them to detect fractures may compromise the accurate forensic investigation of blunt trauma victims. However, the use of Lodox for initial screening of major trauma is still of value. Sensitivities are generally higher for detecting fractures in pigs compared to piglets, indicating that increased diagnostic value is achieved when imaging pigs compared to piglets.

Casper's sign in the elderly

Casper's sign refers to the absence of external signs of trauma despite severe and often lethal internal injuries. It occurs because the elasticity and resilience of the skin results in it deforming and moving rather than sustaining injuries from being tethered and relatively immobile. Given the known increase in skin and soft-tissue fragility in the elderly with a greater vulnerability for bruising and skin tears, a study was undertaken to determine whether Casper's sign may be present or not in older populations. A review of autopsy files at Forensic Science SA over a 20-year period from January 2000 to December 2019 was performed in individuals ≥80 years of age where death involved blunt chest trauma, blunt abdominal trauma or multiple blunt-force injuries. Four cases were identified. All of the decedents were males aged 82-89 years (Mage=86 years) with deaths associated with a fall (n=1) and vehicle impacts (n=3). Despite significant and often lethal internal chest/abdominal injuries, none of the cases had external injuries to their torsos. Thus, as Casper's sign may be present at all ages, the absence of external injury in the elderly may be no reflection of the force of the impact or the degree of resultant skeletal and/or internal organ disruption. This may be pertinent in cases of elder abuse.