Development of age-estimation formula using postmortem oral findings: A pilot study

The goal of this pilot study was to develop an age-estimation formula and assess its effectiveness after evaluating individual intraoral findings. A total of 198 Japanese adults were included, and intraoral findings were collected from the corpses. To analyze the condition of each tooth, 20 items were established for intraoral findings, and seven tooth states were established. Logistic regression analysis was used to estimate the impact of age on each intraoral finding. Sequentially, linear regression was applied to verify the correlation between age and type of tooth, and multiple regression was used to correlate age-dependent factors. The intraoral findings with age dependency were tooth stump, edentulous jaw, attrition, no caries, dental prostheses, partial dentures, and complete dentures. Tooth stump, attrition, and dental prostheses showed positive multicollinearity. Missing tooth, extant tooth, normal teeth, and untreated lost teeth were age-correlated. Multiple regression analysis included age as the response variable and five factors as the explanatory variables in a new age-estimation formula, resulting in ± 10 years for 86.96% of cases (60-69 years old), 76.47% (70-79 years old), and 61.05% of all cases. The multiple correlation was 0.551, and the contribution rate of the multiple regression formula was 0.304. The accuracy of the proposed age-estimation formula was within ± 10 years for 61.05% of all subjects. However, the accuracy of age estimation in subjects aged 60-79 years was excellent (76.47-86.96%), which showed that this age-estimation formula would be effective for estimating the age of middle-aged to older subjects.

Case report: clinical and postmortem findings in four cows with rib fracture

Background

Published reports of rib fractures in adult cattle are limited to the occurrence of chronic rib swellings caused by calluses, which are unremarkable from a clinical standpoint, whereas studies identifying clinical signs of rib fractures were not found in a literature search. This report describes the clinical and postmortem findings in four cows with rib fractures.

Case presentation

The 13th rib was fractured in three cows and the 11th rib in the remaining cow; three fractures were on the right and one on the left side. Clinical and postmortem findings varied considerably, and percussion of the rib cage elicited a pain response in only one cow. One cow had generalised peritonitis because of perforation of the rumen by the fractured rib. One cow was recumbent because of pain and became a downer cow, and two other cows had bronchopneumonia, which was a sequel to osteomyelitis of the fracture site in one. In the absence of a history of trauma, the diagnosis of rib fracture based on clinical signs alone is difficult.

Conclusions

Although rib fractures undoubtedly are very painful, the four cases described in this report suggest that they are difficult to diagnose in cattle because associated clinical signs are nonspecific.

Discrepancies Between Clinical Diagnoses and Autopsy Findings in Critically Ill Children: A Prospective Study

OBJECTIVES

To evaluate the discrepancies between clinical and autopsy diagnoses in patients who died in the pediatric intensive care units (PICUs) of a tertiary care university hospital.

METHODS

A prospective study of all consecutive autopsies discussed at monthly mortality conferences over 5 years. Discrepancies between premortem and autopsy diagnoses were classified according to modified Goldman et al criteria.

RESULTS

From January 1, 2011, to December 31, 2015, a total of 2,679 children were admitted to the two PICUs of our hospital; 257 (9.6%) died, 150 (58.4%) underwent autopsy, and 123 were included. Complete concordance between clinical and postmortem diagnoses was observed in 86 (69.9%) patients; 20 (16.3%) had a class I discrepancy, and eight (6.5%) had a class II discrepancy. Comparing 2011 and 2015, the rate of major discrepancies decreased from 31.6% to 15%.

CONCLUSIONS

Our results emphasize the importance of autopsy to clarify the cause of death and its potential contribution to improvement of team performance and quality of care.