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Abbreviated injury scale scoring in traffic fatalities: comparison of computerized tomography and autopsy.

https://arctichealth.org/en/permalink/ahliterature146834
Source
J Trauma. 2010 Jun;68(6):1413-6
Publication Type
Article
Date
Jun-2010
Author
Peter Mygind Leth
Marlene Ibsen
Author Affiliation
Institute of Forensic Medicine, University of Southern Denmark, Odense, Denmark. pleth@health.sdu.dk
Source
J Trauma. 2010 Jun;68(6):1413-6
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Abbreviated Injury Scale
Accidents, Traffic - mortality
Autopsy
Denmark - epidemiology
Female
Forensic Medicine
Humans
Male
Prospective Studies
Reproducibility of Results
Tomography, X-Ray Computed
Wounds and Injuries - epidemiology - radiography
Abstract
The purpose of this investigation is to evaluate the value of postmortem computerized tomography (CT) for Abbreviated Injury Scale (AIS) scoring and Injury Severity Scoring (ISS) of traffic fatalities.
This is a prospective investigation of a consecutive series of 52 traffic fatalities from Southern Denmark that were CT scanned and autopsied. The AIS and ISS scores based on CT and autopsy (AU) were registered in a computer database and compared. Kappa values for reproducibility of AIS-severity scores and ISS scores were calculated.
On an average, there was a 94% agreement between AU and CT in detecting the presence or absence of lesions in the various anatomic regions, and the severity scores were the same in 90% of all cases (range, 75-100%). When different severity scoring was obtained, CT detected more lesions with a high severity score in the facial skeleton, pelvis, and extremities, whereas AU detected more lesions with high scores in the soft tissues (especially in the aorta), cranium, and ribs. The kappa value for reproducibility of AIS scores confirmed that the agreement between the two methods was good. The lowest kappa values (>0.6) were found for the facial skeleton, cerebellum, meninges, neck organs, lungs, kidneys, and gastrointestinal tract. In these areas, the kappa value provided moderate agreement between CT and AU. For all other areas, there was a substantial agreement between the two methods. The ISS scores obtained by CT and by AU were calculated and were found to be with no or moderate variation in 85%. Rupture of the aorta was often overlooked by CT, resulting in too low ISS scoring.
The most precise postmortem AIS and ISS scorings of traffic fatalities was obtained by a combination of AU and CT. If it is not possible to perform an AU, then CT may be used as an acceptable alternative for AIS scoring. We have identified one important obstacle for postmortem ISS scoring, namely that aorta ruptures are not easily detected by post mortem CT.
PubMed ID
19996793 View in PubMed
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Computerized tomography used as a routine procedure at postmortem investigations.

https://arctichealth.org/en/permalink/ahliterature149005
Source
Am J Forensic Med Pathol. 2009 Sep;30(3):219-22
Publication Type
Article
Date
Sep-2009
Author
Peter Mygind Leth
Author Affiliation
Department of Forensic Pathology, Institute of Forensic Medicine, University of Southern Denmark, Odense, Denmark. pleth@health.sdu.dk
Source
Am J Forensic Med Pathol. 2009 Sep;30(3):219-22
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - mortality
Adolescent
Adult
Aged
Aged, 80 and over
Autopsy
Cause of Death
Child
Child, Preschool
Denmark
Female
Forensic Dentistry
Forensic Pathology - methods
Humans
Infant
Infant, Newborn
Male
Microscopy
Middle Aged
Prospective Studies
Tomography, X-Ray Computed
Wounds and Injuries - mortality - pathology
Young Adult
Abstract
This is a prospective investigation of a consecutive series of 250 deceased individuals who were computerized tomography (CT)-scanned and autopsied. In 13% of patients, important findings at the CT-scanning were not found at the autopsy, and in 48% of patients, important autopsy findings were not found at the CT-scanning. The cause of death could be established by CT in 31%, by autopsy in 74%, and by toxicology in 22%. CT combined with data from the inquest could establish the cause of death in a majority of deaths due to severe trauma, but only in a minority of deaths caused by disease or poisoning. We found the Siemens Somatom Spirit dual-slice CT-scanner cost effective, quick, and well suited as a supplement to the routine autopsy. CT is useful in identifications, gunshot lesions, and traffic accidents. CT allows investigation of anatomic regions that are not easily available by autopsy and allows fractures and inner organs to be seen "in situ." CT provides documentation in digital form - easily stored - permits review by others and provides pictures that may be more suitable for presentation in court than autopsy photos.
PubMed ID
19696574 View in PubMed
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Forensic medical examination of refugees who claim to have been tortured.

https://arctichealth.org/en/permalink/ahliterature74891
Source
Am J Forensic Med Pathol. 2005 Jun;26(2):125-30
Publication Type
Article
Date
Jun-2005
Author
Peter Mygind Leth
Jytte Banner
Author Affiliation
Institute of Forensic Medicine, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. pleth@health.sdu.dk
Source
Am J Forensic Med Pathol. 2005 Jun;26(2):125-30
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Adult
Asia, Western - ethnology
Cicatrix - pathology
Denmark - epidemiology
Ecchymosis - pathology
Foot Injuries - pathology
Forensic Medicine
Hematoma - pathology
Humans
Joints - injuries
Male
Medical History Taking
Middle Aged
Pain - epidemiology
Peripheral Nerves - injuries
Physical Examination
Prisoners - psychology
Refugees - psychology
Skin - injuries - pathology
Stress Disorders, Post-Traumatic - epidemiology
Tooth Injuries - pathology
Torture - psychology - statistics & numerical data
Walking - physiology
Yugoslavia - ethnology
Abstract
The United Nations Convention against torture prohibits repatriation of refugees if there is reason to believe they will be tortured on return to their country. A history of torture is therefore an important factor in making a case for asylum. In this study, the results of the medical examinations of 59 torture victims investigated at the Department of Forensic Medicine, University of Aarhus, Denmark, 1996-2002, are presented and discussed. Variables including age, sex, education, health, torture methods, condition of confinement, torture aftereffects, and findings at the forensic examination were registered in a database (Paradox) and analyzed. In 70%, aftereffects of torture could be documented. These included scars after fixation, burns, incisions, or flogging. Symptoms and signs from joints, muscles, and nerves were common in victims who had been suspended. Many of the victims of phalanga had painful feet and signs of walking impairment. A majority of the victims suffered from posttraumatic stress syndrome. An independent medical report offers an opportunity to evaluate and elaborate the story told by the victim and should be used in disputed cases. We have a duty to protect refugees against torture.
PubMed ID
15894844 View in PubMed
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