Forensic considerations of missed diagnoses in trauma deaths

Sharma, B.R.; Gupta, Manisha; Bangar, Sumedha; Singh, Virender Pal

doi:10.1016/j.jcfm.2006.02.027

Cited by 22 publications

(16 citation statements)

References 42 publications

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“…Autopsy as a tool for evaluation of trauma Autopsy as a tool for evaluation of trauma Autopsy as a tool for evaluation of trauma Autopsy as a tool for evaluation of trauma Autopsy as a tool for evaluation of trauma Studies of trauma cases through autopsy represent a valuable tool for a noble review, quality control and, finally, a better clinical management of these patients 2,3 . Woks have shown that a significant number of lesions not initially localized is detected only at autopsy, with data ranging from 11 to 22% 4,5 . Not only the diagnosed lesions, but also the severity of trauma, evaluated by the Injury Severity Scale (ISS), are different when the autopsy data are compared with clinical findings 3,6 .…”

Section: Results Resultsmentioning

confidence: 99%

Lesões fatais em trauma numa grande metrópole Brasileira: um estudo de autópsias

Wilson

Herbella

Takassi

et al. 2011

Rev. Col. Bras. Cir.

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Section: Results Resultsmentioning

confidence: 99%

Lesões fatais em trauma numa grande metrópole Brasileira: um estudo de autópsias

Wilson

Herbella

Takassi

et al. 2011

Rev. Col. Bras. Cir.

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“…The most frequently omitted craniocerebral lesions are, according to Sharma BR et al: subdural hematoma (11,70%), epidural hematoma (3,19%), cerebral dilaceration (8,51%) and diffuse axonal lesion (5,32%) [47].…”

Section: Resultsmentioning

confidence: 99%

Clinical diagnosis versus autopsy diagnosis in head trauma

Velnic¹,

Hanganu²,

Ciudin³

et al. 2017

Romanian Neurosurgery

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Abstract:The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1) to total discordance (C4) and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis-missing injuries in the autopsy reports) and C3 (partial discordance in favor of the necroptic diagnosis-missing injuries in the medical files). Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral hematoma and ventricular hemorrhage (21.6%). In C3 cases the most frequently omitted injuries were subarachnoidian hemorrhage and skull base fractures autopsy diagnosis. Autopsy may identify the inconsistencies in diagnosis, the injuries frequently skipped and the factors favoring the discordance rate between the clinical death diagnosis and the autopsy diagnosis, making it a valuable tool for improving the clinical care of the patients with head trauma.

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“…21 According to previous studies the accuracy of the cause of death as recorded on death certificates has been analyzed in trauma deaths resulting in a frequency of unrecognized injuries of 11% of all cases. 22 However, in the literature the percentage of missed injuries discovered at autopsy after traumatic death can be higher than that, going up to 68%. 23e25 Minor as well as severe missed injuries can be often discovered at autopsy.…”

Section: Discussionmentioning

confidence: 97%

Undetected patricide: Inaccuracy of cause of death determination without an autopsy

Campobasso

Laviola

Grattagliano

et al. 2015

Journal of Forensic and Legal Medicine

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Patricide (killing the father) is uncommon form of homicide. Usually the assaults occur at home in the absence of witnesses and adult sons are frequently involved. Homicides in a domestic context usually do not tend to recurrence, because the motivation for the crime ends with the death of the parent. However, this is not what was observed in the present case study dealing with the death of a 70 years old white man originally misclassified as accident and discovered three years later only after an additional homicide in a family context of a 60 years old white lady. Multiple stab wounds to the neck and thorax were misinterpreted at the external male body examination as blunt trauma falling down stairs. No forensic autopsy was requested and no comparison of medical findings with the results from the death scene, such as a bloodstain analysis was performed by the police officers nor required by the judicial authority. This was quite surprising because an additional but preliminary post-mortem external examination performed by a general practitioner on the male body already raised the suspicion that the external lesions were stab wounds thus requiring a forensic autopsy. Only the exhumation of the elderly body, performed years later, confirmed the diagnostic hypothesis raised by the first physician. The present case is quite representative of a death investigation not run professionally and performed by individuals with no specific training where most of the medico-legal investigations (especially for traumatic and violent deaths) are restricted to an external body examination without subsequent autopsy. Although misinterpretation of external lesions is inevitable and significant discrepancies between external body examination and forensic autopsy are not rare, in the case of contradictory results of post-mortem external examination or unclear/suspicious cause and manner of death, investigation should proceed necessarily with a forensic autopsy.

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Forensic considerations of missed diagnoses in trauma deaths

Cited by 22 publications

References 42 publications

Lesões fatais em trauma numa grande metrópole Brasileira: um estudo de autópsias

Lesões fatais em trauma numa grande metrópole Brasileira: um estudo de autópsias

Clinical diagnosis versus autopsy diagnosis in head trauma

Undetected patricide: Inaccuracy of cause of death determination without an autopsy

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