Pub Date : 2024-03-18DOI: 10.1097/PAF.0000000000000932
Jane E Persons, Stephanie Stauffer
Abstract: Cervical spine manipulation is a known risk factor for vertebral artery dissection. In this report, we present a case of fatal vertebral artery dissection that occurred as the result of self-manipulation of the cervical spine. The decedent was a 40-year-old man with no significant past medical history. He was observed to "crack his neck" while at work. Soon after, he began experiencing neck pain, then developed strokelike symptoms and became unresponsive. He was transported to a local medical center, where imaging showed bilateral vertebral artery dissection. His neurological status continued to decline, and brain death was pronounced several days later. An autopsy examination showed evidence of cerebellar and brainstem infarcts, herniation, and diffuse hypoxic-ischemic injury. A posterior neck dissection was performed to expose the vertebral arteries, which showed grossly visible hemorrhage and dilation. There was no evidence of traumatic injury to the bone or soft tissue of the head or neck. Bilateral dissection tracts were readily appreciated on microscopic examination. Death was attributed to self-manipulation of the neck, which in turn led to bilateral vertebral artery dissection, cerebellar and brainstem infarcts, herniation, hypoxic-ischemic injury, and ultimately brain death.
{"title":"Fatal Vertebral Artery Dissection Following Self-Manipulation of the Cervical Spine.","authors":"Jane E Persons, Stephanie Stauffer","doi":"10.1097/PAF.0000000000000932","DOIUrl":"https://doi.org/10.1097/PAF.0000000000000932","url":null,"abstract":"<p><strong>Abstract: </strong>Cervical spine manipulation is a known risk factor for vertebral artery dissection. In this report, we present a case of fatal vertebral artery dissection that occurred as the result of self-manipulation of the cervical spine. The decedent was a 40-year-old man with no significant past medical history. He was observed to \"crack his neck\" while at work. Soon after, he began experiencing neck pain, then developed strokelike symptoms and became unresponsive. He was transported to a local medical center, where imaging showed bilateral vertebral artery dissection. His neurological status continued to decline, and brain death was pronounced several days later. An autopsy examination showed evidence of cerebellar and brainstem infarcts, herniation, and diffuse hypoxic-ischemic injury. A posterior neck dissection was performed to expose the vertebral arteries, which showed grossly visible hemorrhage and dilation. There was no evidence of traumatic injury to the bone or soft tissue of the head or neck. Bilateral dissection tracts were readily appreciated on microscopic examination. Death was attributed to self-manipulation of the neck, which in turn led to bilateral vertebral artery dissection, cerebellar and brainstem infarcts, herniation, hypoxic-ischemic injury, and ultimately brain death.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1097/PAF.0000000000000933
Hannah Cutshall, Murat Gokden
Abstract: Lipid emulsion therapy (LET) is the intravenous administration of lipid solution for parenteral alimentation, especially in preterm infants and adults with debilitating illnesses. It has also been used in attempts of detoxification in suspected cases of drug overdose. Whether this interferes with circulation and/or perfusion is debatable, and it is suggested that it may interfere with coagulation process. The emulsifying agent has been identified microscopically mainly in the lungs of these patients, with rare reports in adults and even more rare ones in the brain; however, although it is rarely reported in other organs, to our knowledge, no reports of gross autopsy findings in the brain are available in the English literature, nor are there reports of pathologic findings after lipid emulsion therapy administration for drug toxicity. Although it is also debated in the literature whether this material forms as an artifact or represents the actual agent, here we report the gross and microscopic autopsy findings in the brain of a patient who received LET for suspected beta-blocker intoxication. It will be beneficial for pathologists who perform autopsies in the forensic or medical settings to be aware of these findings, along with the uses and potential complications of LET.
摘要:脂质乳剂疗法(LET)是一种静脉注射脂质溶液的肠外营养疗法,尤其适用于早产儿和患有衰弱疾病的成人。脂质乳剂疗法还被用于疑似药物过量病例的解毒尝试。这是否会干扰血液循环和/或灌注还有待商榷,有人认为它可能会干扰凝血过程。从显微镜下看,乳化剂主要存在于这些患者的肺部,成人很少见,脑部更少见;不过,虽然其他器官也很少见,但据我们所知,英文文献中没有关于脑部大体解剖结果的报道,也没有关于药物中毒使用脂质乳剂治疗后病理结果的报道。虽然文献中对这种物质是作为人工制品还是代表真正的药剂还存在争议,但我们在此报告了一名因疑似β-受体阻滞剂中毒而接受 LET 治疗的患者脑部的大体和显微尸检结果。对于在法医或医疗机构进行尸检的病理学家来说,了解这些发现以及 LET 的用途和潜在并发症将大有裨益。
{"title":"Brain Autopsy Findings in a Patient Who Received Lipid Emulsion Therapy for Suspected Drug Intoxication.","authors":"Hannah Cutshall, Murat Gokden","doi":"10.1097/PAF.0000000000000933","DOIUrl":"https://doi.org/10.1097/PAF.0000000000000933","url":null,"abstract":"<p><strong>Abstract: </strong>Lipid emulsion therapy (LET) is the intravenous administration of lipid solution for parenteral alimentation, especially in preterm infants and adults with debilitating illnesses. It has also been used in attempts of detoxification in suspected cases of drug overdose. Whether this interferes with circulation and/or perfusion is debatable, and it is suggested that it may interfere with coagulation process. The emulsifying agent has been identified microscopically mainly in the lungs of these patients, with rare reports in adults and even more rare ones in the brain; however, although it is rarely reported in other organs, to our knowledge, no reports of gross autopsy findings in the brain are available in the English literature, nor are there reports of pathologic findings after lipid emulsion therapy administration for drug toxicity. Although it is also debated in the literature whether this material forms as an artifact or represents the actual agent, here we report the gross and microscopic autopsy findings in the brain of a patient who received LET for suspected beta-blocker intoxication. It will be beneficial for pathologists who perform autopsies in the forensic or medical settings to be aware of these findings, along with the uses and potential complications of LET.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-05DOI: 10.1097/PAF.0000000000000926
Roger W Byard
{"title":"Unsafe Cribs Remain an Issue.","authors":"Roger W Byard","doi":"10.1097/PAF.0000000000000926","DOIUrl":"https://doi.org/10.1097/PAF.0000000000000926","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2023-08-30DOI: 10.1097/PAF.0000000000000860
Thomas Auen, Erin Linde
Abstract: Vascular involvement in tuberous sclerosis complex (TSC) is uncommon and even more so in pediatric patients. When asymptomatic, these vascular abnormalities carry increased risk of rupture with increased morbidity and mortality. Here, we describe a case of a ruptured unrecognized abdominal aortic aneurysm in an 11-month-old patient with a history of TSC. The abdominal aortic aneurysm was discovered at autopsy and highlights the rarity of abdominal aortic aneurysm in pediatric patients diagnosed with TSC and the importance of screening for associated aneurysmal disease in the pediatric population with TSC. Furthermore, the extensive retroperitoneal hemorrhage seen in this case also highlights a rare but potential mimic of abuse in the pediatric population.
{"title":"An Autopsy Case of Abdominal Aortic Aneurysm in a Pediatric Decedent With Tuberous Sclerosis Complex.","authors":"Thomas Auen, Erin Linde","doi":"10.1097/PAF.0000000000000860","DOIUrl":"10.1097/PAF.0000000000000860","url":null,"abstract":"<p><strong>Abstract: </strong>Vascular involvement in tuberous sclerosis complex (TSC) is uncommon and even more so in pediatric patients. When asymptomatic, these vascular abnormalities carry increased risk of rupture with increased morbidity and mortality. Here, we describe a case of a ruptured unrecognized abdominal aortic aneurysm in an 11-month-old patient with a history of TSC. The abdominal aortic aneurysm was discovered at autopsy and highlights the rarity of abdominal aortic aneurysm in pediatric patients diagnosed with TSC and the importance of screening for associated aneurysmal disease in the pediatric population with TSC. Furthermore, the extensive retroperitoneal hemorrhage seen in this case also highlights a rare but potential mimic of abuse in the pediatric population.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2023-11-25DOI: 10.1097/PAF.0000000000000890
Hadi Sasani, Yasin Etli, Burak Tastekin, Yavuz Hekimoglu, Siddik Keskin, Mahmut Asirdizer
Abstract: Previous studies on the sexual dimorphism of the mastoid triangle have typically focused on linear and area measurements. No studies in the literature have used mastoid air cell system volume measurements for direct anthropological or forensic sex determination. The aims of this study were to investigate the applicability of mastoid air cell system volume measurements and mastoid triangle measurements separately and combined for sex estimation, and to determine the accuracy of sex estimation rates using machine learning algorithms and discriminant function analysis of these data. On 200 computed tomography images, the distances constituting the edges of the mastoid triangle were measured, and the area was calculated using these measurements. A region-growing algorithm was used to determine the volume of the mastoid air cell system. The univariate sex determination accuracy was calculated for all parameters. Stepwise discriminant function analysis was performed for sex estimation. Multiple machine learning methods have also been used. All measurements of the mastoid triangle and volumes of the mastoid air cell system were higher in males than in females. The accurate sex estimation rate was determined to be 79.5% using stepwise discriminant function analysis and 88.5% using machine learning methods.
{"title":"Sex Estimation From Measurements of the Mastoid Triangle and Volume of the Mastoid Air Cell System Using Classical and Machine Learning Methods: A Comparative Analysis.","authors":"Hadi Sasani, Yasin Etli, Burak Tastekin, Yavuz Hekimoglu, Siddik Keskin, Mahmut Asirdizer","doi":"10.1097/PAF.0000000000000890","DOIUrl":"10.1097/PAF.0000000000000890","url":null,"abstract":"<p><strong>Abstract: </strong>Previous studies on the sexual dimorphism of the mastoid triangle have typically focused on linear and area measurements. No studies in the literature have used mastoid air cell system volume measurements for direct anthropological or forensic sex determination. The aims of this study were to investigate the applicability of mastoid air cell system volume measurements and mastoid triangle measurements separately and combined for sex estimation, and to determine the accuracy of sex estimation rates using machine learning algorithms and discriminant function analysis of these data. On 200 computed tomography images, the distances constituting the edges of the mastoid triangle were measured, and the area was calculated using these measurements. A region-growing algorithm was used to determine the volume of the mastoid air cell system. The univariate sex determination accuracy was calculated for all parameters. Stepwise discriminant function analysis was performed for sex estimation. Multiple machine learning methods have also been used. All measurements of the mastoid triangle and volumes of the mastoid air cell system were higher in males than in females. The accurate sex estimation rate was determined to be 79.5% using stepwise discriminant function analysis and 88.5% using machine learning methods.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2023-09-27DOI: 10.1097/PAF.0000000000000887
Sherri L Kacinko, Daniel S Isenschmid, Barry K Logan
{"title":"Are Postmortem Cannabinoid Concentrations Forensically Reliable?","authors":"Sherri L Kacinko, Daniel S Isenschmid, Barry K Logan","doi":"10.1097/PAF.0000000000000887","DOIUrl":"10.1097/PAF.0000000000000887","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41168166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2023-08-14DOI: 10.1097/PAF.0000000000000877
Mark W Kroll, Stacey L Hail, Michael A Brave
Abstract: Spit hoods are used by law enforcement, officers in correctional facilities, and medical personnel during the restraint of agitated subjects that are actively spitting to prevent the transmission of droplet-transmitted pathogens. We could find no studies reporting on the time course of normal breathing to clear saliva from such a saturated spit hood. We purchased samples of 3 popular spit hood models and applied a section over the output of a pneumatic test system. We used a digital anemometer, digital manometer, and an inline controllable fan for back pressure and flow. The pressure was 3 mm Hg to match quiet breathing. The tested area was saturated with artificial saliva, and air pressure was applied while we recorded the pressure and airflow. Within 5 seconds, the spit hoods all cleared sufficient artificial saliva to allow 1 m/s of airflow, which exceeds that of an N95 mask with similar pressure. Commonly used spit hoods offer very low resistance to breathing even after being initially saturated with artificial saliva. Our results do not support the hypothesis that a saliva-filled spit hood might contribute to death.
{"title":"Do Saliva-Saturated Spit Hoods Interfere With Ventilation?","authors":"Mark W Kroll, Stacey L Hail, Michael A Brave","doi":"10.1097/PAF.0000000000000877","DOIUrl":"10.1097/PAF.0000000000000877","url":null,"abstract":"<p><strong>Abstract: </strong>Spit hoods are used by law enforcement, officers in correctional facilities, and medical personnel during the restraint of agitated subjects that are actively spitting to prevent the transmission of droplet-transmitted pathogens. We could find no studies reporting on the time course of normal breathing to clear saliva from such a saturated spit hood. We purchased samples of 3 popular spit hood models and applied a section over the output of a pneumatic test system. We used a digital anemometer, digital manometer, and an inline controllable fan for back pressure and flow. The pressure was 3 mm Hg to match quiet breathing. The tested area was saturated with artificial saliva, and air pressure was applied while we recorded the pressure and airflow. Within 5 seconds, the spit hoods all cleared sufficient artificial saliva to allow 1 m/s of airflow, which exceeds that of an N95 mask with similar pressure. Commonly used spit hoods offer very low resistance to breathing even after being initially saturated with artificial saliva. Our results do not support the hypothesis that a saliva-filled spit hood might contribute to death.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10005526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2023-12-21DOI: 10.1097/PAF.0000000000000900
Atthasit Dul-Amnuay
Abstract: Thailand began offering the coronavirus disease 2019 (COVID-19) vaccine nationwide in February 2021, with 1,885 deaths reported by the end of the year. Therefore, it is essential to assess the correlation between vaccination and cause of death from autopsy. This study included 34 autopsies of a deceased within 30 days after COVID-19 vaccination performed in Bangkok under the postmortem inquest service area of Bhumibol Adulyadej Hospital. The autopsies were performed by forensic pathologists. Moreover, detailed information about the deceased was collected, including age, sex, medical records, vaccination history, scene investigation reports, autopsy reports, cause of death, and a probable causal relationship between vaccination and cause of death. There were 24 males (70.59%), and the average age of the deceased was 52.76 years. Of all individuals, 28 (82.36%), 4 (11.76%), and 2 (5.88%) were vaccinated with AstraZeneca, Sinopharm, and SinoVac, respectively. The most common cause of death was ischemic heart disease (n = 17). None of the deceased patients had a causal relationship to the vaccine. Deaths were due to natural causes, as no definitive link between vaccination and cause of death was established in the study.
{"title":"Case Study of Autopsy Findings in a Population of Post-COVID-19 Vaccination in Thailand.","authors":"Atthasit Dul-Amnuay","doi":"10.1097/PAF.0000000000000900","DOIUrl":"10.1097/PAF.0000000000000900","url":null,"abstract":"<p><strong>Abstract: </strong>Thailand began offering the coronavirus disease 2019 (COVID-19) vaccine nationwide in February 2021, with 1,885 deaths reported by the end of the year. Therefore, it is essential to assess the correlation between vaccination and cause of death from autopsy. This study included 34 autopsies of a deceased within 30 days after COVID-19 vaccination performed in Bangkok under the postmortem inquest service area of Bhumibol Adulyadej Hospital. The autopsies were performed by forensic pathologists. Moreover, detailed information about the deceased was collected, including age, sex, medical records, vaccination history, scene investigation reports, autopsy reports, cause of death, and a probable causal relationship between vaccination and cause of death. There were 24 males (70.59%), and the average age of the deceased was 52.76 years. Of all individuals, 28 (82.36%), 4 (11.76%), and 2 (5.88%) were vaccinated with AstraZeneca, Sinopharm, and SinoVac, respectively. The most common cause of death was ischemic heart disease (n = 17). None of the deceased patients had a causal relationship to the vaccine. Deaths were due to natural causes, as no definitive link between vaccination and cause of death was established in the study.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2023-08-14DOI: 10.1097/PAF.0000000000000876
Devendra Jadav
{"title":"Factors Influencing the Pattern of Injuries in Falls From Height.","authors":"Devendra Jadav","doi":"10.1097/PAF.0000000000000876","DOIUrl":"10.1097/PAF.0000000000000876","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10416043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2024-01-11DOI: 10.1097/PAF.0000000000000911
James R Gill, Erik Christensen, Emily H Dennison, Susan F Ely, Thomas Gilson, Kelly Keyes, Kelly Lear, Jonathan Lucas, Tara J Mahar, Reade Quinton
Abstract: Pediatric deaths that occur because of environmental neglect often involve 4 common scenarios: (1) hyperthermia due to environmental exposure, (2) ingestion of an accessible drug or poison, (3) unwitnessed/unsupervised drownings, and (4) unsafe sleep practices. Given the same fact pattern, the manner of death will vary from accident to homicide to undetermined based on local custom and/or the certifier's training and experience. Medical examiner/coroner death certifications are administrative public health determinations made for vital statistical purposes. Because the manner of death is an opinion, it is understandable that manner determinations may vary among practitioners. No prosecutor, judge, or jury is bound by the opinions expressed on the death certificate. This position paper does not dictate how these deaths should be certified. Rather, it describes the challenges of the investigations and manner determinations in these deaths. It provides specific criteria that may improve consistency of certification. Because pediatric deaths often are of public interest, this paper provides the medical examiner/coroner with a professional overview of such manner determination issues to assist various stakeholders in understanding these challenges and variations.
{"title":"The National Association of Medical Examiners Position Paper on the Investigation and Certification of Pediatric Deaths From Environmental Neglect.","authors":"James R Gill, Erik Christensen, Emily H Dennison, Susan F Ely, Thomas Gilson, Kelly Keyes, Kelly Lear, Jonathan Lucas, Tara J Mahar, Reade Quinton","doi":"10.1097/PAF.0000000000000911","DOIUrl":"10.1097/PAF.0000000000000911","url":null,"abstract":"<p><strong>Abstract: </strong>Pediatric deaths that occur because of environmental neglect often involve 4 common scenarios: (1) hyperthermia due to environmental exposure, (2) ingestion of an accessible drug or poison, (3) unwitnessed/unsupervised drownings, and (4) unsafe sleep practices. Given the same fact pattern, the manner of death will vary from accident to homicide to undetermined based on local custom and/or the certifier's training and experience. Medical examiner/coroner death certifications are administrative public health determinations made for vital statistical purposes. Because the manner of death is an opinion, it is understandable that manner determinations may vary among practitioners. No prosecutor, judge, or jury is bound by the opinions expressed on the death certificate. This position paper does not dictate how these deaths should be certified. Rather, it describes the challenges of the investigations and manner determinations in these deaths. It provides specific criteria that may improve consistency of certification. Because pediatric deaths often are of public interest, this paper provides the medical examiner/coroner with a professional overview of such manner determination issues to assist various stakeholders in understanding these challenges and variations.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}