Are "Accidental" Gun Deaths as Rare as They Seem? A Comparison of Medical Examiner Manner of Death Coding With an Intent-Based Classification Approach

PEDIATRICS ◽  
2003 ◽  
Vol 111 (4) ◽  
pp. 741-744 ◽  
Author(s):  
J. Schaechter ◽  
I. Duran ◽  
J. De Marchena ◽  
G. Lemard ◽  
M. E. Villar
Keyword(s):  
Medical Examiner ◽  
Manner Of Death ◽  
Classification Approach

scholarly journals “Rust stain”: a rare mark in firearm suicide—a case report and review of the literature

2021 ◽  
Author(s):  
Luca Tomassini ◽  
Daniele Paolini ◽  
Anna Maria Manta ◽  
Edoardo Bottoni ◽  
Costantino Ciallella
Keyword(s):  
Case Report ◽  
Medical Examiner ◽  
Experimental Setting ◽  
Review Of The Literature ◽  
Histological Findings ◽  
Porcine Skin ◽  
Manner Of Death ◽  
Prolonged Contact ◽  
Firearm Suicide

AbstractRust stains are marks left by firearms in case of prolonged contact with the cutaneous surfaces. These peculiar signs along with other well-documented findings can guide the medical examiner in the determination of the manner of death, especially in case of firearm suicide. This paper presents the case of a 33-year-old male soldier who committed suicide by using a short-barreled weapon, whose trigger remained in contact with the first finger of his right hand, leading to the formation of a rust stain that perfectly reproduced its design. The forensic examination of the scene, the external cadaveric inspection, and the autopsy are described. For the evaluation of the histological findings typical of rust spots, the authors decided to replicate the phenomenon in an experimental setting using porcine skin. In order to provide an exhaustive overview on the formation and the features of rust stains, a review of the forensic literature concerning this rare mark was performed.

scholarly journals Firearm-Related Deaths in Multnomah County, Oregon, 2010-2016: Linking Medical Examiner Data to State Vital Records Data

2019 ◽  
Vol 135 (1) ◽  
pp. 40-46
Author(s):  
Jaime Walters
Keyword(s):  
Race And Ethnicity ◽  
Public Health Problem ◽  
Medical Examiner ◽  
Data Sets ◽  
Data Systems ◽  
Manner Of Death ◽  
Predictive Values ◽  
Multnomah County ◽  
Routine Surveillance ◽  
Vital Records

Objectives: Violence due to firearms is a substantial public health problem. Death data from medical examiner and vital records were linked to evaluate the use of medical examiner data to augment routine surveillance and determine any differences in sex, age, manner of death, or race and ethnicity between the 2 data systems. Materials and Methods: Medical examiner data were searched for keywords of interest, and vital records data were obtained and linked for deaths occurring in Multnomah County, Oregon, from January 1, 2010, through December 31, 2016. Both data sets were compared for the number and proportion of firearm-related deaths by sex, age, manner of death, and race/ethnicity. Sensitivity and positive predictive values were calculated for variables that had discordant results. Results: A total of 568 firearm-related deaths were identified in the medical examiner data. After matching with manual review, the 2 data systems had 100% case agreement. A reverse match showed that most cases not found in medical examiner data were due to transfer of case jurisdiction. The 2 systems matched nearly perfectly in sex, age, and manner of death but differed in characterization of race and ethnicity. Sensitivity was 62% for Hispanic ethnicity but 93% for white and black race. Practice Implications: Using medical examiner data was a useful way to augment routine surveillance of firearm-related deaths in our jurisdiction in close to real time. However, caution is needed when analyzing data by subgroups because of discordant classifications of race between the data systems.

scholarly journals Medical Examiner Review of the Characteristics of Fire-Related Homicides

2020 ◽  
Vol 10 (2) ◽  
pp. 87-93
Author(s):  
Kyle S. Conway ◽  
Carl J. Schmidt ◽  
Theodore T. Brown
Keyword(s):  
Cause Of Death ◽  
Retrospective Studies ◽  
Medical Examiner ◽  
Manner Of Death ◽  
Wayne County ◽  
Autopsy Findings ◽  
Cohb Level ◽  
Scene Investigation ◽  
Medical Examiners ◽  
Ancillary Studies

While fire-related deaths are regularly encountered by medical examiners, fire-related homicides are relatively uncommon. Although some large retrospective studies of fire-related deaths have been performed, few large studies have specifically reviewed fire-related homicides. Autopsy, scene investigation, and ancillary studies were reviewed for 38 fire-related homicides evaluated at the Wayne County Medical Examiner’s Office in Detroit, Michigan. The largest proportion of cases were inhalation-related deaths in dwelling fires (n = 21, 55%), followed by deaths from thermal injury after immolation (n = 8, 21%) and traumatic death with contemporaneous or subsequent immolation (n = 8, 21%). There was one case of postmortem immolation. Although carboxyhemoglobin (COHb) levels played a significant role in evaluation of these cases, no single factor was diagnostic of a particular cause or manner of death. Fire-related homicides present unique diagnostic challenges because multiple insults frequently contribute to the cause death. Death at the scene and COHb level above 10% are the most useful factors in establishing smoke and soot inhalation as the cause of death. Some autopsy findings are helpful in establishing or ruling out smoke and soot inhalation as contributing to or sole cause of death, but an evaluation of the entire circumstances and autopsy findings is necessary.

Practical Pathology of Gunshot Wounds

2006 ◽  
Vol 130 (9) ◽  
pp. 1283-1289 ◽  
Author(s):  
J. Scott Denton ◽  
Adrienne Segovia ◽  
James A. Filkins
Keyword(s):  
Law Enforcement ◽  
Justice System ◽  
Gunshot Wound ◽  
Gunshot Wounds ◽  
The United States ◽  
Medical Examiner ◽  
Manner Of Death ◽  
Entrance Wound ◽  
Practical Guidelines

Abstract Context.—Gunshot wounds are the most common cause of homicidal death in the United States. Analysis and interpretation of fatal gunshot wounds is an important and common practice among forensic pathologists. Additionally, for pathology residents, it is an integral aspect of their training during their rotations at medical examiner or coroner offices. Objective.—The correct interpretation of gunshot wounds by forensic pathologists not only provides valuable information that can assist law enforcement in their investigation but also is essential for the final determination of manner of death. Discussion of the practical, basic, and essential skills required to interpret gunshot wounds include distinguishing a classic entrance wound from an exit wound; recognizing atypical entrance and exit wounds; utilizing the features of soot and stippling patterns to differentiate among contact, close, and distant range gunshot wounds; understanding of the trauma produced by gunshot wounds; and understanding the importance of recovering and documenting/handling any projectiles recovered at autopsy. Data Sources.—This article reviews numerous standard forensic pathology textbooks and the pertinent literature to formulate practical guidelines to assist the pathologist in the performance of forensic autopsies and the investigation of gunshot wound fatalities. Conclusions.—Pathologists who perform investigations and autopsies to determine the cause and manner of death in gunshot wound cases must be aware of the implications, requirements, and pitfalls in interpretation of the injuries so that the examination fulfills its expectations to the community and the justice system.

Changes in the Era of COVID-19: What Can We Learn from the Acceleration of Opioid Overdose Deaths in Maryland over 15 years

2021 ◽  
Author(s):  
Alison Athey ◽  
Paul Nestadt
Keyword(s):  
Substance Use ◽  
Seasonal Pattern ◽  
Medical Examiner ◽  
Opioid Overdose ◽  
Manner Of Death ◽  
Overdose Death ◽  
Medication Assisted Treatment ◽  
Nationally Representative ◽  
Overdose Deaths ◽  
Data Period

This study tracks the number of accidental opioid overdose deaths (OOD) in Maryland from 2003-2020 and evaluates longitudinal trends, with a focus on increased mortality in the context of the COVID-19 pandemic. All Marylanders with positive toxicology findings for opioids at the time of death from January 2003 through August 2020 (n = 1276) were included in analyses. Data were provided by the Maryland Office of the Chief Medical Examiner (OCME) which evaluates all unexpected deaths in the state. We explored longitudinal trends in the data and found a simple seasonal pattern. The number of OOD during the first six months of the COVID-19 pandemic was similar to the number of predicted by pre-pandemic data period. We compared opioid overdose decedents from spring 2019 with those who died in the spring of 2020 to assess the association of the COVID-19 pandemic with changes in manner of death and risk factors for opioid overdose. The likelihood of an overdose death being ruled intentional was lower during the pandemic, and there was a shift in patterns of substance use which may have reflected disrupted access to preferred substances of abuse and medication assisted treatment during the lockdown. More research that includes nationally representative data, extends beyond the early months of the COVID-19 pandemic, and addresses mechanisms that drive change in substance use and treatment in the context of multiple national emergencies is needed.v

scholarly journals Autopsy Service Death Certificate Review

2020 ◽  
Vol 144 (9) ◽  
pp. 1092-1096
Author(s):  
Alison Krywanczyk ◽  
Elaine Amoresano ◽  
Kanayo Tatsumi ◽  
Sharon Mount
Keyword(s):  
Cause Of Death ◽  
Death Certificate ◽  
Epidemiologic Studies ◽  
The State ◽  
Medical Examiner ◽  
Death Certificates ◽  
Death Certification ◽  
Manner Of Death ◽  
Clinician Education ◽  
Health Initiatives

Context.— Despite the importance of accurate death statistics for epidemiologic studies and public health initiatives, there remains a high frequency of errors in death certification. This deficiency can be addressed by the hospital autopsy service. Objectives.— To improve the quality and accuracy of death certificates issued in the hospital and improve resident and clinician education by initiating a death certificate review process, performed by pathology residents while on their hospital autopsy rotation. Design.— A resident reviewed all death certificates issued in the hospital daily through the state electronic death certificate filing system and correlated with the decedent's medical record. When errors were found, the resident filed an amended death certificate with the state. If applicable, the Office of the Medical Examiner was contacted to investigate. The original certifying physician was then contacted via email with an explanation for the amendment. Results.— In 12 months, 590 death certificates were issued by the hospital. Eighty-eight of 590 (15%) were amended. Of those 88 amended, 41 (47%) were missing an underlying cause of death, 7 (8%) had an inaccurate cause of death, 41 (47%) failed to include relevant contributory causes of death, and 17 (19%) had major typographic errors. Of 88, 24 (27%) fell under the Office of the Medical Examiner's jurisdiction and were reported with a subsequent change in the manner of death in 23 of 88 cases (26%). Conclusions.— Death certificate review by the autopsy service improves the accuracy of death certification, impacts resident and clinician education, and serves as quality assurance for both the hospital and the state.

Rural–Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada

2021 ◽  
pp. 070674372199031
Author(s):  
Charlene Reccord ◽  
Nicole Power ◽  
Keeley Hatfield ◽  
Yordan Karaivanov ◽  
Shree Mulay ◽  
...  
Keyword(s):  
Observational Study ◽  
Suicide Prevention ◽  
Newfoundland And Labrador ◽  
Urban Areas ◽  
Univariate Analysis ◽  
Suicide Mortality ◽  
Medical Examiner ◽  
Data Set ◽  
Rural People ◽  
Manner Of Death

Background: Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. Methods: We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. Results: Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. Discussion: The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.

Custodial deaths seen in the Office of the Chief Medical Examiner, Lagos, Nigeria: An 11-year autopsy study

2021 ◽  
pp. 002580242110042
Author(s):  
Sunday S Soyemi ◽  
Adedayo F Faduyile ◽  
Ayodele D Sanni ◽  
Alban I Mgbehoma ◽  
John O Obafunwa
Keyword(s):  
Causes Of Death ◽  
Hypertensive Heart Disease ◽  
Cerebral Injury ◽  
Medical Examiner ◽  
Autopsy Study ◽  
Manner Of Death ◽  
Blunt Force Trauma ◽  
Global Concern ◽  
Males And Females ◽  
Deaths In Custody

Introduction Deaths in custody are a matter of global concern. However, such information is often missing in developing countries. This study aimed to examine retrospectively the profile, cause and manner of deaths amongst cases of custodial deaths in Lagos State, Nigeria. Method An 11-year study (June 2008–June 2019) was done of all autopsy cases of custodial deaths in the Office of the Chief Medical Examiner. Variables including age, sex, offence, place of death, duration in custody prior to death and cause and manner of death were extracted from the records. Results were analysed using frequencies and percentages. Results Out of 9894 autopsies over the study period, 45 custodial deaths were identified. Males and females constituted 84.4% and 15.6%, respectively (M:F = 5.4:1). Ages ranged from 20 to 64 years, with a mean age of 37 ± 11.0 years. These deaths were most common in the third decade. Armed robbery and financial crime were the two leading reasons for arrest, while most deaths occurred within 24 hours of arrival in custody. The two leading causes of death were acute cardiac failure from hypertensive heart disease and cranio-cerebral injury from blunt-force trauma. Conclusion Deaths in custody need to be properly investigated and particular attention needs to be paid to unlawful deaths if and when they arise.

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