Cardiac implantable electronic devices (CIEDs) store information continuously; however, the log of these devices is rarely analyzed in forensic practice. We retrospectively reviewed all cases ...referred for CIED interrogation by the Los Angeles County Department of Medical Examiner‐Coroner between 2001 and 2020. According to the Department's practice, CIED interrogation may be requested for decedents in which details or cause of death are not clear from autopsy and clinical history. The CIED analysis was considered informative for the coroner's investigation either if it detected an arrhythmia or malfunction likely related to decedent's terminal event or if it was essential to determine time of death or identity of decedent. A total of 57 CIEDs were evaluated during the 20‐year period. In almost half of cases (26/57: 45.6%), device analysis was informative for coroner's investigation. Arrhythmias likely related to terminal event were commonly detected (21/57: 36.8%). Device malfunction was identified as the likely cause of death in almost 10% of decedents (5/57: 8.8%), including three cases of battery depletion (3/57: 5.3%), one case of misclassification of ventricular tachycardia as supraventricular tachycardia with failure to deliver therapy (1/57: 1.7%), and one case of lead failure due to a broken pacing wire (1/57: 1.7%). Not infrequently, CIED interrogation was essential for determination of time of death (9/57: 15.8%), and there was one case (1/57: 1.7%) in which interrogation was essential for identifying the decedent. Our study shows that postmortem CIED interrogation can provide unique information regarding mechanism and time of death, and decedent's identity.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objectives To determine interoffice variability in routinely performed sudden unexpected infant death (SUID) postmortem studies for infection and to assess availability and perceived utility of ...various tests of infectious diseases. Study design Online surveys were sent to all 154 offices of US medical examiners and coroners serving populations >300 000 people. Surveys included a set of potential laboratory tests for infectious disease. Respondents were asked to select which tests were available in their offices, and which tests were performed routinely in SUIDs vs which tests should be performed routinely. Results Of the 45 complete responses, 4.4% did not routinely perform histology, 8.9% did not routinely perform viral studies (ie, culture or molecular diagnostics), 22.2% did not routinely perform blood cultures, 26.7% did not routinely perform lung bacterial cultures, and 44.4% did not routinely perform cerebrospinal fluid cultures. Conclusions Our findings suggest that there is considerable interoffice variability with testing for infectious diseases in SUIDs. This appeared to be largely the result of a perceived lack of testing utility rather than a lack of test availability. Evidence-based practice guidelines regarding the interpretation of microbial testing results, as well as common testing protocols/algorithms, may lead to more accurate and standardized data, thus improving SUID investigation and surveillance.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
ABSTRACTContagious disease reporting is an important mechanism for public health officials to be informed of emerging and ongoing risks to the communityʼs health. There are several mechanisms for ...reporting, including automated reporting from computer sources, required reporting from physicians and other health care professionals, and reporting of sales of certain over-the-counter medications such as cold remedies.Reporting by medical examiners is a significant source of information because contagious disease may first come to the medical examiner by causing sudden unexpected death. This study describes how the Los Angeles County Department of Medical Examiner–Coroner improved contagious disease reporting from coronerʼs cases. Methods used include computerized transmission to public health of initial coronerʼs case reports, e-mailed requests to the coroner to obtain cultures, having all results of coronerʼs cultures come through a single person who reports contagious disease as necessary, and including infectious disease screening in retrospective case review.
ABSTRACTAs a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19–infected decedents at ...autopsy. While in some cases a history of fever and/or respiratory distress (eg, cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with—but not of—COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have been issued regarding scene investigative protocol, and there is a paucity of publications characterizing COVID-19 postmortem gross and histologic findings. A case of sudden unexpected death due to COVID-19 is presented as a means of illustrating common autopsy findings, as well as diagnostic and biosafety considerations. We also review and summarize the current COVID-19 literature in an effort to provide practical evidence-based biosafety guidance for medical examiner-coroner offices encountering COVID-19 at autopsy.
ABSTRACTInfections due to bacteria of the genus Paenibacillus are exceedingly rare and therefore predominately described on a case-by-case basis. Here, we present a case of a 25-day-old premature ...neonate who died from presumed Paenibacillus sepsis and meningitis. Most prior reported cases of Paenibacillus bacteremia were among patients who had prosthetic medical devices, were immunocompromised, or were injection drug users. However, to our knowledge, this is the first reported case of infant death from presumed Paenibacillus thiaminolyticus. This case suggests the potential for severe human infection by an environmental bacterium previously considered to be of little consequence.
In the United States, the office of the Medical Examiner-Coroner is responsible for investigating all sudden and unexpected deaths and deaths by violence. Its jurisdiction includes deaths during the ...arrest procedures and deaths in police custody. Police officers are sometimes required to subdue and restrain an individual who is violent, often irrational and resisting arrest. This procedure may cause harm to the subject and to the arresting officers. This article deals with our experiences in Los Angeles and reviews the policies and procedures for investigating and determining the cause and manner of death in such cases. We have taken a "quality improvement approach" to the study of these deaths due to restraint asphyxia and related officer involved deaths, Since 1999, through interagency coordination with law enforcement agencies similar to the hospital healthcare quality improvement meeting program, detailed information related to the sequence of events in these cases and ideas for improvements to prevent such deaths are discussed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
8.
Fat Transfer and Fatal Macroembolization Astarita, Denis C.; Scheinin, Lisa A.; Sathyavagiswaran, Lakshmanan
Journal of forensic sciences,
March 2015, Volume:
60, Issue:
2
Journal Article
Peer reviewed
Fat embolism is usually associated with long bone fractures or other trauma. The diagnosis is usually clinical, and in most cases, emboli are not fatal and not usually seen on gross examination. At ...the Los Angeles County Coroner's Office, we autopsied the victim of fatal macroscopic fat embolization to the lungs. The patient died during buttock enhancement surgery when fat from liposuction was injected into her buttocks. Fat embolism from liposuction and fat injection is reportedly rare, and macroscopic embolization is rarer still. Varicose veins can occur in the area of the sciatic notch and are known to cause painful sciatica symptoms. We suggest them as a potential conduit for macroscopic fat to reach the lungs. Simple pre‐operative questioning for sciatica symptoms and possible radiologic study to rule out sciatic varices seem prudent before undertaking buttock‐enhancing surgery. Careful fat injection with pre‐aspiration is always advised.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract In the U.S. today, the pathologists, both hospital-based and forensic, are regularly involved in quality assurance (QA) programs, the evaluation of patient safety at all levels of medical ...care, including treatments in walk-in clinics and medical offices. In the United States, official death investigations are conducted by the Medical Examiner’s Office. The Medical Examiner’s Office is aided in its work by a network of coordinating agencies to provide complete, comprehensive reporting and investigation of deaths placed under its jurisdiction. Those agencies are the Health Department, the Registrar of Vital Statistics on Births and Deaths, Division of Health Facilities, the Hospital Office of Decedent Affairs and the State medical licensing agencies, as well as the various law enforcement and regulatory agencies and the prosecuting attorney’s office. Forensic pathologists are witnesses to the fatal results of often avoidable untoward events. They need to use their experiences to address and emphasize overall prevention programs to improve the quality of life in the community, to publicize the avoidable actions which can lead to untoward results. In the current growing atmosphere of threatening chemical, biological and radiation terrorist attacks, the health care system, especially hospitals, including emergency services, are mobilizing to develop plans to meet possible anticipated need for disaster preparedness.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
ABSTRACTChikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, ...children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase–polymerase chain reaction to aid in rapid and accurate diagnosis and management.
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