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Diagnostics
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Trauma Diagnosis: Multidisciplinary Management and Forensic Profiles
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Trauma Diagnosis: Multidisciplinary Management and Forensic Profiles

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 22502

Special Issue Editor

Dr. Isabella Aquila

E-Mail Website
Guest Editor
Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
Interests: poisoning; toxicity; forensic toxinology; human rights; forensic science; legal medicine; domestic violence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Traumas are injuries of the body caused by the sudden and violent action of external agents, leading to permanent or fatal consequences in the subjects involved (accidents, violence, etc.). The population involved belongs to all ages, from childhood to geriatric, without sex differences. There are many ways in which trauma can occur: accidental, suicidal or homicidal. When the cause is accidental, it specifically refers to falls, road accidents, crushing, falls from a height, or pedestrian road accidents. There are many figures involved in the management of the traumatized patient or traumatic brain injury. The consequences of trauma in accidental cases can be minor but, in severe cases, they can lead to coma or death. Injuries can involve many districts and systems, and often require radiological investigations and surgical interventions. Since there are multiple anatomical localizations involved, there are also numerous specialized areas in which a traumatized subject may find him/herself managed. Based on the anatomical location and severity of the trauma, the patient who is managed as a whole could have septic or coagulation complications. Where the cause is violent (abuse, sexual violence or mistreatment) or the outcome is fatal, the analysis of the trauma assumes different characteristics and, for forensic and judicial purposes, it becomes essential to reconstruct the trauma, analyze its characteristics and determine its psychological impact, extent and timing, especially for the latter field of application—patients who die after long hospitalizations with diffuse brain damage. Additionally, in this context, evaluation of the ways in which the trauma occurred, in particular when it comes to minors or traumas occurring in association with drug or alcohol abuse, plays a crucial role. In particular, in the evaluation of those who cause the traumatic injury, the analysis of biological traces becomes relevant. It is clear that the fields of application in trauma are diversified and research in this sense should be addressed in order to draw up new applicative perspectives in the management and reconstruction of trauma.

The topics of the Special Issue will concern: trauma management, analysis and diagnosis of trauma, treatment of trauma, reconstruction of the dynamics of trauma, description of the timing of the trauma, and multidisciplinary assessment of trauma.

The specialized branches involved are: Forensic medicine and forensic pathology, Pathological anatomy, Pediatrics, General and specialist surgery, Maxillofacial surgery, Anesthesia and resuscitation, Neurology, Translational medicine, Pulmonology, Cardiology, Infectious diseases, Urology, Physiatry, Orthopedics, Psychiatry, Geriatrics, Internal Medicine, Gynecology and Obstetrics, Gastroenterology and hepatology, Nephrology, Cardiac surgery, Neurosurgery, Toxicology, Genetics, Biology, Psychology, Clinical chemistry, Computer engineering, Sports medicine, Rehabilitation medicine, Neuroradiology, Forensic entomology, Forensic veterinary, and Forensic anthropology.

Prof. Dr. Isabella Aquila
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • trauma
  • diagnosis, autopsy
  • forensic pathology
  • clinical trauma
  • brain injury
  • accident, fall
  • emergency
  • management of trauma
  • coma
  • death
  • injury
  • radiological investigation
  • surgical intervention
  • sepsis
  • violent
  • abuse
  • psychological trauma
  • drugs
  • toxicology
  • treatment of trauma
  • treatment of trauma
  • reconstruction of trauma
  • multidisciplinary profiles
  • pediatric trauma
  • resuscitation
  • surgery
  • data analysis
  • forensics

Published Papers (6 papers)

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Research

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11 pages, 1842 KiB  
Article
Diagnostic Accuracy of 128-Slice Single-Source CT for the Detection of Dislocated Bucket Handle Meniscal Tears in the Setting of an Acute Knee Trauma—Correlation with MRI and Arthroscopy
by Georg Gohla, Mareen Sarah Kraus, Isabell Peyker, Fabian Springer and Gabriel Keller
Diagnostics 2023, 13(7), 1295; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13071295 - 30 Mar 2023
Viewed by 1666
Abstract
(1) Background: Meniscal tears are amongst the most common knee injuries. Dislocated bucket handle meniscal tears in particular should receive early intervention. The purpose of this study was to evaluate the diagnostic performance of CT in detecting dislocated bucket handle meniscal tears compared [...] Read more.
(1) Background: Meniscal tears are amongst the most common knee injuries. Dislocated bucket handle meniscal tears in particular should receive early intervention. The purpose of this study was to evaluate the diagnostic performance of CT in detecting dislocated bucket handle meniscal tears compared with the gold-standard MRI and arthroscopy. (2) Methods: Retrospectively, 96 consecutive patients underwent clinically indicated CT of the knee for suspected acute traumatic knee injuries (standard study protocol, 120 kV, 90 mAs). Inclusion criteria were the absence of an acute fracture on CT and a timely MRI (<6 months). Corresponding arthroscopy was assessed. Two experienced musculoskeletal radiologists analyzed the images for dislocated bucket handle meniscal tears, associated signs thereof (double posterior cruciate ligament sign, double delta sign, disproportional posterior horn sign), and subjective diagnostic confidence on a 5-point-Likert scale (1 = ‘non-diagnostic image quality’, 5 = ‘very confident’). (3) Results: Dislocated bucket handle meniscal tears were detected on CT by standard three-plane bone kernel reconstructions with a sensitivity of 90.7% and a specificity of 99.3% by transferring the knowledge of established MRI signs. The additional use of soft-tissue kernel reconstructions in three planes increased the sensitivity by 4.0% to 94.7%, specificity to 100%, inter-rater agreement to 1.0, and the diagnostic confidence of both readers improved to a median 4/5 (‘confident’) in both readers. (4) Conclusions: Trauma CT scan of the knee with three-plane soft-tissue reconstructions delivers the potential for the detection of dislocated bucket handle meniscal tears with very high diagnostic accuracy. Full article
(This article belongs to the Special Issue Trauma Diagnosis: Multidisciplinary Management and Forensic Profiles)
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12 pages, 6769 KiB  
Article
Haemorrhage and Survival Times: Medical–Legal Evaluation of the Time of Death and Relative Evidence
by Maricla Marrone, Loredana Bellantuono, Alessandra Stellacci, Federica Misceo, Maria Silvestre, Fiorenza Zotti, Alessandro Dell’Erba and Roberto Bellotti
Diagnostics 2023, 13(4), 732; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13040732 - 15 Feb 2023
Cited by 1 | Viewed by 927
Abstract
Haemorrhage is the name used to describe the loss of blood from damaged blood vessels (arteries, veins, capillaries). Identifying the time of haemorrhage remains a clinical challenge, knowing that blood perfusion of systemic tissues is poorly correlated with the perfusion of specific tissues. [...] Read more.
Haemorrhage is the name used to describe the loss of blood from damaged blood vessels (arteries, veins, capillaries). Identifying the time of haemorrhage remains a clinical challenge, knowing that blood perfusion of systemic tissues is poorly correlated with the perfusion of specific tissues. In forensic science, one of the most discussed elements is the time of death. This study aims to provide the forensic scientist with a valid model to establish a precise time-of-death interval in cases of exsanguination following trauma with vascular injury, which can be useful as a technical aid in the investigation of criminal cases. To calculate the calibre and resistance of the vessels, we used an extensive literature review of distributed one-dimensional models of the systemic arterial tree as a reference. We then arrived at a formula that allows us to estimate, based on a subject’s total blood volume and the calibre of the injured vessel, a time interval within which a subject’s death from haemorrhage from vascular injury falls. We applied the formula to four cases in which death had been caused by the injury of a single arterial vessel and obtained comforting results. The study model we have offered is only a good prospect for future work. In fact, we intend to improve the study by expanding the case and statistical analysis with particular regard to the interference factors to confirm its actual usability in practical cases; in this way, useful corrective factors can be identified. Full article
(This article belongs to the Special Issue Trauma Diagnosis: Multidisciplinary Management and Forensic Profiles)
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Review

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12 pages, 5695 KiB  
Review
The Role of Forensic Investigation in an Unusual Case of Patricide by a Schizophrenic Woman Involving Dismemberment of a Decomposed Body
by Isabella Aquila, Matteo Antonio Sacco, Fabrizio Cordasco, Carmen Scalise, Francesco Maria Galassi, Elena Varotto, Walter Caruso, Valerio Riccardo Aquila and Pietrantonio Ricci
Diagnostics 2022, 12(7), 1577; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12071577 - 29 Jun 2022
Cited by 1 | Viewed by 5026
Abstract
Dismemberment is characterized by the fragmentation of the body into anatomical sections. It can occur because of a murder, suicide, or accident. In the literature, there are no cases of patricide perpetrated by a daughter in which the offender performed the dismemberment. However, [...] Read more.
Dismemberment is characterized by the fragmentation of the body into anatomical sections. It can occur because of a murder, suicide, or accident. In the literature, there are no cases of patricide perpetrated by a daughter in which the offender performed the dismemberment. However, in this paper, we reported a case of patricide by a schizophrenic daughter that was not treated with antipsychotic therapy. Post-mortem Computed Tomography (PMCT), autopsy, and histological examinations were performed. The soft tissues were removed through maceration techniques and chemical treatment. An analysis was performed to study the bone margins and clarify the weapon and manner of death. This investigation, which used radiological and histological studies, helped to assess the vitality of the injuries. The purpose of the study is to discover the weapon used, the cause, and the manner of death, with particular interest in this case due to the dismemberment. Moreover, we emphasize the correlation between patricide, dismemberment, and a lack of antipsychotic treatment in patients with schizophrenia. Full article
(This article belongs to the Special Issue Trauma Diagnosis: Multidisciplinary Management and Forensic Profiles)
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10 pages, 659 KiB  
Review
Liver Trauma: Management in the Emergency Setting and Medico-Legal Implications
by Angela Saviano, Veronica Ojetti, Christian Zanza, Francesco Franceschi, Yaroslava Longhitano, Ermelinda Martuscelli, Aniello Maiese, Gianpietro Volonnino, Giuseppe Bertozzi, Michela Ferrara and Raffaele La Russa
Diagnostics 2022, 12(6), 1456; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12061456 - 13 Jun 2022
Cited by 6 | Viewed by 4020
Abstract
Traumatic abdominal injuries are life-threatening emergencies frequently seen in the Emergency Department (ED). The most common is liver trauma, which accounts for approximately 5% of all ED admissions for trauma. The management of blunt liver trauma has evolved significantly over the past few [...] Read more.
Traumatic abdominal injuries are life-threatening emergencies frequently seen in the Emergency Department (ED). The most common is liver trauma, which accounts for approximately 5% of all ED admissions for trauma. The management of blunt liver trauma has evolved significantly over the past few decades and, according to the injury’s severity, it may require massive resuscitation, radiological procedures, endoscopy, or surgery. Patients admitted to the ED with blunt abdominal trauma require a multidisciplinary evaluation, including emergency physicians, surgeons, radiologists, and anesthetists, who must promptly identify the extent of the injury to prevent serious complications. In case of a patient’s death, the execution of a forensic examination carried out with a multidisciplinary approach (radiological, macroscopic, and histological) is essential to understand the cause of death and to correlate the extent of the injuries to the possibility of survival to be able to manage any medico-legal disputes. This manuscript aims to collect the most up-to-date evidence regarding the management of hepatic trauma in the emergency room and to explore radiological findings and medico-legal implications. Full article
(This article belongs to the Special Issue Trauma Diagnosis: Multidisciplinary Management and Forensic Profiles)
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Other

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8 pages, 2866 KiB  
Case Report
When the Helmet Is Not Enough: Forensic Multidisciplinary Reconstruction of a Deadly Motorcycle Accident
by Antonio Maria Catena, Michele Treglia, Luigi Tonino Marsella, Marcello Locatelli, Enrica Rosato, Abuzar Kabir, Martina Bonelli and Cristian D’Ovidio
Diagnostics 2022, 12(10), 2465; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102465 - 12 Oct 2022
Cited by 3 | Viewed by 3098
Abstract
We report the case of a 54-year-old man who died in a motorcycle accident due to loss of control of the vehicle on a viaduct. No other vehicles were apparently involved, except for a car hit by the motorcycle after it fell. A [...] Read more.
We report the case of a 54-year-old man who died in a motorcycle accident due to loss of control of the vehicle on a viaduct. No other vehicles were apparently involved, except for a car hit by the motorcycle after it fell. A post-mortem CT scan (computed tomography scan) was performed showing complex head trauma with a subarachnoid hemorrhage and multiple skull and facial bone fractures. A forensic cinematic reconstruction performed by an engineer was needed to exclude other incident causes other than the loss of control. The multidisciplinary approach that included autopsy findings, a cinematic reconstruction, a helmet test and an examination played a key role in clarifying the dynamics of the accident, allowing us to explain how the death occurred despite the motorcyclist’s helmet use. The cause of death was identified as a penetrating head trauma with cerebral material exposure, produced by the impact of the head against a fixed bolt in the guardrail base. Despite the use of the helmet, the impact force was enough to render the protection ineffective and allowed the bolt to penetrate through the helmet and the skull. Full article
(This article belongs to the Special Issue Trauma Diagnosis: Multidisciplinary Management and Forensic Profiles)
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38 pages, 12248 KiB  
Study Protocol
Cause of Death in Charred Bodies: Reflections and Operational Insights Based on a Large Cases Study
by Aniello Maiese, Costantino Ciallella, Massimiliano dell’Aquila, Alessandra De Matteis, Chiara Toni, Andrea Scatena, Raffaele La Russa, Eleonora Mezzetti, Marco Di Paolo, Emanuela Turillazzi, Paola Frati and Vittorio Fineschi
Diagnostics 2022, 12(8), 1986; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12081986 - 16 Aug 2022
Cited by 1 | Viewed by 6084
Abstract
Our study aims to demonstrate the experience of analyzing fully or partially charred corpses to offer a proper implementation protocol for determining the cause of death. In this study, we present a total of 103 cases obtained from the University of Rome La [...] Read more.
Our study aims to demonstrate the experience of analyzing fully or partially charred corpses to offer a proper implementation protocol for determining the cause of death. In this study, we present a total of 103 cases obtained from the University of Rome La Sapienza and the University of Pisa archives. All cases were classified based on the extent and severity of burns using a visual method. We divided all cases into two groups. The first group included grade I–II burns (21 cases) without the need for identification. The second group (82 cases) included injuries worse than grade burns II, so all cases were analyzed using an analytical method. For each case, we have documented which of the following analyses have been used and the corresponding findings: inspection, autopsy examination, imaging examination, genetic and toxicological examinations, and histological examination. The results describe the main diagnostic findings and show that only the application of all the above systematic analyses can provide greater accuracy and reliability in describing the causes of death or solving problems, such as identification. In conclusion, we propose an available protocol that defines the main steps of a complete diagnostic pathway that pathologists should follow daily in studying charred bodies. Full article
(This article belongs to the Special Issue Trauma Diagnosis: Multidisciplinary Management and Forensic Profiles)
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