Post-mortem cardiomegaly descriptor: Call for consistent criteria.

Although the post-mortem descriptor of cardiomegaly is an important component of understanding a sudden death, there is no unified definition. A recent survey reported the usage of heart weight correction models of Molina or Kitzman, for example, or simple step cutoffs such as 350, 400, 450, or 500 g in common use. The goal of the present study was to determine how a diagnosis of cardiomegaly relates to these definitions and heart weight using a database of sudden deaths using 1071 autopsy reports from across the USA in which the heart weight and the presence (n = 373) or not (n = 698) of cardiomegaly were recorded.

Sickle cell trait in non-firearm arrest-related deaths of Black persons.

The role of sickle cell trait (SCT) in sudden exertional death is well-recognized in sports and military training. However, it is not yet studied for non-firearm arrest-related death (NF-ARD). With extensive multi-pronged searches, a large database (n = 1389) of NF-ARDs was established.

Homicide Manner-of-Death Classification in Arrest-Related Death.

Multiple studies have documented various factors that influence or determine forensic pathologist classification of manner of death. There do not appear to be any published studies on manner of death classification specifically regarding arrest-related deaths (ARDs). The goal of this study was to consider a large body of cases of nonfirearm ARDs to analyze the homicide classification with regards to numerous decedent and practitioner (medical examiner/coroner [ME/C]) variables.

The silent killer: Previously undetected pulmonary emboli that result in death after discharge.

Introduction: Pulmonary embolism (PE) is a recognized cause of death in hospitalized trauma patients, yet less is known about PE after discharge.

Patients & Methods: All post-discharge, autopsy-demonstrated, fatal PE resulting from trauma within a large US county over six years were analyzed. Counts, percentages, mean values, SD, and IQR were calculated for all variables.

Geospatial Analysis of Prehospital Triage and Early Potential Preventable Traumatic Deaths.

Severely injured patients often depend on prompt prehospital triage for survival. This study aimed to examine the under-triage of preventable or potentially preventable traumatic deaths. A retrospective review of Harris County, TX, revealed 1848 deaths within 24 hours of injury, with 186 being preventable or potentially preventable (P/PP).

An Analysis of Traumatic and Non-Traumatic Hemopericardium Using Autopsy Data From a County Medical Examiner.

The volume of hemopericardium requiring hemodynamic changes in the trauma patient is not well understood. We performed a study using autopsy data from trauma patients who died with hemopericardium (>20 mL). Of 1848 traumatic deaths, 54 had hemopericardium at autopsy.

Impact of Covid-19 pandemic on volume and surgeon professional fees generated by emergency general surgery procedures.

Introduction: The COVID-19 pandemic has changed the dynamics of healthcare in the USA. In early 2020, most states issued orders to stop non-emergent elective surgeries. This contracted the overall revenue generated by the hospital systems.

Nontraumatic In-Custody Homicidal Deaths in Harris County, Texas (2015-2019): Justification for a Separate Manner of Death Category.

A subset of in-custody deaths, typically occurring in the precustody phase, arise from a combination of mechanisms, rather than a single anatomically or circumstantially demonstrable cause. This case series examined nontraumatic in-custody deaths that occurred over a 5-year period (2015-2019) in Harris County, Texas. Cases were identified as "in custody" or "during police intervention," with a homicide manner; traumatic causes of death (eg, police shootings) were excluded.

Identifying gaps and improving investigation of fatal elder abuse and/or neglect.

Death investigator and autopsy reports for decedents 65 years and older within a major metropolitan area over a five-year period were assessed for the possibility of elder abuse and/or neglect. The study consisted of two stages. A simple two-question screening criteria was used to determine whether the decedent was (1) dependent on another for at least one activity of daily living and (2) had a presence of at least one indicator of abuse and/or neglect.

Fatal and Nonfatal Injury Patterns of Stranded Motorists.

Because nonfatal and fatal incidents for stranded motorists are not separated from vehicular accidents, little data are available on incident characteristics. To close this gap, data fields were inserted into databases at a medical examiner's office and two trauma centers to collect injury-related information. Forensic nurses and pathologists aided in forming a collaboration among the agencies involved and supported data collection efforts.

A Postmortem Portrait of the Coronavirus Disease 2019 (COVID-19) Pandemic: A Large Multi-institutional Autopsy Survey Study.

Context.—: This study represents the largest compilation to date of clinical and postmortem data from decedents with coronavirus disease 2019 (COVID-19). It will augment previously published small series of autopsy case reports, refine clinicopathologic considerations, and improve the accuracy of future vital statistical reporting.

When falls become fatal-Clinical care sequence.

Objectives: This study encompassed fall-related deaths, including those who died prior to medical care, that were admitted to multiple healthcare institutions, regardless of whether they died at home, in long-term care, or in hospice. The common element was that all deaths resulted directly or indirectly from injuries sustained during a fall, regardless of the temporal relationship. This comprehensive approach provides an unusual illustration of the clinical sequence of fall-related deaths.

Quality Assurance Through Standard Operating Procedures Development and Deviation: A Medicolegal Death Investigation Systems Response to the COVID-19 Pandemic.

Standard operating procedures drive everyday practice within any organization, including those within a forensic setting. In the event of unusual circumstances, organizations must respond rapidly to address the impact on operations while ensuring that the quality and safety outcomes of routine services are not affected. This case study illustrates how standard operating procedures can be newly developed or modified, and rapidly deployed and quickly revised, to address unusual circumstances.

Bleeding to death in a big city: An analysis of all trauma deaths from hemorrhage in a metropolitan area during 1 year.

Background: Hemorrhage is the most common cause of potentially preventable trauma deaths, but no studies have focused on all civilian traumatic deaths from hemorrhage, so we describe a year of these deaths from a large county to identify opportunities for preventing hemorrhagic deaths.

Methods: All trauma-related deaths in Harris County, Texas, in 2014 underwent examination by the medical examiner; patients were excluded if hemorrhage was not their primary reason for death. Deaths were then categorized as preventable/potentially preventable hemorrhage (PPH) or nonpreventable hemorrhage.

Morphoproteomics and Etiopathogenic Features of Pulmonary COVID-19 with Therapeutic Implications: A Case Study.

Objective: The COVID-19 pandemic has challenged the world economically and medically. Understanding and defining the biology of this specific coronavirus infection may lead to targeted therapies to lessen its virulence and expand the host resistance. This study's objective was to apply morphoproteomics to pulmonary lung sections from a forensic autopsy of an untreated COVID-19 victim, so that we may better define its biology from the perspective of its interaction with the host and provide options for therapeutic targets.

The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities.

This paper collates the pathological findings from initial published autopsy reports on 23 patients with coronavirus disease 2019 (COVID-19) from 5 centers in the United States of America, including 3 cases from Houston, Texas. Findings confirm that COVID-19 is a systemic disease with major involvement of the lungs and heart. Acute COVID-19 pneumonia has features of a distinctive acute interstitial pneumonia with a diffuse alveolar damage component, coupled with microvascular involvement with intra- and extravascular fibrin deposition and intravascular trapping of neutrophils, and, frequently, with formation of microthombi in arterioles.

Evaluation of Fundamental Forensic Knowledge and Perceived Ability in Emergency Nurse Practitioner Education via Forensic Simulation.

Introduction: The need for trauma care and forensic services is among the top five reasons for seeking healthcare in the United States. Critical aspects of caring for a forensic patient include early recognition of the need for implementing forensic approaches to care: assessment, evidence collection and preservation, and forensic documentation. The intent of this study was to examine fundamental forensic knowledge and perceived ability of graduate-level emergency nurse practitioner students.

Elevator-Related Deaths.

Elevators are mechanical transportation devices used to move vertically between different levels of a building. When first developed, elevators lacked the safety features. When safety mechanisms were developed, elevators became a common feature of multistory buildings.

Establishing a regional pediatric trauma preventable/potentially preventable death rate.

Purpose: Although trauma is the leading cause of death for the pediatric population, few studies have addressed the preventable/potentially preventable death rate (PPPDR) attributable to trauma.

Methods: This is a retrospective study of trauma-related death records occurring in Harris County, Texas in 2014. Descriptive and Chi-squared tests were conducted for two groups, pediatric and adult trauma deaths in relation to demographic characteristics, mechanism of injury, death location and survival time.

Individual and community characteristics associated with premature natural and drug-related deaths in 25-59 year old decedents.

The purpose of the study was to identify circumstances of death, disease states, and sociodemographic characteristics associated with premature natural and drug-related deaths among 25-59 year olds. The study also aimed to address the paucity of research on personal, community-based, and societal factors contributing to premature death. A population-based retrospective chart review of medical examiner deaths within a highly populated and ethnically diverse county [in Texas] was undertaken to identify individuals dying prematurely and circumstances surrounding cause of death [in 2013].