Functional time limit and onset of symptoms in infant abusive head trauma

Aim: To analyse medical and witness evidence collected during investigations of infant abusive head trauma with a view to (i) isolating cases where a functional time limit could be established and (ii) examining those cases for evidence of the onset of neurological symptoms. Methods: A retrospective study was undertaken of severe infant abusive head trauma cases investigated by the Queensland Police Service over a 10-year period. In cases where sufficient reliable (non-perpetrator) evidence was available, a functional time limit was documented. Those files were then examined for further medical, witness or perpetrator evidence of the infant victim's response to the assault. Results: A functional time limit was established in 16 of 52 cases (31%). In 11 of the 16 cases there was evidence of an immediate neurological response on the part of the victim. Conclusion: The study suggests that the period between assault and onset of symptoms in infant abusive head trauma is brief, particularly in cases of an acute deterioration where proximate medical intervention is required. In those cases with sufficient evidence of the victim's condition post-injury, the symptoms presented without delay.</p

Limited post-mortem examination. An alternative and viable way to avoid full examination?

A complete post-mortem examination is required in most medicolegal investigation systems. Though uncommon, some jurisdictions allow limited post-mortem examination if it is adequate to fulfil the death inquiries. One such jurisdiction is the state of Queensland with the commencement of the new Coroners Act. It permits the Coroner to order limited post-mortem examination confined to a specific region or regions of the body based on the circumstances received from the investigating police.There is a paucity of literature comparing the completeness of limited post-mortem examination compared with complete examination. We aim to study whether limited post-mortem examination can partially replace complete examination in specific circumstances. Archival post-mortem reports with history are obtained. Cases where obvious complete post-mortem examination is required [e.g., sudden infant death syndrome (SIDS), homicide, medicolegal hospital cases, pregnancy deaths], decomposed and skeletonized cases are excluded from the study. The region or regions (head, neck, chest, or abdomen) most appropriate for examination are derived from studying the circumstances given.Three hundred and fifty-one cases were reviewed, of which 136 were found to be suitable to be incorporated into the study. Discrepancies were present in 17.7% (n≤24) of the cases (15 cases due to different cause of death, seven due to changes in interpretation, and two where pathology may be significant to the family). When classified according to mode of death, the percentages were 46.4%, 11.1%, and 9.3% for the accident, natural, and suicide groups, respectively. When compared to region examined, the discrepancies were 9 out of 18 for head, 1 out of 20 for neck, 5 out of 70 for chest, none of out 2 for extremities, and 3 out of 4 for abdomen.The study showed a significantly high percentage of discrepancies when limited post-mortem examination was performed. The missed information may impede medicolegal inquiries, police investigation, and interfere with the course of justice. Significant information about familial disease may be missed