Tracey S. Corey

Unnatural Deaths in Nursing Home Patients

Nursing home residents comprise a large and rapidly growing segment of the national population. Despite this fact, the majority of deaths occurring in nursing homes are not investigated because of the significant medical illnesses suffered by most residents. Herein, we report a series of unnatural deaths in nursing home residents, including two homicides and seven accidental deaths. In four of the deaths, there was an attempted concealment of the cause and manner of death. Fearing criminal or civil proceedings, nursing home personnel may attempt to conceal homicidal or accidental deaths in nursing home residents. Because of the serious, chronic illnesses suffered by these patients, attending physicians are often willing to sign death certificates without personally investigating the circumstances surrounding the patients demise. The authors contend that unnatural deaths of nursing home patients are significantly underreported. Attending physicians and death investigators should be urged to investigate more fully sudden deaths in nursing home patients.

Children in Motor Vehicle Collisions: Analysis of Injury by Restraint Use and Seat Location

This study was a retrospective chart review of hospital records and autopsy reports of 499 children nine years old or younger involved in motor vehicle collisions from 1994 to 1998. The objective was to evaluate the frequency and severity of injuries as a function of age, restraint use, and seat position. We found that 33% of the children were unrestrained and 20% were improperly restrained. Unrestrained children had the highest mean Maximum Abbreviated Injury Scores (MAIS) and Injury Severity Scores (ISS), accounted for 70% of the fatalities, and had the highest incidence of head injuries. Although most of the head injuries were superficial, 80% of the fatalities were the result of a head injury. Improperly restrained children had the highest frequency of abdominal injuries. Regardless of restraint use, the back seat was associated with fewer head injuries and lower mean MAIS and ISS scores compared to the front seat. Also, properly restrained children in the front seat had lower mean MAIS and ISS scores than unrestrained children in the back seat, suggesting that restraint use is more beneficial than seat position.

Case report nonfracture associated fatal fat embolism in a case of child abuse

Fatal fat embolism is usually thought of as a sequel to long-bone fracture, although cases secondary to soft tissue injury and atraumatic conditions have been infrequently reported. In this case of a two-year-old child-abuse victim who sustained multiple blunt traumatic injuries without skeletal fractures, pulmonary and systemic (brain and kidney) fat emboli were identified. At autopsy, all thoracic and abdominal viscera were intact; cranial contents exhibited only diffuse symmetrical petechial hemorrhages of the white matter. Because of the severe and widespread nature of soft tissue hemorrhage, and the absence of a grossly discernible cause of death, fat embolism was suspected. Using a combination of frozen section with oil red O staining and formalin-fixed osmium stained tissues, the immediate cause of death was determined to be diffuse fat embolism. Review of the literature reveals a pathophysiologic basis for fat embolism in the absence of fracture, both as a consequence of an acute increase in local pressure at the site of trauma and an alteration of the emulsification of blood lipids during shock. In light of these findings, we present this case to remind the forensic science community to consider fat embolism as the cause of death in cases of blunt-force injury without fracture.

Cosleeping and sudden unexpected infant deaths in Kentucky: a 10-year retrospective case review.

This retrospective case review investigates modifiable risk factors in sudden unexpected infant deaths, including those attributed to sudden infant death syndrome, and examines the impact of cosleeping with adults or siblings. The study examines sudden unexpected infant deaths from 1991 to 2000 in the state of Kentucky, excluding homicides and deaths from identifiable natural causes. Meta-analysis provides a cosleeping prevalence control in normal infants. Based on the findings described herein, we conclude that cosleeping may represent a risk factor in sudden unexpected infant deaths and that a full scene investigation, including whether the infant was cosleeping, should be sought in all cases of sudden infant death.

In the shadow of the baron: Sudden death due to Munchausen Syndrome

The authors describe a woman who died suddenly in an emergency department restroom after self-injection of corn starch in an attempt to gain admission to the hospital. At autopsy, multiple pulmonary vascular corn starch granulomata were identified, as well as pulmonary arteries filled with brewers yeast. Retrospective evaluation of the patients medical history showed multiple signs of Munchausen Syndrome. The authors suggest that the case illustrates the importance of scene investigation and review of the medical history by emergency department personnel and the forensic pathologist.

The Interaction, Roles, and Responsibilities of the FBI Profiler and the Forensic Pathologist in the Investigation of Serial Murder

Of the many challenges facing the law enforcement community, one of the most difficult is the investigation of serial murder cases since these are high-profile, resource intensive investigations that provide unique challenges to the investigators. In addition, it is not uncommon for serial murder cases to extend across multiple jurisdictions, creating communication, investigation, and prosecution problems. The motivations of serial killers can be complex, and are more likely to be related to internal fantasies or desires, than to more traditional motivations such as financial gain. FBI Special Agents assigned to the Behavioral Analysis Units of the National Center for Analysis of Violent Crime are regularly called upon for assistance in the investigation of serial murder. A close working relationship between the medical examiner and forensic pathologist, respectively, with the primary investigator is essential to overcome challenges associated with investigating serial murder. In many serial homicide cases, the last activities and whereabouts of the victim are not known. In such cases, when a body is discovered, the forensic pathologist may be able to assist in determining final activities or events. In certain instances, the forensic pathologist may shed light on activities during the interval between disappearance and body discovery by analysis of findings such as stomach contents, and comparison of these findings with verifiable known accounts of the decedent’s activities in the period immediately preceding the disappearance. Investigatively and behaviourally, these findings will provide essential information regarding the window of opportunity that the offender had to commit the murder, as well as other important information, such as whether the offender kept the victim alive for a period of time before killing her/him.