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- Beer, Torfinn, 1992-
(författare)
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An epidemiological perspective on heart and lung weight in cardiac and intoxication deaths
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main purpose of a medico-legal autopsy is to determine the cause and manner of death. A forensic pathologist makes assessments of this using several sources of information, one of which is the discrepancy between measured organ weight and reference values. Of particular interest is the heart weight in heart disease and the weight of the lungs in fatal intoxications. In this thesis, a linear model of lung weight was created, but the model could at best explain only 13% of the variation in combined lung weight (Paper I). Unsurprisingly, this meant that the model was a poor definition of “normal” lung weight and could not be used to identify intoxication cases (Paper II). A ratio of lung weight to heart weight (LWHW ratio) also failed to differentiate intoxication cases from controls. The poor performance of these methods could plausibly have been due to fatal intoxications with only some substances being associated with increased lung weight, but an analysis showed that many common intoxicants were associated with heavier lungs than hanging deaths (Paper III). To establish heart weight references more applicable in a medico-legal autopsy population, a model of heart weight accounting for undiagnosed cardiac hypertrophy was created (Paper IV). The model showed that for a decedent of average the evidence that a was hypertrophic reached, substantial support at around 470 g.In conclusion, a definition of “heavy lungs” remains elusive. However, it seems to be a finding compatible with fatal intoxications with many substances and the low predictive value found may be due to study design. The heart weight model presented allows pathologists to assess the evidence of cardiac hypertrophy more easily than previously published models.
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| 2. |
- Beer, Torfinn, et al.
(författare)
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Cardiac enlargement in a medicolegal autopsy setting
- 2023
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Ingår i: American Journal of Forensic Medicine and Pathology. - : Wolters Kluwer. - 0195-7910 .- 1533-404X. ; 44:4, s. 267-272
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Tidskriftsartikel (refereegranskat)abstract
- A key element for diagnosing cardiac enlargement in an autopsy setting is relevant heart weight references. However, most available references are to a large extent not representative of a medicolegal autopsy population, implying that reference weights are likely lower than those in the relevant population.To establish more applicable heart weight references in a medicolegal autopsy population, we designed a heart weight model that accounts for undiagnosed cardiac enlargement using data from 11,897 nontraumatic Swedish medicolegal autopsy cases autopsied between 2010 and 2019. The model was validated in 296 nonobese young adult suicidal hanging cases.For a decedent of average height (174 cm), the evidence that a heart weight was enlarged reached weak support at approximately 430 g, substantial support at approximately 480 g, and strong support at 520 g. The modeled prevalence of cardiac enlargement was very high among elderly and obese decedents.We believe that our model is more applicable in a medicolegal setting than those previously published. The presented quantification of the degree of uncertainty regarding diagnosis can help the pathologist in diagnosing cardiac enlargement. To facilitate the use of this model, we also made it available through a simple online tool (https://formedum.shinyapps.io/HeartWeightCalc/).
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| 3. |
- Beer, Torfinn, et al.
(författare)
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Increased lung weight in fatal intoxications is not unique to opioid drugs
- 2023
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Ingår i: Journal of Forensic Sciences. - : John Wiley & Sons. - 0022-1198 .- 1556-4029. ; 68:2, s. 518-523
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Tidskriftsartikel (refereegranskat)abstract
- Fatal intoxications with opioids are known to be associated with an increased lung weight, as well as with brain and pulmonary edema and urinary retention. However, there is evidence to suggest that fatal intoxications with non-opioid substances are also associated with increased lung weight; however, the latter aspect has not been comprehensively analyzed. To determine to what extent opioid and non-opioid substances are associated with increased lung and brain weight, we studied these organs in cases where the cause of death was attributed to intoxication with a single agent. Using data from cases autopsied at the National Board of Forensic Medicine (NBFM) in Sweden from 2009 through 2019 where the cause of death was attributed to a single substance, we created models of combined lung weight and brain weight. The models used age and sex as predictors as well as nested varying effects for the specific intoxicant and category of intoxicant. Suicidal hanging with negative toxicology cases served as controls. The population majority was male among both intoxications (68%) and controls (83%). The most common single substance group was opioids. All tested substances were associated with heavier lungs than controls, with the largest effect in the opioid group. Our findings show that several substances are associated with increased lung weight and that among intoxication deaths there is no difference in expected brain weight between substances. Hence, heavy lungs, without a reasonable explanation, should prompt a broad toxicological screening.
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| 4. |
- Berg von Linde, Maria, et al.
(författare)
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A Swedish nationwide forensic study of the manner of death in single stab injuries to the trunk
- 2024
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Ingår i: Forensic Science International. - 0379-0738. ; 354
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Forensic pathologists are frequently confronted with questions about whether an injury is likely to have been inflicted by an assault or be self-inflicted. However, little is known of the epidemiological variables that might be applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk. Method Using the Swedish forensic autopsy register, we identified 94 homicides and 45 suicides between 2010 and 2021 in which death followed a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using the Mann-Whitney U test, Chi-square test and logistic regression model. Results Victims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p
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| 5. |
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| 6. |
- Berg von Linde, Maria, et al.
(författare)
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Forensic assessment of single stab injuries to the trunk
- 2023
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionForensic pathologists are frequently confronted with questions about the likelihood that an injury is inflicted by an assault or is self-inflicted. However, little is known of epidemiological variables applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk. MethodUsing the Swedish forensic autopsy register we identified 94 homicides and 45 suicides between 2010 and 2021 that died following a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using Mann-Whitney U and Chi-square test.ResultVictims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p < 0.05), and males were in majority in both groups (93% vs. 82%). Some homicidal stab wounds were placed on the posterior (12%) and axillar trunk (11%) unlike the suicidal stabs which were all placed on the anterior trunk. Most stab wounds of all examinations were placed on the left side of the anterior thorax (60%). In suicides, single stab injuries to the heart were more common than in homicides (67% vs. 48%, p < 0.05). Vasculature injuries were more common in homicides (51% vs. 9%, p < 0.05).DiscussionThe epidemiological variables could be used as a tool when assessing the manner of death in single stabs. Further research on variables associated with manner of death are needed and we suggest also including surviving victims in such analyses.
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| 7. |
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| 8. |
- Gustafsson, Torfinn, et al.
(författare)
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The utility of lung weight to heart weight ratio as a means to identify suspected drug intoxication deaths in a medico-legal autopsy population
- 2021
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Ingår i: Journal of Forensic Sciences. - : John Wiley & Sons. - 0022-1198 .- 1556-4029. ; 66:4, s. 1329-1333
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Tidskriftsartikel (refereegranskat)abstract
- Fatal intoxications are common in a medico-legal autopsy setting and are associated with sparse findings during autopsy. It has been suggested that an increased lung weight may be associated with such fatalities. Previous literature is generally limited to a descriptive approach, including only opioid deaths, and lacking a definition of “heavy” lungs. Our aim was to create a model to identify cases with heavy lungs and to assess the predictive power of “heavy” lungs in identifying cases of different types of fatal intoxications during autopsy in an unselected medico-legal autopsy population. We identified all medico-legal autopsy cases ≥18 years in Sweden from 2000 through 2013. The lung weight to heart weight (LWHW) ratio was calculated. The positive predictive values (PPV) and negative predictive values (NPV) of both lung weight and LWHW ratio were calculated. Mean lung weight was higher in the intoxication group but the predictive power in the individual case was limited. Lung weight to heart weight ratio had better predictive power than lung weight alone, with a PPV of at most 0.15(0.14, 0.16 95% CI), while the NPV was 0.96 (0.95, 0.96 95% CI). The association between fatal intoxication and increased lung weight was positive, regardless of method and cutoffs used. While the PPV was poor, the NPV could reduce suspicion of fatal intoxication in the absence of other information. LHWH ratio is only a probability factor for fatal intoxication; accurate cause of death determination—as always—requires consideration of circumstances, autopsy, and toxicologic findings.
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| 9. |
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| 10. |
- Ringqvist, Alexandra, et al.
(författare)
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Understanding medical aspects of violent crimes in Sweden’s region Skåne: a retrospective cross-sectional design of the ViCS project
- 2023
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Ingår i: Frontiers in Psychiatry. - 1664-0640. ; 14, s. 01-07
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: While there has been a reduction in specific homicide categories in Sweden, the last decade has witnessed an increase in the overall rate. The escalation is predominantly linked to heightened gun violence associated with criminal gangs. As a result, Sweden faces an extreme rate of shootings and firearm-related homicides, constituting one of the most severe instances across Europe. However, comprehensive scientific studies on this phenomenon are lacking. This paper presents the design of the Violent Crimes in Skåne (ViCS) project, which aims to investigate violent crimes requiring hospitalization or causing death in Sweden’s region Skåne from a medical, forensic, and criminological perspective. The project aims to examine the epidemiology and trends of violent crimes, injury profiles, treatments, patient outcomes, causes of death, and victim demographics.Methods and analysis: Using a retrospective cross-sectional design, ViCS will examine trauma by violent crimes from 2000 to 2019. Data will be sourced from several institutions, including hospital records from nine emergency hospitals, and the National Board of Forensic Medicine Agency. The project aims to study medical and criminological aspects of violent crimes, primarily focusing on assaults involving firearms, sharp weapons, blunt instruments, kicks, punches, and other types of assault like strangulation. Data analysis will involve descriptive and inferential statistics.Discussion: ViCS aims to contribute to the limited body of knowledge about victims of violent crimes in Sweden. The findings may inform evidence-based interventions in medical, forensic, and criminological fields, potentially enabling targeted prevention strategies and improvements in emergency care for victims.
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