Journal Article

An evidence-based approach to forensic life-threat assessments using spleen injuries as an example

Wingren, Carl Johan

2023

Overview

During the judicial process of addressing violent crime, a forensic practitioner may need to assess whether an inflicted injury should be considered life-threatening. This could be important for the classification of the crime. To some extent, these assessments are arbitrary since the natural course of an injury might not be completely known. To guide the assessment, a quantitative and transparent method based on rates of mortality and acute interventions is suggested, using spleen injuries as an example. The electronic database PubMed was searched using the term “spleen injuries” for articles reporting on rates of mortality and interventions such as surgery and angioembolization in spleen injuries. By combining these different rates, a method for a transparent and quantitative assessment of the risk to life across the natural course of spleen injuries is presented. A total of 301 articles were identified, and 33 of these were included in the study. The mortality rate of spleen injuries, as reported in studies, varied between 0% and 2.9% in children, and between 0% and 15.4% in adults. However, when combining the rates of acute interventions and the mortality rates, the risk of death across the natural course of spleen injuries was estimated as 9.7% in children, and 46.4% in adults. The calculated risk of death across the natural course of spleen injuries in adults was considerable higher than the observed mortality. A similar but smaller effect was observed in children. The forensic assessment of life-threat in cases involving spleen injury needs further research; however, the applied method is a step towards an evidence-based practice for forensic life-threat assessments. •Introducing an evidence-based practice in assessing the threat to life that an injury carries in a judicial context.•In the natural course of spleen injuries the observed mortality rate underestimates the risk to life.•The risk to life in a judicial setting is estimated by adding the rates of mortality and acute interventions.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Adult / Adults / Annan medicin och hälsovetenskap / Assessments / Cause of Death / Child / Children / clinical forensic medicine / Crime / Databases, Factual / Death / evidence-based practice / Forensic Medicine / Forensic Science / Forensic sciences / Humans / Injuries / Intervention / Life-threat assessment / Medical and Health Sciences / Medicin och hälsovetenskap / Mortality / Mortality rate / Other Medical and Health Sciences / Pediatrics / risk / Risk assessment / Rättsmedicin / Spleen / Spleen injury / Surgery / Threat assessment / Threat evaluation / Violence / Wounds and Injuries