Abstract:The correct and complete diagnosis is essential for the adequate care and the favourable clinical evolution of the patients with head trauma. Purpose: To identify the error rate in the clinical diagnosis of head injuries as shown in comparison with the autopsy diagnosis and to identify the most common sources of error. Material and method: We performed a retrospective study based on data from the medical files and the autopsy reports of patients with head trauma who died in the hospital and underwent forensic autopsy. We collected: demographic data, clinical and laboratory data and autopsy findings. To quantify the concordance rate between the clinical diagnosis of death and the autopsy diagnosis we used a 4 classes classification, which ranged from 100% concordance (C1) to total discordance (C4) and two classes of partial discordance: C2 (partial discordance in favour of the clinical diagnosis-missing injuries in the autopsy reports) and C3 (partial discordance in favor of the necroptic diagnosis-missing injuries in the medical files). Data were analyzed with SPSS version 20.0. Results: We analyzed 194 cases of death due to head injuries. We found a total concordance between the clinical death diagnosis and autopsy diagnosis in 30.4% of cases and at least one discrepancy in 69.6% of cases. Increasing the duration of hospitalization directly correlates with the amount of the imaging investigations and these in turn correlates with an increased rate of diagnosis concordance. Among the patients with stage 3 coma who associated a spinal cord injury, we found a partial diagnosis discordance in 50% of cases and a total discordance in 50% of cases, possibly due to the need for conducting emergency imaging investigation and the need for surgical treatment. In cases with partial and total discordant diagnosis, at least one lesion was omitted in 45.1% of the cases. The most commonly omitted injuries in C2 cases were subdural hematoma, intracerebral hematoma and ventricular hemorrhage (21.6%). In C3 cases the most frequently omitted injuries were subarachnoidian hemorrhage and skull base fractures autopsy diagnosis. Autopsy may identify the inconsistencies in diagnosis, the injuries frequently skipped and the factors favoring the discordance rate between the clinical death diagnosis and the autopsy diagnosis, making it a valuable tool for improving the clinical care of the patients with head trauma.

The natural course of evolution of the human body after death includes autolysis, putrefaction and skeletonization. Under specific environmental conditions, the body may bypass this natural path, leading to preservation, such as saponification (adipocere), lignification, mummification or refrigeration, comprising the entire body or being limited only to some parts of it. All these preservation processes have a chemical substrate, and the identification of their components may be useful in many forensic circumstances, such as clandestine activity and identification of victims in mass disasters, when pentanoic, butanoic, hexanoic acid, butanoic acid-butyl ester, hexanoic acid-ethyl ester, indole, dimethyl disulphide may be used to train human remains detection dogs. The authors present the case of a 73 years old woman who was found dead in a sewage collection basin 4 months after her disappearance in July. The autopsy revealed a mixture of cadaveric processes, some parts being disintegrated, with putrefaction and skeletonization, while other parts were preserved by saponification: areas of adipocere were found on the neck, thorax and the anterior part of the abdomen. In some instances the saponification of the corpses makes identification possible and preserves violence marks, but the combination with putrefaction burdens these goals. The identification in this case was possible using the teeth formula, keeping in mind that tooth and bones are the most resistant to putrefaction. Even though saponification makes difficult the estimation of postmortem interval, investigations of its chemical composition may be useful in this direction, as the epicoprostanol-cholesterol ratio proved to increase with the increasing of postmortem interval.

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From its beginning, the autopsy represented a useful instrument for the progression of medicine and continues to be a valuable tool in postmortem diagnosis of various diseases or traumatic injuries. Modern laboratory technology is an important aid in achieving autopsy goals but it is either not available or not permanently available in all the departments of Forensic Medicine and do not offer every time quick results, which might be necessary to guide the next steps of the forensic investigation. In this paper the authors present a set of rapid, sensitive and effective chemical reactions, described in the literature over the time and meant to support the forensic experts, as they can be easily performed in the autopsy room. Moreover, the application of these reactions may reduce the costs of laboratory analyzes in cases where the use of expensive laboratory technologies is no longer required or limited by the results of these reactions. Also, a brief description of the collection method for biological samples to be used is provided. At the end of the paper the authors suggest a minimum kit of chemical substances which are necessary in the autopsy room, in order for these analyses to be performed.