legal medicine journal club alejandro garcés descovich emily rincón Álvarez jorge enrique ruíz m...

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Legal MedicineJournal Club

Alejandro Garcés Descovich

Emily Rincón ÁlvarezJorge Enrique Ruíz M

Universidad de La SabanaLegal MedicineXI SemesterApril 24th of 2010

KEYWORDS:

• Forensic age estimation• Criminal proceedings• Dental age• Skeletal maturity

CONTENT INDEX

1. Introduction

2. Materials and Methods

3. Results

4. Discussion

5. Conclusions

6. Questions time

INTRODUCTION

Estimating the age of living subjects as a problem

Difficult problems facing forensic medicine Criminal Proceedings Doubt (Authorities) Charging of a crime according to age

INTRODUCTION

The need for accurate age estimation techniques has never been greater due to armed conflicts in many countries in our time Immigrants Asylum-seekers

INTRODUCTION

Time consuming task that requires interdisciplinary approach.

Physicians with forensic experience Knowledge of Auxology Radiology Dentistry Legal Medicine

INTRODUCTION

Main objective Differences between

Skeletal Dental age assesments

Comparison of left hand/wrist radiographs and OPG’s

INTRODUCTION

INTRODUCTION

A = Calcification of oclusal points.

B = Fusion of the calsification points

C = End of formation of the enamel.

D = Formation of the crown.

E = The lenght of the root is shorter than the height of the crown.

F = The lenght of the root is the same that the crown.

G = the end of the formation of the root.

H =Closing of the apical orifice.

DERMIRJIAN METHOD

MATERIALS AND METHODS

Retrospective review

Sample 52 immigrants (41 males 11

females) Bari, Italy.

MATERIALS AND METHODS

Originated from areas with major world conflict The Balkans (Slovenia, Serbia, Croatia) Albania Middle East (Palestine, Lebanon, Iran, Iraq, Egypt) (Algeria, Morocco, Nigeria).

MATERIALS AND METHODS

Data: May 1989 to September 2007

Clinical assessment of the individuals Physical examination (Body Mass Index) Signs of sexual maturity (Tanner Staging System)

MATERIALS AND METHODS

Data: Skeletal development

Radiologic exam of Left hand/wrist (Greulich-Pyle method)

Dental examination Inspection oral cavity OPG’s (Panorex)

Pelvic X-ray (23 individuals)

MATERIALS AND METHODS

RESULTS

26 of the 52 individuals Reported ages lower than the assessed ages.

In 43 of all cases, the reported age was 18 years, but only 17 were confirmed by radiographic examinations

OPGs Hand/wrist X-rays

In 26 cases age estimation the individuals were older than had been reported.

RESULTS

RESULTS

Case no. 25: Reported age:

16 years and 8 months Estimated biological age:

22 years and 6 months

Discrepancy in reported age was 5 years and 10 months

RESULTS

Statistically significant difference between: Reported age and assessed biological age

(t = 4.085; p < 0.001)

No statistically significant difference between: Skeletal age and assessed dental age

(t = 0.791; p = 0.431).

DISCUSSION

Analysis of the data revealed:

Significant correlation between: Results from:

Left hand/wrist X-rays OPGs

Almost every individual, indicating:

• Similar growth patterns:• Skeletal• Dental structures

Younger than 16 years

THE OLDER A SUBJECT BECOMES=

THE LESS ACCURATE THE METHODS ARE

DISCUSSION

Markers for: Bones Teeth Sexual development

The only reliable indices for assessing a living individual’s age in forensic settings.

DISCUSSION

Sexual development markers + BMI Is not appropriate for age estimation (Variability)

Diseases (disproportionate growth) Result of malnutrition Congenital disorders

Physical examination (Empirical)

DISCUSSION

X-rays represent the most objective method Assessing dental and bone maturity.

Immigrants in an attempt to avoid criminal prosecution Report their ages as younger than they actually are.

CONCLUSIONS

Standardization of methods used in the age estimation of living individuals is imperative.

All of the techniques employed to asses age in a living individual Estimates of Biological age Doesn’t certains chronological age

CONCLUSIONS

Differences in the rate of ossification in various age-groups Primarily the result of:

Socioeconomic factors

A careful approach to age determination is necessary Few physicians are skilled in forensic age determination. Entrust expert pathologists with the task of performing

age assessment

QUESTIONS???

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