Freeman Michael D, Kohles Sean S
Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, USA.
Wien Med Wochenschr. 2011 Oct;161(19-20):458-68. doi: 10.1007/s10354-011-0909-3. Epub 2011 Jul 29.
Biomechanical tests of post hoc probability have been proposed by prior authors as reliable tests of causation in forensic settings. Biomechanical assessment of injury kinetics and kinematics is a potentially important tool in forensic medicine, but there is also the potential for misapplication. The most reliable application is when biomechanical analysis is used to explain injury mechanisms, such as how an injury may have occurred. When a biomechanical analysis is used as a means of determining whether, rather than how an injury has resulted from a traumatic exposure, then a lack of reliability of the methodology limits its application in forensic medicine. Herein, we describe a systematic assessment of causation by adapting established general causation principles to specific causation scenarios, and how biomechanical analysis of injury mechanics is properly used to augment such an approach in conjunction with the principles of forensic epidemiology. An example calculation of relative risk associated with cervical spine injury is provided as a representative probabilistic metric for assessing causation. The statistical benefits and limitations of biomechanical analysis are discussed as an adjunct to forensic medicine.
先前的作者提出了事后概率的生物力学测试，作为法医环境中因果关系的可靠测试。损伤动力学和运动学的生物力学评估是法医学中一个潜在的重要工具，但也存在误用的可能性。最可靠的应用是将生物力学分析用于解释损伤机制，例如损伤可能是如何发生的。当生物力学分析被用作确定损伤是否由创伤暴露导致，而不是如何导致时，该方法缺乏可靠性限制了其在法医学中的应用。在此，我们描述了通过将既定的一般因果关系原则应用于特定因果关系场景进行因果关系的系统评估，以及如何将损伤力学的生物力学分析与法医流行病学原则相结合，恰当地用于增强这种方法。提供了一个与颈椎损伤相关的相对风险的示例计算，作为评估因果关系的代表性概率指标。讨论了生物力学分析作为法医学辅助手段的统计益处和局限性。
