Bright Fiona, Gilbert John D, Winskog Calle, Byard Roger W
Discipline of Anatomy and Pathology, The University of Adelaide, Frome Road, Adelaide, SA 5005, Australia.
J Forensic Leg Med. 2013 Aug;20(6):595-7. doi: 10.1016/j.jflm.2012.11.002. Epub 2012 Dec 2.
An 86-year-old woman was found dead lying on her back on the floor of an unkempt kitchen. She had last been seen four days before. Her dress was pulled up and she was not wearing underpants. The house was noted to be in "disarray" with papers covering most surfaces and the floor. Rubbish was piled up against one of the doors. At autopsy the major findings were of a fractured left neck of femur, fresh pressure areas over her right buttock, Wischnewski spots of the stomach and foci of pancreatic necrosis, in keeping with hypothermia. No significant underlying organic diseases were identified and there was no other evidence of trauma. Death was due to hypothermia complicating immobility from a fractured neck of femur. This case confirms the vulnerability of frail, elderly and socially-isolated individuals to death from hypothermia if a significant illness or injury occurs. Additional risk factors for hypothermia are also illustrated in this case that involve inadequate housing construction with absent insulation and window double glazing. The approach to hypothermic deaths should, therefore, include checking for these features as well as measuring room and environmental temperatures, evaluating the type and quality of heating and the nature of the floor and its coverings, Given the ageing population in many Western countries, increasing social isolation of the elderly, cost of fuel and electricity, and lack of energy efficient housing, this type of death may become an increasingly witnessed occurrence during the colder months of the year.
一名86岁女性被发现仰卧在凌乱不堪的厨房地板上死亡。人们最后一次见到她是在四天前。她的裙子被撩起，且未穿内裤。房子里一片“混乱”，大多数表面和地板上都堆满了文件。垃圾堆积在其中一扇门前。尸检的主要发现包括左股骨颈骨折、右臀部有新的受压区域、胃内出现维斯涅夫斯基斑以及胰腺坏死灶，符合体温过低的表现。未发现明显的潜在器质性疾病，也没有其他外伤证据。死亡原因是股骨颈骨折导致行动不便并发体温过低。该病例证实了体弱、年迈且社会孤立的个体在发生重大疾病或损伤时，极易因体温过低而死亡。该病例还说明了体温过低的其他危险因素，包括房屋建筑隔热不足且没有双层玻璃窗。因此，对于体温过低导致的死亡案例，调查方法应包括检查这些特征，以及测量室内和环境温度，评估供暖类型和质量、地板及其覆盖物的性质。鉴于许多西方国家人口老龄化、老年人社会孤立现象加剧、燃料和电力成本高昂以及缺乏节能住房，在一年中较寒冷的月份，这类死亡情况可能会越来越常见。
