Laakko Essi, Oura Petteri
Department of Forensic Medicine, University of Helsinki, P.O. Box 21, Helsinki, FI-00014, Finland.
Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland.
Forensic Sci Med Pathol. 2024 Nov 14. doi: 10.1007/s12024-024-00913-5.
Traumatic brain injury (TBI) is a significant global health concern and frequently encountered in medico-legal autopsies. Previous studies suggest that certain TBI subtypes are more likely to co-occur than others. Therefore, we aimed to explore the potential of latent class analysis (LCA) to identify and characterize primary head injury combinations in neuropathologically examined medico-legal autopsy cases. The dataset comprised 78 cases from the Forensic Medicine Unit of the Finnish Institute for Health and Welfare over the period of 2016-2022. Data on background and circumstantial characteristics as well as primary and secondary head and brain injuries were collected from police documents, medical records, general autopsy reports and neuropathology reports. Latent class solutions with two to five classes were explored to identify clustering of primary head injuries among the sample. The dataset comprised 69.2% males and the median age was 49 years. In LCA, the solutions appeared reasonable, and each class appeared to represent a distinct TBI profile. The two-class solution was found to fit the present dataset best. Class 1 was characterized by older age, presence of an underlying CNS disease, and less diverse primary head injuries; these were interpreted as suggestive of lower traumatic forces. Class 2 was characterized by male sex and assaults as a prominent injury circumstance; subarachnoid and intracerebral/ventricular haemorrhages and contusions were classified exclusively into this class. In conclusion, this study identified two distinct subgroups of primary head injuries. Understanding typical injury combinations related to distinct circumstances could assist not only forensic pathologists but also clinicians treating TBI patients. However, the present latent class solution should not be interpreted as "ground truth", but instead further research is needed.
创伤性脑损伤（TBI）是一个重大的全球健康问题，在法医学尸检中经常遇到。先前的研究表明，某些TBI亚型比其他亚型更易同时出现。因此，我们旨在探讨潜在类别分析（LCA）在法医学尸检病例神经病理学检查中识别和表征原发性头部损伤组合的潜力。该数据集包括芬兰健康与福利研究所法医学部门在2016年至2022年期间的78例病例。从警方文件、医疗记录、普通尸检报告和神经病理学报告中收集了背景和情况特征以及原发性和继发性头部及脑部损伤的数据。探索了具有两到五类的潜在类别解决方案，以识别样本中原发性头部损伤的聚类情况。该数据集男性占69.2%，中位年龄为49岁。在LCA中，解决方案看起来合理，每个类别似乎都代表了一种独特的TBI特征。发现两类解决方案最适合当前数据集。第1类的特征是年龄较大、存在潜在的中枢神经系统疾病以及原发性头部损伤种类较少；这些被解释为提示较低的创伤力。第2类的特征是男性以及袭击是突出的损伤情况；蛛网膜下腔和脑内/脑室内出血及挫伤仅归入此类。总之，本研究确定了原发性头部损伤的两个不同亚组。了解与不同情况相关的典型损伤组合不仅有助于法医病理学家，也有助于治疗TBI患者的临床医生。然而，目前的潜在类别解决方案不应被解释为“基本事实”，而是需要进一步研究。
