Validation of age-related changes in contusions by gross examination and objective analyses

Abstract

The determination of age of injuries has been a longstanding issue in Forensic Medicine. There is paucity of work in this field and  standardized methodology. Estimation of age of wounds by visual inspection alone is subjective and susceptible to variation in  perception. This study intends to record, document and interpret the age of wounds from available history, gross examination by  naked eye and results of objective analyses by magnified digital photograph, examination under Wood's lamp and histological  evaluation, to devise a method for retrospective evaluation of the age of contusions. This is an autopsy based prospective study for a  period of 1year, involving 50 consecutive cases of contusions, conducted on dead bodies brought to the Department of Forensic  Medicine. The data obtained was analyzed by SPSS v18. Comparison of different components, significance of association, level of  correlation between various variables were determined, and sensitivity and specificity of various methods of analysis in determining  the age of wounds was established. On gross examination, contusions were predominantly red when <24hours old, bluish black on  day2,a greenish colour appeared at the earliest on day 3,and yellow on day 7. There was co-existence of yellow and green colours on  8-9days and all contusions on day10 were yellowish. There was positive correlation between the period of survival with  histopathological findings and also with colour by magnification of digital photograph which increased till 5-6 days. The association  between colour of contusion could be established precisely when examined under Wood's lamp illumination and survival period  reached maximum on 5-6days. Histology of contusions <24hours showed red blood cells, day2 showed neutrophils, lymphocytes on  day 3, macrophages from day 4, pigments from day 5, collagen fibres from 6 days, complete re-epithelisation from day 7, fibroblasts from  day 8, which increased in density on day 9 and10.The age of contusions was determined, and sensitivity and specificity of various  methods were assessed. It was concluded that an array of subjective and objective analyses can be used to establish the age of wound.