Relative blood loss in forensic medicine—do we need a change in doctrine?

Potente, Stefan

Ramsthaler, Frank

Kettner, Mattias

Sauer, Patrick

Schmidt, Peter

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Name

Value

Titel

Relative blood loss in forensic medicine—do we need a change in doctrine?

Autor/in

Erscheinungsjahr

2020

Publikationstyp

Artikel |

Online veröffentlicht

2020-03-06

Erschienen in

http://lobid.org/resources/99370678532606441#! |

Quellenangabe

134(3):1123-1131

Copyrightjahr

2020

Lizenz

https://creativecommons.org/licenses/by/4.0/ |

Verlagsversion

https://doi.org/10.1007/s00414-020-02260-w |
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181451/ |

Publikationsstatus

Postprint Verlagsversion |

Sprache der Publikation

Englisch |

Abstract/Summary

In forensic medicine, blood loss is encountered frequently, either as a cause of death or as a contributing factor. Here, risk to life and lethality assessment is based on the concept of relative blood loss (absolute loss out of total volume). In emergency medicine, the Advanced Trauma Life Support (ATLSⓇ) classification also refers to relative blood loss. We tested the validity of relative blood loss benchmarks with reference to lethality. Depending on the quality of the total blood volume (TBV) estimation formula, relative blood loss rates should be reflected in the case cohort as significantly higher absolute blood loss in heavier individuals since all TBV estimation formulas positively correlate body weight with TBV.!##!Method!#!80 autopsy cases with sudden, quantifiable, exclusively internal blood loss were retrospectively analyzed and a total of 8 different formulas for TBV estimation were applied.!##!Results!#!No statistical correlation between body weight and absolute blood loss was found for any of the tested TBV estimation algorithms. All cases showed a wide spread of both absolute and relative blood loss.!##!Discussion!#!The principle of relative blood loss is of very limited use in casework. It opens the forensic expert opinion to unnecessary criticism and possible negative legal implications.!##!Conclusion!#!We challenge the use of relative blood loss benchmarks in textbooks and practical casework and advocate for its elimination from the ATLSⓇ 's grading system. If necessary, we recommend the use of BMI-adjusted algorithms for TBV estimation.

Sacherschließung

lokal	Algorithms [MeSH]
lokal	Female [MeSH]
lokal	Exsanguination
lokal	Humans [MeSH]
lokal	Reference values
lokal	Forensic
lokal	Retrospective Studies [MeSH]
lokal	Shock/classification [MeSH]
lokal	Body Weight [MeSH]
lokal	Practice Guidelines as Topic/standards [MeSH]
lokal	Hypovolemic shock
lokal	Nomograms [MeSH]
lokal	Body Mass Index [MeSH]
lokal	Original Article
lokal	Haemorrhagic shock
lokal	Male [MeSH]
lokal	ATLSR
lokal	Blood Volume [MeSH]
lokal	Autopsy/methods [MeSH]
lokal	Blood loss
lokal	Hemorrhage/classification [MeSH]

Liste der Beteiligten

https://orcid.org/0000-0002-7196-5964|https://frl.publisso.de/adhoc/uri/UmFtc3RoYWxlciwgRnJhbms=|https://frl.publisso.de/adhoc/uri/S2V0dG5lciwgTWF0dGlhcw==|https://frl.publisso.de/adhoc/uri/U2F1ZXIsIFBhdHJpY2s=|https://frl.publisso.de/adhoc/uri/U2NobWlkdCwgUGV0ZXI=

Hinweis

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