Vehicular homicide or cardiovascular event? The importance of the autopsy findings

• Published in: Legal medicine (Tokyo, Japan) Vol. 67; p. 102386
• Main Authors: Capasso, Emanuele, Cortese, Roberto, Auriemma, Gianluca, Di Biase, Sabrina, Di Donna, Gaetano, Niola, Massimo
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.03.2024
• Subjects: Autopsy; Chronic ischemic heart disease; Excess mortality; Female; Femur fracture; Heart Arrest; Homicide; Humans; Middle Aged; Myocardial infarction; Myocardial Ischemia; Pedestrian investment; Myocardial infarction; Femur fracture; Pedestrian investment; Excess mortality; Chronic ischemic heart disease
• ISSN: 1344-6223; 1873-4162
• DOI: 10.1016/j.legalmed.2023.102386

•Vehicular accidents are the most dangerous mode of transport in the world.•Pedestrian investment may pose numerous medico – legal issues when death occurs not in the immediacy of the event.•The analysis of such cases needs integration of a full autopsy, study of clinical records and multidisciplinary approach.•This type of cases is little reported and discussed in scientific literature.•This paper is a call to the scientific community to study epidemiological and medico-legal aspects of the issue. We present the case of a 61 years old woman who was hit by a car, resulting in fractures of the pubic bone, left ischium-pubis ramus and right femur, with need of hip replacement surgery. In the next days she was affected by two episodes of acute coronary syndrome, treated with coronary angioplasty surgery. After undergoing total hip replacement surgery an episode of asystole caused her death. A full autopsy showed coronary stenosis and chronic ischemic heart disease associated with a recent myocardial infarction. The pre-existing condition of T.L. could not be ignored but the initial traumatic event and the subsequent fractures played a further co-occurrent causal role. The initial trauma represented the first step of the phenomenological chain that led to a series of adverse cardiological events and to an irreversible asystole, so that the car driver should be partly considered accountable for the death of the woman.