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Medico-Legal Update

Reliability of Postmortem Lividity as an indicator of Time Since Death in Cold Stored Bodies

Author(s): Bhat Vrinda J, Palimar Vikram, G Pradeep Kumar

Vol. 5, No. 4 (2005-10 - 2005-12)

Bhat Vrinda J(1), Palimar Vikram(1), G Pradeep Kumar(2)

(1)Assistant Professor, (2)Professor, Department of Forensic Medicine, Kasturba Medical College, MAHE, Manipal – 5756119

Abstract

Determining the time since death is one of the most important aspects of postmortem examination. It is necessary for the forensic expert to estimate the time since death with high degree of accuracy, as subsequent investigation will be based on this estimate. It is evaluated with the help of the evidence, either on or around the body. Cooling of the body, postmortem lividity, rigor mortis and putrefactive changes are certain criteria by which time since death can be estimated from the body.

A study was conducted in the Department of Forensic Medicine, Kasturba Medical College, Manipal to determine the reliability of time since death with the help of postmortem lividity in cold stored bodies. 633 medico-legal autopsies conducted on the hospital deaths in the period of 2001-2004 were included in the study, of which postmortem lividity was appreciated only in 417 cases. The exact time of death and the duration of preservation in cold chamber were known in all the cases. The effect of cold temperature on the time of appearance and fixation of postmortem lividity was studied and correlated with the literature.

Key Words: Cooling, PM lividity, cold stored bodies

INTRODUCTION

The role of forensic medical examiner is often to interpret the last mute message of a violent death. One of the first things to be determined is the time since death or Postmortem interval. The longer between the time since death and the autopsy, the less exact the estimation of Postmortem interval will become. Post mortem lividity is one of the factors, which helps the doctor in estimating the time since death. Lividity results from gravitational pooling of blood in the veins and capillary beds on the dependent parts of the body following stoppage of circulation. It starts appearing as mottled patches by 1-3 hours after death and the process is complete by 4-6 hours post mortem. It is fixed in about 6-8 hours.

All the afore-mentioned observations apply to the bodies, which are stored in unaltered environmental conditions.

In the present study the authors have attempted to find whether there occurs any modification of the various parameters of Postmortem lividity when the bodies are stored in cold chamber

MATERIALS AND METHODS

633 medicolegal autopsies conducted in the Department of Forensic Medicine, KMC, Manipal over a period of 4 years (January 2001 to December 2004) were taken as pilot study.

The exclusion criteria for the study group were:

  1. Any evidence of external injury over the dependent parts for e.g. burns
  2. Bodies not preserved in cold chamber
  3. Brought dead cases where the exact time of death is not known

Hence, a total number of 417 cases were studied.

METHODS

The method of assessing the state of PM lividity was as follows:

  1. If there was no evidence of any discolouration, it was noted as: Lividity not appeared
  2. If the area blanched on pressure* it was noted as: Lividity not fixed
  3. If there was no change in the colour of Lividity on application of pressure* it was noted as: Lividity fixed
*Force applied with the thumb over the livid area for a period of 30 seconds.

OBSERVATIONS AND RESULTS

Of the 417 medicolegal autopsies, the PM lividity had not appeared in 32 cases, whereas, the lividity was not fixed in 143 cases. Two hundred and forty two (242) cases showed fixation of PM lividity. The PM interval was divided into 5 categories. The duration of their fixation, as per the categories, is as shown in Table 1. Maximum number of cases (122- 29.2%) were stored in the cold chamber within 2 hrs after death. The appearance, non-fixation, and fixation of the PM lividity in relation to the duration in the cold chamber are as depicted in Table. 2.

DISCUSSION

PM lividity is usually evident with in ½ – 2 hrs after death. In individuals, dying of terminal cardiac failure, it may actually appear antemortem. Lividity develops gradually, usually reaching its maximum coloration at 8- 12 hrs1. When there is no evidence of blanching of the livid area on pressure, it is said to be fixed. It is a well known fact that if the body is moved or turned prior to this the PM lividity shifts. In our study we have seen that in only 4.1% (17 cases) of cases PM lividity was not fixed even upto 12-18 hrs. Fixation of PM lividity can occur before 8-12 hrs if decomposition is accelerated but at cold temperatures it may be delayed upto 24-36 hrs1. In a study conducted on estimation of PM interval by lividity, over 50% of cases showed fixation of PM lividity after 12-24 hrs2. In the same study a significant number of cases showed non-fixation of PM lividity upto 3 days.

Fechner, Koops and Henssge3 conducted a study for the effect of different cold temperatures on the reaction of PM lividity and observed that the reaction was dependent on cold temperature but there was no linear relationship between fixation and time of death. The phenomenon of appearance of PM lividity showed variation in fixation according to different storage temperatures3. Our findings co-related with Di Maio & Di Maio1 and Fechner’s3 study. Thus the statement that PM lividity becomes fixed at 8-12 hrs is just a vague generalization, when the bodies are cold stored. Then, its variability is such that it is not useful for any estimation of time since death. To conclude, postmortem lividity as a parameter in determining postmortem interval is not reliable in circumstance where the bodies are exposed to cold temperatures.

REFERENCES

  1. Di Maio VJ, Di Maio D. Time of Death. In: Forensic Pathology, 2nd edition, CRC Press, New York; 2001, page 24
  2. Suzutani T, Ishibashi H, Takatori T. Studies on the estimation of Postmortem Interval. 2. The Postmortem lividity. Hokkaido Igaku Zasshi; 1978, 52 (6): pages 259-267
  3. Fechner G, Koops E, Henssge C. Cessation of Livor in Defined Pressure conditions. Z Rechtsmed; 1984, 93 (4): pages 283-287

Table 1: Distribution of the cases based on non-appearance, appearance and fixation of PM Lividity in relation to the time since death

Time Since Death PM Lividity
Not appeared
PM Lividity
Appeared
not Fixed
PM Lividity
Appeared &
Fixed
0 – 6 hours 09 34 19
6 – 12 hours 18 48 63
12 – 18 hours 04 44 75
18 – 24 hours 01 17 70
> 24 hours 00 00 15

Table. 2: Distribution of the cases based on non-appearance, appearance and fixation of PM Lividity in relation to the duration of cold storage of the

Time in
Cold Chamber
PM Lividity
Not appeared
PM Lividity
Appeared
not Fixed
PM Lividity
Appeared &
Fixed
0 – 3 hours 04 16 05
3 – 6 hours 05 21 20
6- 9 hours 13 23 25
9 – 12 hours 03 24 38
12 – 15 hours 03 14 40
15 – 18 hours 02 28 29
18 – 21 hours 01 08 38
21 – 24 hours 01 09 32
> 24 hours 00 00 15

Dr. Vrinda J Bhat
Assistant Professor
Department of Forensic Medicine, Kasturba Medical College, MAHE, Manipal – 5756119

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