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Aim of the work In forensic anthropology, the estimation of age at death is required to establish a biological profile and facilitate individual identification. The pubic symphysis represents one of the most studied skeletal structures due to its late maturation. In this respect, the Suchey-Brooks (SB) system is one of the most commonly used methods of assessment based on the morphological characteristics of the pubic symphysis. However, the SB method has certain drawbacks, including frequently inaccurate estimation for individuals over 40 years old. The main aim of this work was to study the inter-observer agreement in the SB method then to test the errors of estimation by three observers with heterogeneous experience from a computed tomography sample for individuals aged between 15 and 98 years old. Patients and methods We retrospectively studied pubic bones from 50 males and 50 females undergoing clinical multislice computed tomography (MSCT) in a French hospital between November 2017 and April 2018. Results The inter-observer reliabilities, with or without the early and advanced patterns, were excellent between the observers (kappa values between 0.8 and 0.95). By focusing on the first three phases (I–III) versus the last three phases (IV–VI), there was no significant difference between the inter-observer reliabilities (kappa values between 0.44 and 0.85). Conclusion The inaccuracy rose with age, showing a growing underestimation from 40 years old and beyond. Besides, we highlighted a moderate overestimation for younger individuals. These errors of estimation were slightly dependent on the experience of the observer.

Resume Introduction La taille est l’un des elements d’identification en medecine legale qui doit etre estime lorsque l’etat du corps n’en permet pas la mesure. La plupart du temps, cette estimation s’appuie sur les equations de Trotter et Gleser (ETG) etablies, il y a 70 ans sur une population americaine a partir de la mesure d’os longs d’individus de taille connue. L’objectif principal de notre etude etait de comparer des mesures scanographiques d’os longs effectuees sur des corps d’individus francais autopsies au modele issu des ETG puis de comparer la taille estimee par ces equations a la taille reelle. Materiel et methode Nous avons inclus l’ensemble des corps ayant beneficie d’une autopsie et d’un scanner a l’institut medicolegal de Tours en 2017. Nous avons mesure les os longs sur les scanners et les avons compares au modele des ETG. La taille estimee a ensuite ete comparee a la taille mesuree. Resultats Au total, 99 hommes et 43 femmes ont ete inclus. Les longueurs effectuees sur le femur etaient a 95,96 % (chez l’homme) et a 100 % (chez la femme) incluses dans l’intervalle de confiance a 95 % de l’ETG. L’estimation de la taille par les ETG tendait a sous-estimer la taille des individus les plus grands et a surestimer la taille des individus les plus petits. Conclusion Ce travail a confirme le femur comme l’os long le plus utile pour estimer la taille. Une etude sur un nombre plus important d’individus permettrait d’adapter les ETG a notre population.

In forensic anthropology, the estimation of age at death is mainly required to establish a biological profile and facilitate individual identification. The Suchey–Brooks (SB) system represents one of the most commonly used and tested methods of assessment based on the morphological characteristics of the pubic symphysis. However, this method has certain drawbacks, including frequently inaccurate estimation for older individuals. The aim of this work was to test the evolution of pubic bone mineral density (BMD) according to age, especially for individuals over 40 years old. We retrospectively studied pubic bones from males (n = 88) and females (n = 113) over 40 years of age undergoing clinical multi-slice computed tomography (MSCT) in a French hospital between November 2017 and April 2018. The results revealed a significant negative correlation between BMD and age for males (R = −0.62) and females (R = −0.55). The intra- and inter-observer reliabilities of the phase allocation were moderate for males (kappa values at 0.72 and 0.65) and strong for females (kappa values at 0.93 and 0.86). Moreover, a significant difference in BMD between stages 6-1 and 6-2 for males was observed. We hypothesize that BMD might help improve the reliability of the SB system for older individuals. In addition to the pubic bone, numerous other anatomical regions such as the area of Ward could represent interesting areas of study in order to relate bone density to age.

International audience; Medicolegal physicians are increasingly called upon to aid in determining the administrative age group affiliation of refugees with questionable unaccompanied minor claims. According to guidelines for forensic age assessment, age differentiation along the 18-year-old cut-off relies on clavicular ossification. The thin-slice computed tomography scan (TSCTs) of the medial clavicular epiphysis (MCE) is one of the methods contributing to this assessment, though it is not yet universally accepted. The aim of this systematic review was to identify scientific papers where age was assessed using TSCTs of the MCE and to observe whether this examination was reproducible and reliable in estimating a person's age relative to the 18-year-old threshold. A search algorithm was applied to several databases to identify articles in accordance with the PRISMA (Preferred Reporting Items for Systematic-Reviews and Meta-Analyses) statement. One boxplot per article was constructed, separating by stage of maturation and sex. The 13 articles selected represented a sample of 5605 individuals (3396 males, 2209 females) aged 10 to 35~years. All individuals classified as stages 4 and 5 were aged 18~years or older. The same result was obtained concerning stage 3c, except in one article. The results thus appear reliable and reproducible, in particular, with respect to the 18-year-old threshold; medicolegal physicians should be able to estimate that all individuals in stages 4 and 5 are at least 18~years old. Additional studies applied to several other populations in the world should complement the selected studies.

International audience; We report on a comprehensive 25-year study on criminal medical liability in France, undertaken to establish trends in the number of cases being brought before the criminal courts. We did this by interrogating the database on the Légifrance website using a Boolean equation (' pénal' (criminal) AND ' médecin' (physician) OR ' docteur' (doctor)). In total 539 cases were selected, in which the status of the physician either influenced the punishment imposed, or was a prerequisite for the commission of the offence. The results of the search produced two outcomes: offences and the dates of the most recent criminal judgements (which had been left blank). Further data were also collected: references to court cases, hearing dates, offence dates, procedural time limits, numbers of accused parties, types of punishments and physician characteristics. The number of court hearings increased from the 1980s until the late 1990s. Since then, it has remained stable at around 25 cases per year. Of the defendants appearing before the courts, 39.2% have been found guilty. On average, 10 to 13 physicians every year - that is, one per month - are punished. Those most often punished are obstetrician-gynaecologists (13%), followed by intensive care anaesthetists (11%) and then by general practitioners (6.7%). The offences most frequently occurring are manslaughter (36.5%), illegal profits (12%), unintentional injuries (11.5%) and sexual offences (10.1%). The results are most reassuring in terms of the risks posed by the practice of medicine in France. Such a risk does indeed exist; however, it is at a low level and stable.