Journal of forensic and legal medicine最新文献

{"title":"Forensic diatomology of Pong dam reservoir: Implications for drowning diagnosis and site identification","authors":"Ajay Singh Rana ,&nbsp;Priyanka Verma ,&nbsp;Meenakshi Mahajan","doi":"10.1016/j.jflm.2026.103094","DOIUrl":"10.1016/j.jflm.2026.103094","url":null,"abstract":"<div><div>Determining antemortem drowning in medico-legal casework remains a persistent forensic challenge, particularly in bodies exhibiting advanced putrefactive changes, where conventional morphological indicators are no longer discernible. Forensic diatomology provides a critical microtrace-evidence framework for substantiating drowning and enabling immersion-site attribution through ecological fingerprinting of diatom assemblages. Despite the frequent retrieval of suspected drowning victims from the Pong Dam reservoir hydrologically influenced by the Beas river no comprehensive spatiotemporal diatom baseline exists to support comparative forensic analyses.</div><div>In this study, high-resolution limnological profiling and detailed morphotaxonomic diatom characterization were undertaken across five sampling stations and six seasonal intervals. A total of 113 taxa were identified using light microscopy and standardized diatom preparation protocols. Canonical Correspondence Analysis (CCA) demonstrated statistically robust relationships between diatom community composition, hydroclimatic seasonality, and key physicochemical drivers. The reservoir exhibited pronounced assemblage homogenization, reflecting dominance by environmentally tolerant euryhaline and eurythermal taxa with high dispersal potential.</div><div>This investigation provides the first spatially resolved, seasonally stratified diatom reference dataset for Pong Dam, delineating site-specific and season-responsive indicator taxa with demonstrable forensic utility. The dataset significantly strengthens diatomological comparison in drowning cases, particularly when postmortem intervals encompass multiple seasonal transitions. These findings enhance diagnostic reliability in immersion-site reconstruction and reinforce the evidentiary value of diatom microtraces in complex medico-legal drowning determinations.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103094"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Safety of Conducted Energy Devices: Electrophysiological mechanisms, risk assessment, and forensic interpretation","authors":"Charles D. Deakin","doi":"10.1016/j.jflm.2026.103082","DOIUrl":"10.1016/j.jflm.2026.103082","url":null,"abstract":"<div><h3>Background</h3><div>Conducted Energy Devices (CEDs) or Conducted Energy Weapons (CEWs), among which the best known are the TASER® brand, are increasingly deployed by law-enforcement agencies. Their established cardiac safety is overshadowed by temporally-associated sudden deaths, which are often directly attributed to CED discharge. Concern remains that in rare cases, high-voltage CED pulses might directly induce fatal cardiac arrhythmias.</div></div><div><h3>Methods</h3><div>This review considers electrophysiological evidence, computational modelling, and forensic case data to understand the mechanisms governing cardiac stimulation during CED exposure. It discusses strength–duration relationships, differential excitement of neuromuscular and myocardial tissues, and compares predicted electrical stimulation thresholds with those determined by finite element modelling. This evidence is compared with clinical evidence of CED-induced malignant arrythmias.</div></div><div><h3>Findings</h3><div>CED pulses of 50–100 μs are both too brief and too weak to depolarise cardiac myocytes under normal anatomical conditions. Finite-element and finite-integration models show typical myocardial current densities of 0.27–0.6 mA cm⁻² which are more than two orders of magnitude below the short-pulse VF threshold of ∼100–150 mA cm⁻² (≈4 mA cm⁻² RMS). Layered thoracic modelling demonstrates that muscle anisotropy and chest-wall thickness diverts almost 90 % of current laterally, producing cardiac field strengths far beneath depolarisation levels. Rare trans-cardiac probe alignments or thin chest walls, however, may approach capture thresholds and therefore cannot be considered completely risk-free.</div></div><div><h3>Conclusions</h3><div>Current evidence indicates that in all but extreme probe geometries or paediatric exposures, CED are at minimal risk of inducing malignant arrhythmias. Forensic assessment of CED-related deaths should consider electrophysiological principles with probe placement, the timing of the collapse, and toxicological findings in order to distinguish coincidental from causally related events.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103082"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence of point-of-care diagnostics in forensic death investigations: A scoping review","authors":"Sebueng Ramatsokotla ,&nbsp;Bathabile Soul ,&nbsp;Evans Duah ,&nbsp;Letlhogonolo Sekwele ,&nbsp;Gabrielle Thompson ,&nbsp;Kuhlula Maluleke ,&nbsp;Linda Mbonambi ,&nbsp;Tivani Mashamba-Thompson","doi":"10.1016/j.jflm.2026.103086","DOIUrl":"10.1016/j.jflm.2026.103086","url":null,"abstract":"<div><h3>Background</h3><div>Point-of-care (POC) diagnostics represent promising health-technology tools capable of providing rapid, on-site analytical support for forensic investigations. This scoping review aimed to systematically map the available evidence on applying POC diagnostics in forensic investigations. The focus is on their potential ability to act as rapid screening and triage tools to assist in determining the cause of death and exploring the challenges and opportunities associated with their implementation on a global scale.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across multiple databases, including PubMed, ProQuest Central, Academic Search Complete, Africa Wide, CINAHL, MEDLINE, and Web of Science. Out of the 7603 records screened, four studies met the eligibility criteria and were included in the review. Reporting adhered to the PRISMA-ScR guidelines.</div></div><div><h3>Results</h3><div>These studies demonstrated the expanding role of POC devices in various aspects of forensic investigations, including rapid triage in overdose cases, malaria diagnosis in travel-related deaths, SARS-CoV-2 screening, and hemoglobin testing in child deaths. These studies also highlighted the limitations of POC devices in the postmortem context, emphasizing the need for careful calibration, confirmation, and interpretation of the results. This review identified POC diagnostics as a potential bridge between forensic investigations and public health surveillance, with findings indicating both cause-of-death determination and broader public health strategies. Operational, ethical, and policy considerations for using POC devices in forensic investigations were also discussed.</div></div><div><h3>Conclusion</h3><div>This review revealed challenges in ensuring the standardization, accuracy, and integration of POC diagnostics into established forensic practices. Further research is required to evaluate the diagnostic accuracy, cost-effectiveness, and performance of POC tools in forensic settings. Comprehensive guidelines and standardized operating procedures should be developed to ensure the successful implementation of POC diagnostics in forensic investigations. Given the limited and heterogeneous evidence, POC devices in forensic death investigations should be seen as preliminary aids rather than diagnostic instruments.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103086"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional judgement in Forensic & Legal Medicine (FLM)","authors":"Margaret Stark ,&nbsp;Bernadette Butler ,&nbsp;Michael Devlin ,&nbsp;Alex Gorton","doi":"10.1016/j.jflm.2026.103084","DOIUrl":"10.1016/j.jflm.2026.103084","url":null,"abstract":"<div><div>Professional judgement in forensic &amp; legal medicine (FLM) refers to the ability of healthcare professionals (HCPs) to use their knowledge, experience, and critical thinking skills to make informed decisions about patient care, often in complex or ambiguous situations.</div><div>Clinicians must keep patients the focus of any assessment and HCPs need to use professional judgement when interpreting Guidelines and/or Recommendations and when there is a clear and justifiable requirement to deviate from a Standard Operating Procedure because of patient need. Only with training and supervision by expert educators will quality standards be maintained with a workforce that is skilled in using professional judgement.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"118 ","pages":"Article 103084"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salivary biomarkers in forensic science: Bridging molecular biology and legal medicine","authors":"Arathi Padutholil Ajith Kumar ,&nbsp;Premalatha Bidadi Rajashekaraiah ,&nbsp;Sheethal Chandra Aralaguppe Chandraprakash ,&nbsp;Parvathy Beena Chandran ,&nbsp;Vaishaka Ashok Malali ,&nbsp;Vidyadevi Chandavarkar","doi":"10.1016/j.jflm.2025.103044","DOIUrl":"10.1016/j.jflm.2025.103044","url":null,"abstract":"<div><div>Saliva has emerged as a versatile and non-invasive biological specimen in forensic science. It is a rich source of genomic, transcriptomic, proteomic, metabolic, and microbiomic factors, offering significant potential in forensic investigations. This review explores the multi-dimensional aspects of salivary biomarkers in forensic science, integrating molecular biology with legal medicine.</div><div>It provides a comprehensive overview of the saliva composition, highlighting its biochemical constituents and the methodologies employed for its effective collection in forensic scenarios. From a molecular and analytical perspective, we delve into the diverse classes of salivary biomarkers, including genomic markers that enable individual and kinship profiling; transcriptomic and proteomic biomarkers that reveal gene expression and protein profiles that contribute in post-mortem interval estimation and physiological state evaluation; and metabolomic and microbiomic signatures which offer additional discriminatory power to infer health, lifestyle, and even geographic origins.</div><div>The forensic applications of these biomarkers and their growing acceptance in judicial proceedings, where the admissibility and evidential value of saliva-derived data are critically assessed, are discussed. Supported by relevant case studies, this review highlights the real-world utility and impact of salivary biomarkers in forensic practice. The challenges and limitations of saliva in forensics are addressed. Additionally, insights into future prospects, such as salivaomics, lab-on-a-chip platforms, and AI-driven data interpretation, are provided.</div><div>In conclusion, by mapping the intersection of molecular diagnostics and legal frameworks, this review underscores that saliva can be a revolutionary medium that advances the accuracy and accessibility of forensic identification by bridging its biological complexity with forensic applications.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103044"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age estimation based on Demirjian's method using third molars in individuals from Southeastern Brazil","authors":"Amanda Farias-Gomes ,&nbsp;Maria Luíza dos Anjos Pontual ,&nbsp;Thaísa Pinheiro Silva ,&nbsp;Maria Fernanda Silva Andrade-Bortoletto ,&nbsp;Matheus L. Oliveira ,&nbsp;Francisco Haiter-Neto ,&nbsp;Cleber Zanchettin ,&nbsp;Deborah Queiroz Freitas","doi":"10.1016/j.jflm.2025.103045","DOIUrl":"10.1016/j.jflm.2025.103045","url":null,"abstract":"<div><div>This study assessed the applicability of third molar mineralization stage for estimating chronological age in a Southeastern Brazilian population and tested a previously developed age estimation formula from a Northeastern Brazilian population. Digital panoramic radiographs of 1570 individuals aged 7–22 years were analyzed; 1260 radiographs were used to create the new formula, and 310 to test it. Two independent examiners classified the third molars on the radiographs according to Demirjian's developmental stages. Paired <em>t</em>-test compared chronological and estimated ages; Mann-Whitney test assessed sex differences in mineralization stages (α = 0.05). Multiple linear regression was used to develop a new age estimation formula. Chronological age was similar across all four third molars for different developmental stages, with no sex-related significant differences (p &gt; 0.05). The initial appearance of third molar formation (stage A) and root apex closure (stage H) occurred at mean ages of 8.6 and 19.8 years, respectively. A strong correlation (R = 0.925) was found between chronological age and third molar mineralization stages. The previously developed formula significantly overestimated chronological age by approximately one year (p &lt; 0.05). In contrast, the new formula achieved strong performance, explaining 85 % of the variance in the outcome (R² = 0.85), with low prediction errors (MAE = 1.35; RMSE = 1.71), with no significant differences between estimated and chronological age for most age groups (p &gt; 0.05). This study confirms the strong correlation between third molar mineralization stages and chronological age in a Southeastern Brazilian population. It also underscores the need for population-specific models, as the previously developed formula led to overestimation. The new formula provides a more accurate method for age estimation in this subpopulation, supporting its forensic and clinical applicability.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103045"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of clinical toxicology results from 2017 to 2023: exploring the characteristics and prevalence trends of detected drugs and poisons","authors":"Yuxuan Fu ,&nbsp;Sujing Zhang ,&nbsp;Yibo Yan ,&nbsp;Ping Xiang ,&nbsp;Jian Li ,&nbsp;Lei Xin ,&nbsp;Hongxiao Deng ,&nbsp;Hejian Wu ,&nbsp;Xin Wang","doi":"10.1016/j.jflm.2025.103052","DOIUrl":"10.1016/j.jflm.2025.103052","url":null,"abstract":"<div><div>To characterize temporal trends in toxic substance patterns involved in clinical toxicology cases in Shanghai, while considering regulatory changes, and to benchmark these findings against data from other regions. The clinical toxicology results reported by the Academy of Forensic Science (AFS) from January 2017 to December 2023 were collated, summarized, and retrospectively analyzed for the types and blood concentrations of different drugs and poisons. Overall, 4422 clinical toxicology cases were recorded, accounting for an average of approximately 630 cases per year, with 62 % presenting positive results. The positively detected substances were mainly clinical drugs and pesticides. The detected clinical drugs were predominantly sedative-hypnotics, antidepressants, and antipsychotics. Estazolam (n = 347), midazolam (n = 272), bromadiolone (n = 265), clonazepam (n = 228), and quetiapine (n = 199) were the top five most frequently detected substances in clinical toxicological cases. Other cases related to plant poisons, toxic heavy metals, and toxic alcohols were also recorded. The blood concentrations of the various drugs showed significant variability. This study highlights a concerning rise in psychoactive drug use, particularly sedative-hypnotics and antidepressants, reflecting a growing mental health burden in the population. This pattern is further supported by the frequent detection of blood drug concentrations exceeding therapeutic upper limits, indicating widespread non-therapeutic exposure. In response, psychotropic drug prescribing practices must be comprehensively strengthened through stricter regulations and the establishment of prescription surveillance to ensure rational and safe medication use. Additionally, a decline in certain toxicants, such as paraquat, suggests the effectiveness of policy interventions. The findings also emphasize the risks of polypharmacy and the need for enhanced poisoning prevention and emergency response systems.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103052"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual violence and associated factors among female night students in Ethiopia: A systematic review and meta-analysis","authors":"Yeshiwas Ayale Ferede ,&nbsp;Worku Chekol Tassew ,&nbsp;Melese Legesse Mitku ,&nbsp;Abiyie Demelash Gashe ,&nbsp;Girum Meseret Ayenew ,&nbsp;Adane Nigussie ,&nbsp;Agerie Mengistie Zeleke","doi":"10.1016/j.jflm.2025.103053","DOIUrl":"10.1016/j.jflm.2025.103053","url":null,"abstract":"<div><h3>Background</h3><div>Despite numerous efforts to prevent and control sexual violence in Ethiopia, the incidence continues to rise. It's crucial to have solid evidence to highlight the severity of the issue. Thus, this study aims to determine the overall prevalence of sexual violence and pinpoint the contributing factors among female night students in Ethiopia.</div></div><div><h3>Method</h3><div>A comprehensive and systematic literature search was conducted across various electronic databases, including PubMed, HINARI, Scopus, EMBASE, Web of Science, African Journal online (AJOL), and Google Scholar. The quality of the studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for analytical cross-sectional studies, consisting of nine criteria. The heterogeneity of the studies was assessed using the Cochrane Q and I2 test statistics. The pooled prevalence estimate of sexual violence among female night students was calculated using a random-effects model.</div></div><div><h3>Result</h3><div>Out of 6410 studies reviewed, six studies involving 2699 night students were deemed relevant. The pooled estimate of sexual violence among female night students in Ethiopia was found to be 43.58 % (95 % CI: 30.68, 56.48). Factors associated with sexual violence included rural residency (POR = 2.51; 95 % CI: 1.17, 5.41), alcohol use (AOR = 3.30; 95 % CI: 1.68, 6.48), having multiple sexual partners (POR = 2.78; 95 % CI: 1.97, 3.92), and a commute time to school exceeding 20 min (POR = 1.74; 95 % CI: 1.18, 2.58).</div></div><div><h3>Conclusion</h3><div>The research revealed that nearly half of female night students encountered sexual violence, with significant correlations identified between this violence and factors such as having multiple sexual partners, residing in rural areas during childhood, having a commute time to school of over 20 min, and having a history of alcohol use. To effectively address and prevent sexual violence, the Federal Ministry of Health (FMOH), policymakers, and stakeholders must prioritize these findings and take targeted actions.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103053"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How people die inside: Fact patterns in civil litigation for in-custody deaths","authors":"Taleed El-Sabawi ,&nbsp;Shelly Weizman ,&nbsp;Regina LaBelle","doi":"10.1016/j.jflm.2025.103048","DOIUrl":"10.1016/j.jflm.2025.103048","url":null,"abstract":"<div><div>Civil litigation provides a novel and underutilized source of information about deaths in U.S. jails, particularly when official data are incomplete. This study systematically analyzes verdicts, settlements and judgments to explore patterns in practices linked to preventable mortality in U.S jails.</div></div><div><h3>Results</h3><div>Content analysis of facts alleged in 90 cases filed between 2015 and 2020 revealed thematic patterns related to inadequate or delayed medical care. Alleged facts routinely included observable signs of serious medical need—such as incoherence, convulsions, or pleas for help—followed by failures to provide timely or medically appropriate care. In cases of suicide, allegations commonly describe known mental health conditions, discontinued medication, and lapses in monitoring or suicide prevention protocols. Despite repeated warnings—by the individuals themselves, fellow incarcerated persons, or family members—jail staff frequently failed to act. A small subset of cases resulted in judgments for the defense, often where some care was provided or protocols were followed, even if outcomes were still fatal.</div></div><div><h3>Conclusion</h3><div>These findings suggest that in cases resulting in reported settlements, verdicts or judgments in-custody deaths in the U.S. could be prevented through improved intake screening, timely medical monitoring, care coordination, and adherence to established protocols. Litigation records offer important insight into how systemic failures contribute to jail mortality, with implications for policy, public health, and correctional practice.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103048"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of psychoactive substances and attention-related impairments on driving performance: Sex differences and road crash involvement","authors":"Claudio Terranova ,&nbsp;Clara Cestonaro ,&nbsp;Stefano Palumbi ,&nbsp;Laura Marino ,&nbsp;Alessandro Gentili ,&nbsp;Francesco Pozzebon ,&nbsp;Rocco Miazzi ,&nbsp;Anna Aprile","doi":"10.1016/j.jflm.2025.103050","DOIUrl":"10.1016/j.jflm.2025.103050","url":null,"abstract":"<div><h3>Introduction</h3><div>Crashes are a global public health concern, with psychoactive substance use and attention impairments potentially increasing risk and affecting male and female drivers differently. This study aims to identify factors related to psychoactive substance use and attention impairments that predict road crash involvement by sex, offering insights for targeted prevention effort.</div></div><div><h3>Methods</h3><div>This observational study examined individuals assessed for driving license reissuance after driving under the influence of alcohol and/or drugs. Data collected included personal and sociodemographic details, results from a Continuous performance test (CPT-3) (a neuropsychological test assessing inattentiveness, impulsivity, sustained attention, and vigilance), and toxicological analyses of biological samples. Statistical analyses (chi-square, logistic regression, and ROC curve) aimed at identifing sex-specific predictors of road crash involvement.</div></div><div><h3>Results</h3><div>The study included 169 participants (82.8 % males, 17.2 % females). Initial univariate analyses indicated sex differences that were not confirmed after Bonferroni correction for multiple comparisons. Logistic regression found blood alcohol concentration predictive of crashes in males (p = 0.005, OR = 2.52), while inattentiveness was a major factor for females (p = 0.045, OR = 12.0). In the combined model, sex itself was not an independent predictor after adjusting for these factors. The model showed moderate accuracy for males (ROC-AUC = 0.695) and higher accuracy for females (ROC-AUC = 0.816), suggesting that inattentiveness may play a particularly important role in predicting crashes in the female subgroup.</div></div><div><h3>Conclusions</h3><div>Inattentiveness and alcohol use emerged as key predictors of crash involvement, with inattentiveness showing particular relevance in the female subgroup. Prevention should focus on modifiable risk factors rather than sex. The model's higher accuracy in females suggests attentional measures may help identify at-risk drivers, though the small female sample limits generalizability.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103050"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}