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doi: 10.1111/1556-4029.13411
PAPER Available online at: onlinelibrary.wiley.com
PATHOLOGY/BIOLOGY
Melissa Thompson,1,2 M.B., B.S.; Neil E.I. Langlois,2,3 M.D.; and Roger W. Byard,2,3 M.D.
ABSTRACT: Following the death of a woman with blunt force chest trauma, the question was asked how common was the finding at
autopsy of a flail chest in decedents after failed cardiopulmonary resuscitation. It was suggested in court that this was an uncommon occur-
rence. To address this issue, autopsy cases in adults (>18 years) with rib fractures attributable to cardiopulmonary resuscitation were taken from
the files of Forensic Science SA over a 7-year period from 2008 to 2014. Flail chest injuries were defined as those arising from fractures at
two sites in at least three consecutive ribs. From 236 cases with rib fractures attributed to resuscitation, a total of 43 flail chest injuries were
found in 35 cases (14.8%). The majority occurred in the 60-79-year-old age group. These data suggest that flail chest injuries are a more com-
mon sequelae of cardiopulmonary resuscitation than has been previously appreciated in autopsy cases, particularly in the elderly.
KEYWORDS: forensic science, flail chest, rib fracture, cardiopulmonary resuscitation, chest compression, blunt trauma
TABLE 2––Incidence of consecutive ribs with fractures at more than one site (by age group and sex).
Female Male
Number of
consecutive Age 18–39 Age 40–59 Age 60–79 Age 80+ Age 18–39 Age 40–59 Age 60–79 Age 80+
fractured ribs Years Years Years Years Years Years Years Years Total
Three 0 2 3 1 0 6 12 1 25
Four 0 1 2 0 0 1 5 0 9
Five 0 0 0 0 0 2 4 1 7
Six 0 0 0 0 0 2 0 0 2
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