Table of Contents
International Scholarly Research Notices
Volume 2017 (2017), Article ID 9793528, 7 pages
Review Article

Comprehensive Histological and Immunochemical Forensic Studies in Deaths Occurring in Custody

1Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
2Division of Cardiology, UFJAX, Jacksonville, FL, USA

Correspondence should be addressed to Menfil A. Orellana-Barrios

Received 31 October 2016; Revised 5 February 2017; Accepted 28 February 2017; Published 12 March 2017

Academic Editor: Kimimasa Tobita

Copyright © 2017 Kenneth Nugent et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In-custody deaths have several causes, and these include homicide, suicide, natural death from chronic diseases, and unexplained death possibly related to acute stress, asphyxia, excited delirium, and drug intoxication. In some instances, these deaths are attributed to undefined accidents and natural causes even though there is no obvious natural cause apparent after investigation. Understanding these deaths requires a comprehensive investigation, including documentation of circumstances surrounding the death, review of past medical history, drug and toxicology screens, and a forensic autopsy. These autopsies may not always clearly explain the death and reveal only nonspecific terminal events, such as pulmonary edema or cerebral edema. There are useful histologic and biochemical signatures which identify asphyxia, stress cardiomyopathy, and excited delirium. Identifying these causes of death requires semiquantitative morphologic and biochemical studies. We have reviewed recent Bureau of Justice Statistics on in-custody death, case series, and morphological and biochemical studies relevant to asphyxia, stress cardiomyopathy, and excited delirium and have summarized this information. We suggest that regional centers should manage the investigation of these deaths to provide more comprehensive studies and to enhance the expertise of forensic pathologists who would routinely manage potentially complex and difficult cases.