Effect of History and Context on Forensic Pathologist Interpretation of Photographs of Patterned Injury of the Skin

Abstract

In a previous study, a survey-based analysis of pathologist diagnoses of patterned injury was performed. Subjects were provided with photographs of "classic" injuries and asked to diagnose the lesion in the absence of history or context. There was a relatively low diagnostic consensus among respondents. A second survey suggested that the disparate answers were not due to a strong belief in different diagnoses, but instead reflected how the respondents dealt with ambiguity. A third survey was created that asked participants to evaluate patterned injuries of the skin, but provided history and contextual information. The addition of history and contextual information increased consensus from a median of 80% to 98% on a per-question basis. Confidence increased from a median of 56%-92%. These results demonstrate the importance of history and context in medical diagnosis of patterned injuries of the skin.

Keywords: diagnostic error; forensic pathology; forensic science; human factors; image analysis; imaging; inference; photography.