Healthcare professionals often serve as expert witnesses in coroners’ courts and have to provide reports, but the specific requirements have not been clearly articulated. The Chief Coroner’s Bench Book advises that expert reports should follow Civil Procedure Rules Part 35, yet the inquisitorial nature of coronial proceedings creates important differences from civil litigation. In keeping with the Coroners and Justice Act, experts must avoid language that implies civil or criminal liability on the part of a named person when opining on standards of care; instead, they should express themselves in neutral terms. Unlike civil litigation, where a ‘but for’ test applies to proving causation, on balance of probabilities, the coronial threshold requires identification of the acts or omissions that contributed more than minimally, negligibly or trivially to death. Understanding these distinctions is essential to produce reports that are appropriate both in law and in purpose.
Acute appendicitis is the most common surgical emergency in children. While typically presenting with abdominal pain localised to the right iliac fossa, fever and gastrointestinal symptoms, young children may exhibit atypical or delayed manifestations. Failure to recognise these subtle presentations can result in rapid progression to life-threatening complications.
The coroner and inquest system dates back to the 10th century but continues to face criticism and debate. This research evaluates whether the Coroners and Justice Act 2009 has reduced regional disparities – often described as a ‘postcode lottery’. Using Ministry of Justice data from 2000 to 2021, we compared 2 periods: 2000–2013 under the Coroners Act 1988, and 2014–2021 under the 2009 Act, alongside data from 10 jurisdictions. Findings show the 2009 Act has not significantly changed reporting rates or the proportion of cases proceeding to inquest. Processing times increased nationwide, and the number of inquests varied inconsistently across regions. While the coronial system remains an essential part of governance it continues to exhibit structural limitations. The 2009 Act acknowledges operational challenges but fails to provide sufficient clarity and consistency, and this contributes to ongoing regional variations and prevents a uniform delivery of coronial services across England and Wales.
Traumatic thoracic aortic transection is one of the most lethal consequences of blunt chest trauma; it is commonly associated with high-speed deceleration injuries in road traffic collisions. Despite advances in trauma management, survival rates remain poor due to rapid internal haemorrhage and the presence of multiple associated injuries. We report a fatal case of thoracic aortic transection in a 50-year-old restrained male driver involved in a high-velocity head-on collision with a truck. Following admission, he presented with hypotension, left-sided flail chest, multiple long bone fractures and reduced consciousness. Although emergency resuscitation was initiated, he developed sudden cardiovascular collapse during radiological evaluation and could not be revived. Medico-legal autopsy revealed a patterned seat belt contusion across the anterior chest wall, multiple rib fractures, extensive mediastinal haemorrhage, left-sided haemothorax and a circumferential full-thickness transection of the proximal descending thoracic aorta distal to the left subclavian artery. Toxicological analysis detected alcohol and morphine. This case highlights the characteristic pathological features of traumatic thoracic aortic injury and emphasises the medico-legal significance of the seat belt sign in identifying severe underlying thoracic trauma and reconstructing fatal motor vehicle collisions.
