Sriwijaya Journal of Forensic and Medicolegal

Neural Network Versus Stepwise Regression for Forensic Stature Estimation from Percutaneous Tibial Dimensions in South Sumatran Malay Adults

2026-08-13T03:46:11+00:00

Introduction: Stature estimation from skeletal elements underpins forensic biological profiling and is decisive in disaster victim identification, yet no validated osteometric standard exists for the South Sumatran Malay population, and stepwise regression assumes a linearity that skeletal growth biology does not obey.

Methods: 450 healthy South Sumatran Malay adults (225 male, 225 female) aged 20-50 years were enrolled at CMHC Research Center, Palembang, and reported per STROBE. Five percutaneous right-tibial dimensions were measured by one certified anthropologist under the Martin and Saller convention (all relative technical errors of measurement below 1.5%), and a stratified 70:30 partition withheld 135 observations for testing. Stepwise multiple linear regression (SMLR) was compared against a grid-search-optimised 5-64-32-16-1 multilayer perceptron artificial neural network (MLP-ANN).

Results: Sexual dimorphism was large for every dimension (Cohen's d 1.42-1.75; all p < 0.001). Percutaneous tibial length was the strongest single predictor (males r = 0.812, 95% CI 0.762-0.852). The calibration-corrected pooled regression reached R² = 0.742 with RMSE ±4.82 cm, whereas the network reached R² = 0.914 (95% CI 0.891-0.933) and RMSE ±2.78 cm — ΔR² = 0.172 (bootstrap 95% CI 0.141-0.203), a 23.2% gain in explained variance and a 42.3% reduction in error that narrows the 95% forensic identification window from ±9.45 cm to ±5.45 cm.

Conclusion: These first population-specific, artificial-intelligence-driven standards materially improve the biological profiling of incomplete human remains in Indonesian medicolegal and disaster victim identification practice.

Comprehension as the Gatekeeper of Valid Surgical Consent: A Cross-Sectional Medicolegal Analysis of 320 High-Risk Indonesian Surgical Patients

2026-08-18T07:05:11+00:00

Introduction: Documented consent without demonstrable comprehension is medicolegally insufficient, yet comprehension-based informed consent (IC) failure in collectivistic surgical populations is largely unquantified.

Methods: This re-analysis of a previously reported cross-sectional dataset assessed IC efficacy among 320 consecutive adults undergoing high-risk elective surgery (ASA physical status III–IV) at Private Hospital X, Palembang, Indonesia, in 2024, reported per STROBE. Six instruments standardised to 0–100 were administered, including the IC Comprehension Score (ICCS) and the five-domain composite IC Efficacy Score (ICE); adequacy was ICE ≥ 70. Exact intervals and permutation tests, effect sizes, areas under the receiver operating characteristic curve recovered from Mann–Whitney U statistics, E-values, fragility indices, standardisation and a partial-identification audit were added.

Results: Only 19 of 320 patients (5.9%, 95% CI 3.6–9.1) achieved adequate IC efficacy, below both published comparators reporting an explicit adequacy proportion (exact binomial P < 0.001 versus 14.0% and versus 35.8%); standardisation to lower-education distributions reduced this to 2.74–3.79%, so 5.9% is an upper bound. Adequacy rose monotonically across educational strata from 0.0% to 13.3% (exact Cochran–Armitage z = 3.66, P = 0.0003; tertiary versus secondary education or below, odds ratio 8.27, 95% CI 2.36–29.00; E-value 14.29; fragility index 8). ICCS was the only independent predictor in an exploratory multivariable model with 2.71 events per variable (odds ratio 13.75 per SD, 95% CI 3.32–56.92), an association partly constitutive because comprehension is one ICE domain. Neither family influence nor collectivism predicted adequacy.

Conclusion: Comprehension, not cultural collectivism, gates valid surgical consent.

Sociocultural Determinants of Clinical Autopsy Refusal and Their Medicolegal Impact on Diagnostic Accuracy in Indonesian Tertiary Hospitals: A Retrospective Cohort Study

2026-08-18T07:19:09+00:00

Introduction: Clinical autopsy is the only procedure that verifies antemortem diagnosis against pathological truth, yet in Indonesian tertiary hospitals refusal is the norm and neither its determinants nor its medicolegal consequences are quantified.

Methods: This STROBE-reported retrospective cohort study analysed 324 consecutive adult in-hospital deaths across three tertiary referral hospitals in Palembang, South Sumatra, from 2019 to 2023. The primary outcome was next-of-kin refusal of autopsy consent; secondary outcomes were Goldman-class diagnostic discrepancy and time to correct diagnosis, censored at day 90. Proportions carry Wilson intervals; tests were checked against Monte-Carlo exact methods, ordinal exposures against trend tests and multiplicity against Benjamini-Hochberg.

Results: Refusal was 84.0% (272/324; 95% CI 79.6-87.5) and did not differ across hospitals (p = 0.330). Javanese ethnicity carried the strongest association (94.3% versus 77.7%; OR 4.71, 95% CI 2.05-10.82), with monotonic gradients across education (trend z = -3.87, p < 0.001) and income (z = -2.84, p = 0.005) and refusal concentrated among the disadvantaged (Wagstaff index -0.312). Religious affiliation showed no association (p = 0.290; Cramér's V = 0.108). Any diagnostic discrepancy was commoner after refusal (61.4% versus 36.5%; OR 2.76, 95% CI 1.49-5.11), whereas the major-discrepancy contrast did not reach significance (26.1% versus 13.5%; OR 2.27, 95% CI 0.98-5.27; fragility index 1). Median time to correct diagnosis was 19 versus 5 days (p < 0.001).

Conclusion: Autopsy refusal in Indonesia tracks ethnic mortuary practice and socioeconomic position rather than religious affiliation, redirecting policy towards ritual accommodation and mandatory mortality audit where consent is declined.

Failure to Palpate and Failure to Image: Quantifying Standard-of-Care Departure in Fatal Delayed Intracranial Foreign Body Diagnosis, Indonesia

2026-08-18T07:27:24+00:00

Introduction: Retained intracranial foreign bodies in patients alert at a Glasgow Coma Scale (GCS) of 15 are a rare, lethal and medicolegally exposed failure in Indonesian assault casework, yet the share attributable to specific documentable procedural omissions is unquantified.

Methods: This retrospective multi-centre cohort examined 45 confirmed retained intracranial foreign bodies identified from 1,240 mild traumatic brain injury presentations (prevalence 3.63%, 95% CI 2.72–4.82) at three trauma centres in North Sumatra, Indonesia, 2019–2023, per STROBE. Diagnosis beyond 24 hours was the pre-specified outcome. With only aggregate data, inference used Fisher exact tests, exact conditional and Firth-penalised odds ratios with profile penalised-likelihood intervals, Holm multiplicity control, and partial identification of the multivariable model across 4,000 admissible joint arrangements.

Results: Diagnosis was delayed in 14 of 45 cases (31.1%, 95% CI 19.5–45.7). Failure to palpate the wound bed carried an exact conditional odds ratio of 29.86 (4.79–281.0; p < 0.001) and computed tomography non-adherence 20.88 (3.57–174.7; p < 0.001). As a bedside marker, palpation failure achieved sensitivity 78.6%, specificity 90.3% and area under the curve 0.844; the attributable fraction was 76.3% (50.8–96.1) with an E-value of 11.18. Adjusted odds ratios were bounded, not estimated, because aggregate marginal data cannot identify a multivariable model.

Conclusion: Two zero-cost omissions dominate a fatal diagnostic failure; recording wound-bed palpation and the imaging decision is clinically protective and, under KUHAP Articles 133 and 179 and Law No. 17 of 2023, is what a visum et repertum requires.

Age and Sex Associations With Body Mass Index in an Audited Postmortem CT Metadata Cohort

2026-08-19T07:56:09+00:00

Introduction: Open postmortem computed tomography (PMCT) repositories support forensic research, but record duplication and incomplete metadata can distort anthropometric inference. This study examined age- and sex-related variation in body mass index (BMI) after curator-informed audit of VSDFullBody.

Methods: We performed a retrospective secondary analysis of 105 metadata rows. A calibration phantom was excluded; seven concordant duplicate pairs were collapsed; both records from four duplicate pairs with conflicting metadata were excluded; curator data reconciled six sex labels and recovered 13 BMI values. The primary cohort comprised 89 decedents, including 83 complete cases. BMI was regressed on age per 10 years and audited biological sex using HC3 standard errors; bootstrap, duplicate-choice, robust-regression, leave-one-out, head-coverage, and missing-outcome sensitivity analyses assessed stability.

Results: Mean BMI was 24.2 kg/m². Each 10-year age increment was associated with 0.49 kg/m² higher BMI (95% confidence interval [CI], 0.05-0.93; p=0.029). Adjusted BMI was 2.58 kg/m² higher in male than female decedents (95% CI, 0.18-4.99; p=0.036); the bootstrap 95% CI was 0.34-4.88. Sensitivity estimates retained the same direction.

Conclusion: In this audited PMCT metadata cohort, age and male sex were associated with modestly higher BMI. Curator companion files materially increased analyzable completeness, supporting explicit metadata audit before reuse of open forensic imaging collections.