Publication: Análisis de parámetros de maduración ósea en población con patología del crecimiento. Estudio de radiología digital de mano y carpo
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2017-09-12
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Universidad Complutense de Madrid
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Abstract
La llegada de inmigrantes de países extracomunitarios al territorio de la Unión Europea, conlleva la presencia en estos países de numerosos menores extranjeros no acompañados por adultos (MENAS), debiendo las autoridades adoptar medidas legales correspondientes derivadas de su condición de menores. En aquellos casos en los que no existe un documento que acredite fehacientemente su edad cronológica, es una práctica generalizada solicitar un examen médico para estimar dicha edad y poder adoptar decisiones fundadas sobre la custodia de dichos menores. En España, las recomendaciones sobre métodos de estimación forense de la edad de los menores extranjeros no acompañados, se recogen en un Documento de Consenso de Buenas Prácticas entre los Institutos de Medicina Legal (2010), donde entre los medios diagnósticos recomendados incluyen la anamnesis dirigida, el examen físico general, el estudio radiográfico del carpo y de la mano izquierda, el examen de la cavidad oral y estudio radiográfico dental y en los casos dudosos con los estudios anteriores y en los que se solicitan estimaciones de edad entre los 18 y 21 años: estudio radiográfico o con TC (método multicorte fino) de la extremidad proximal de la clavícula. Pero los resultados de estimación de la edad cronológica obtenidos por análisis de parámetros de edad biológica nunca son exactos, sino meras estimaciones probabilísticas de edad cronológica, existe un margen de error debido a numerosos factores, entre ellos los patológicos. En el mejor de los casos, esta aproximación probabilística puede ser medida y cuando se dispone de estudios de población de referencia aceptables, puede conocerse la probabilidad de acierto o de error de la estimación, pero nunca se puede dar una estimación de la edad como un resultado con certeza absoluta. Los métodos de estimación de edad disponibles se aplican habitualmente a población “sana”, disponiendo de los estándares correspondientes...
The arrival of non-EU immigrants to the territory of the European Union, implies the presence of many unaccompanied minors by adults (MENAS), therefore the authorities must take appropriate legal actions to verify their status as minors. In cases where there is not a document that conclusively proves their chronological age, it is widespread to request a medical examination to estimate that age and to make informed decisions about the custody of said minors. In Spain, the recommendations on methods of forensic estimation of the age of unaccompanied minors are included in a consensus document of best practices between the Institutes of Legal Medicine (2010), which included among the recommended diagnostic means directed anamnesis. The general physical examination, radiographic study of the left hand and carpal, examination of the oral cavity and dental radiographic study and in doubtful cases with previous studies in which age estimates are requested between 18 and 21 years: radiographic or TC (thin multi-slice method) of the proximal end of the clavicle study. But the results of such estimations of chronological age parameters obtained by the analysis of biological age are never exact, but merely probabilistic estimates of the chronological age: there is a margin of error due to numerous factors, including pathological ones. In the best case, this probabilistic approach can be a method applicable when you have population studies of reference acceptable, you can know the probability of success or error of the estimate, but you can never give an estimate of the age with absolute certainty. The age estimation methods available are usually applied to "healthy" population, having the appropriate standards of living...
The arrival of non-EU immigrants to the territory of the European Union, implies the presence of many unaccompanied minors by adults (MENAS), therefore the authorities must take appropriate legal actions to verify their status as minors. In cases where there is not a document that conclusively proves their chronological age, it is widespread to request a medical examination to estimate that age and to make informed decisions about the custody of said minors. In Spain, the recommendations on methods of forensic estimation of the age of unaccompanied minors are included in a consensus document of best practices between the Institutes of Legal Medicine (2010), which included among the recommended diagnostic means directed anamnesis. The general physical examination, radiographic study of the left hand and carpal, examination of the oral cavity and dental radiographic study and in doubtful cases with previous studies in which age estimates are requested between 18 and 21 years: radiographic or TC (thin multi-slice method) of the proximal end of the clavicle study. But the results of such estimations of chronological age parameters obtained by the analysis of biological age are never exact, but merely probabilistic estimates of the chronological age: there is a margin of error due to numerous factors, including pathological ones. In the best case, this probabilistic approach can be a method applicable when you have population studies of reference acceptable, you can know the probability of success or error of the estimate, but you can never give an estimate of the age with absolute certainty. The age estimation methods available are usually applied to "healthy" population, having the appropriate standards of living...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Toxicología y Legislación Sanitaria, leída el 25-01-2016