Homicidal and suicidal sharp force fatalities in Stockholm,Sweden.: Orientation of entrance wounds in stabs gives information in the classification

A comparative study of 174 homicidal and 105 suicidal sharp force deaths in the Stockholm area is presented in order to identify variables of importance in the differentiation between homicides and suicides. In homicides, a significantly (p<0.05) higher number of cut and stab wounds were seen in the head, upper and lower extremities and a significantly higher number of vertical stab wounds were found in the chest. Lower numbers were seen in the wrist and the crook of the arm. When counting the injured areas, irrespective of the number of injuries, abdominal wounds and horizontal chest stab wounds were also significantly more often found in victims of homicide. Injuries to the back and to the genitals were not seen in suicides. The suicide victims were significantly older and had significantly lower blood alcohol levels. A new variable pointing at a statistically significant difference between homicides and suicides was found: In homicides, stab wounds with a horizontal axis of entrance wound in the chest was found to be less common than those with a vertical axis. Other variables studied were prevalence of defence and tentative wounds, farewell notes and suicidal ideation, earlier parasuicides, venue, gender of the victims and the types of sharp objects used.     

Gunshot fatalities in children and adolescents in New York City

We reviewed the case records of all fatalities due to gunshot wounds in children and adolescents under 19 years of age in New York City from 1996 to 2000. The epidemiological profile, circumstances, toxicology results, location, and injuries were examined. There were 263 deaths: 242 homicides, 17 suicides, and 4 accidents. Among the homicides, 96% involved Black or Hispanic and 68% involved 17 and 18-year-old decedents. There were 11 times as many male as female homicides. The detection of ethanol and/or illicit drugs was 56% in the homicide and 53% in the suicide groups. Suicide notes were found in 18% of suicides, and an additional 35% verbally expressed a plan to commit suicide. Most suicides (77%) were in the home and half of the homicides occurred on the street.     

Sharp force fatalities: suicide,homicide or accident? A series of 21 cases

Cases at study comprise 21 sharp force fatalities (9 suicides – 7 m and 2 f; 8 homicides – 5 m and 3 f; 2 accidental deaths – 1 m and 1 f; 2 uncertain cases – 2 m), examined from 1993 to 2002. Suicide age range was 17–75 years, mean 42.4; in seven cases the age was upper 40. Scene of death was at home in six cases, at open place in two, during hospitalisation in one. Incised wounds were pre-eminent in suicides. Homicides showed multiple stab wounds. The two accidents were caused by “glassing”. Uncertain cases were a small stab wound to the chest and an eviration.     

Sharp Force Injury Fatalities: A Retrospective Study (1982–2012) in Brescia (Italy)

A retrospective study was carried out on postmortem examination data of 131 sharp force‐related casualties recorded by the Brescia Institute of Forensic Medicine between 1982 and 2012. The objective was to identify relevant parameters that may be used to distinguish the manner of deaths between homicide, suicide, and accident. The following variables were considered: manner of death; demographic data; scene; type of sharp object; location and numbers of wounds; the presence of hesitation marks/defense wounds; toxicological findings; psychiatric history. There were 92 homicides, 28 suicides, and 11 accidents. Most victims were male, with an average age of 43. Injuries in isolation were present in 9.8% of homicides, in 35.7% of suicides, and in 54.5% of accidents. Most injuries involved the left anterior chest in homicides and the forearms in suicides. This study underlines the importance of a meticulous postmortem examination of injuries on the body and their relationship with other results from the death scene investigation.     

Clinicopathologic features of fatal self-inflicted incised and stab wounds: a 20-year study

The files of the Forensic Science Center in Adelaide, South Australia, were examined for all cases listed as suicide in which death had been caused by the use of a sharp instrument during the 20-year period from January 1981 to December 2000. Fifty-one cases were identified, consisting of 35 men and 16 women. The age range was 23 to 83 years (mean 49 years) representing 1.6% of total suicides (513182). Fatal injuries included incised wounds to the arms in 51.4% of men (n = 1835) compared with 87.5% of women (n = 1416), incised and stab wounds to the neck in 40% of men (n = 1435) and 25% of women (n = 416), and stab wounds to the chest or abdomen in 28.6% of men (n = 1035) and 12.5% of women (n = 216). In 8 cases, multiple sites were involved. The use of sharp instruments in suicide was favored by older, rather than younger, individuals, with a tendency for women to incise their wrists. Hesitation marks were present in 23 cases (54%) and scarring of the wrists from previous suicide attempts in 5 cases. Although this study demonstrated a higher number of men than women committing suicide by using sharp objects, this method of suicide remains uncommon.     

Fatal and non-fatal injuries caused by crossbows

Today in modern times, traumatic injuries caused by crossbows are a rarity. The largest collection of cases so far is presented in this study, consisting of four fatalities (two homicides and two suicides) and two non-fatal injuries (grievous bodily harm and an accident). All the victims were male having an age between 31 and 54. The weapons, which were used, were mainly high-performance precision crossbows with telescopic sights and hunting bolts. The parts of the body involved were the facial/head area in three of the cases and the thorax in three of them. There were either deep or total penetration injuries to the cranium and thorax with the bolt remaining in the wound in four out of six cases. The persons with non-fatal crossbow injuries exhibited comparatively few symptoms, despite the sometimes extensive involvement of the interior of the cranium (cerebrocranial penetration, in one instance). The two cases of suicide favoured the body areas often found with gun-users. The aetiological classification of crossbow injuries may be difficult after the removal of the bolt. The external morphology is strongly dependent on the type of tip used. Multiple-bladed hunting broadheads produce radiating incised wounds, whereas conical field tips produce circular to slitlike defects. Correspondingly, the external injuries can be reminiscent of the effects of a violent attack by sharp force or of a gunshot wound. The possibility, supported by clinical data, that the victim might have the ability to act or even to survive for a period of time, even with penetration of the brain, should be taken into account when the cause of death is being investigated.     

Suicide by 120 stab wounds of the chest?

The case history of a suicide due to 120 stab wounds of the chest is presented. The victim was a 41 years old man with a paranoid-hallucinative psychosis. The problem to distinguish homicides and suicides is discussed by the well-known criminalistic and forensic-medical criterias. Induced by this very unusual case the autopsy material with stab wounds was analyzed retrospectively (n = 246, out of about 14,000 autopsies at the Institut of Forensic Medicine in Hamburg). Cases with more than 40 single lesions are normally homicides. However, the pattern of the injuries is more important than the number--especially in doubtful cases.     

Multivariate analysis (`Forensiometrics')—A new tool in forensic medicine: Differentiation between sharp force homicide and suicide

Multivariate projective statistical methods (PCA, PLS-DA) and logistic regression analysis were used to create models to make predictions regarding whether a certain fatality shows similarities to homicide or suicide. The `model set' consisted of 174 deaths due to sharp force injuries that in previous medicolegal investigation had been judged as homicides and 105 as suicides. The models were then validated on a new set of 40 homicides and 27 suicides that had not been used to create the models (test set validation). The model based on the PLS-DA technique had regarding its ability to identify homicides a sensitivity of 40/40=100% and a specificity of 25/27=93%. The model's predictions agreed with previously performed medicolegal investigations except in two suicides which according to the model were likely to be homicides. The reliability of this model was somewhat better than predictions achieved by means of logistic regression analysis, where six otherwise proven homicides were wrongly classified as suicides and two actual suicides were misclassified as homicides. The technique not only identifies variables but also ranks their importance. Ranked according to falling positive correlation (falling `importance' of a finding) to the dependent variable `death caused by homicide', the predictors were: Injuries to clothing, blood alcohol level, presence of defence injuries, injuries due to other type of violence than sharp force, chest stabs with vertical axis of the entrance wound, sharp force injuries to the upper extremity (except wrist and crook of the arm), sharp force injuries to the head and back. Ranked in increasing positive correlation to `death caused by suicide' were the predictors: sharp force injuries to the crook of the arm, venue being the victim's home, presence of farewell letter, victim's age, sharp force injuries to the wrist, known suicidal ideation and presence of tentative injuries.     

Shotgun wounds: a review of range and location as pertaining to manner of death

Shotguns are used in a considerable number of homicides and suicides, and while gunshot wounds are extensively reported in the literature, there is a paucity of shotgun deaths. To specifically study deaths by shotguns, all deaths due to shotguns examined at the Bexar County Medical Examiner's Office between 1988 and 2005 were reviewed. The cases were evaluated by age and sex of the victim, wound location, wound range, and manner of death. Three hundred eighty-seven cases were evaluated, composed of 343 males and 44 females, with 180 homicides, 203 suicides, 3 accidents, and 1 undetermined manner of death. Contact wounds were the most common range in suicides and the head was the most common location. For homicides, the most common range of fire was distant, and the most prevalent distributions of wounds were head, chest, and multiple wound locations. Statistical analysis showed significant differences between homicide and suicide wound locations and ranges, and then odds ratios were generated. Knowledge of the statistical distribution of shotgun wounds in a large series with respect to range of fire and wound location may be of assistance to the medical examiner in evaluating the circumstances of an individual case to arrive at a manner-of-death opinion.     

Rifle wounds: a review of range and location as pertaining to manner of death

Given the prevalence of rimfire and centerfire rifle usage in both suicidal and homicidal cases, there is a paucity of articles in the literature that focus specifically on rifle wounds. Gunshot wounds, in general, have been extensively studied with articles focusing on the types of injuries, weapons used, wound locations and weapon range. We designed a study to examine the characteristics of rifle wounds, including both centerfire and rimfire rifles, especially pertaining to location and range of the wound. All deaths due to rifles examined at the Bexar County Medical Examiner's Office between 1988 and 2004 were reviewed. A total of 509 cases were identified, with 233 suicides and 266 homicides. We found that the average age of suicide victims (41.6 years) tended to be older than that of homicide victims (32.6 years). Suicides tended to be contact wounds to the head whereas homicides most often had multiple wound locations sustained from a distant range. The most common location to the head of suicidal wounds was intraoral whereas homicidal head wounds were more often to the temporoparietal region. We developed odds ratios for assessing the manner of death given a wound location or range; however, we caution that every case should be analyzed based upon it's unique circumstances and not solely its statistical probability.     

Secondary combined suicide viewed by the wife]

A 47-year-old man was found dead at the bottom of a wall outward the door of the cellar of his house. Preliminary physical examination at the scene of the death revealed a laceration of the scalp, an incised wound in front of the neck and several stab wounds in the left chest penetrating through the clothing. Questioned by the police his wife told that her husband who suffered from severe depression had inflicted the incised and the stab wounds himself, had made an unsuccessful attempt at self-strangulation and had finally jumped down from the wall beside the stairs declining to the cellar of their house. As the circumstances of the scenario were suspicious and as the pattern of injuries arose doubts concerning self-infliction homicide was taken into consideration as well. Autopsy showed additional hesitation marks adjacent to the left end of the incised wound in front of the neck. The stab wounds of the chest were restricted to the region of the heart and displayed only minimal penetration of the chest-wall, findings characteristic of self-infliction. As a consequence the manner of death could be determined as prolonged suicide, and exact reconstruction was possible with the help of the wife's testimony.     

Sharp Force Homicide in Denmark 1992–2016

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992–2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.     

Homicide in Cape Town, South Africa

All autopsies performed on homicide victims at the Salt River police mortuary, Cape Town, in the first 6 months of 1986 were reviewed. Most of the homicides that had occurred in Cape Town were as a result of stab wounds to the chest. Smaller, but significant, numbers of homicides were as a result of stab wounds to the head and neck, blunt injury to the head, or gunshot wounds. Homicidal burning also has occurred in civil unrest situations. Infanticide was rarely encountered. Alcohol was detected in the homicide victims in 62.9% of cases; 8.4% had a blood alcohol concentration higher than 0.30 g/100 ml. Our figures confirm that Cape Town has one of the highest homicide rates in the world (56.9/100,000 per annum for 1986). Homicides in Cape Town are characterized by assaults with sharp instruments, usually knives, although "pangas," or cane knives, are also commonly used.     

An unusual death by transcranial stab wound: homicide or suicide?

Penetrating stab wounds of the brain are uncommonly seen in modern times and occur almost exclusively in homicides. We report an unusual death by self-stabbing. A 24-year-old man was found dead at home, the handle of a kitchen knife protruding from his forehead. Data such as the psychiatric history of the victim, the multiplicity and site of wounds, the implement used, the presence of hesitation, and defense wounds were studied to elucidate the manner of death, and the suicidal nature of the event was established after police investigation. Atypical injuries require a careful forensic investigation, and medico-legal aspects of the differentiation between homicide and suicide are discussed in this particular case. A review of the literature revealed few cases of suicidal transcranial stab wounds.     

Forensic analysis of homicides on the basis of cases examined in the Forensic Medicine Department,Medical University of Silesia,Katowice, in the years 1991–2002

The authors have reviewed medico-legal opinions relating to 3690 autopsy cases of homicides. Forensic analysis of all these cases showed a gradual increase in the number of homicides, especially those resulting from beating or using fire-arms. A great number of homicides with incised or stab wounds was also observed.     

Quantitative analysis of proinflammatory cytokines (IL-1beta, IL-6, TNF-alpha) in human skin wounds

Proinflammatory cytokines play an important role in the mediation of inflammation and trauma. They could be useful for the determination of vitality and wound age. In the present study, 144 human skin wounds due to sharp force were investigated. The material was collected during operations (N=96) and postmortem examinations (N=48). The wound age varied from several seconds or minutes to 9 days. Control skin was available in each individual. The tissue specimens were homogenized and extracted in a solution of PBS and protease inhibitors. Interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) were measured by quantitative ELISA analysis. Statistical evaluation was performed by the t-test using the quotients of levels (wound sample/control skin). In surgical specimens the cytokine levels revealed a clear tendency to increase with wound age. IL-1beta in early skin wounds (24 h, P<0.05). The quantitative analysis of proinflammatory cytokines in wound extracts can contribute to the determination of vitality and wound age, in particular in the very early post-traumatic interval (classic stab wounds).     

Characteristic Features of Pediatric Firearm Fatalities—Comparisons Between Australia and the United States

Abstract:  Gunshot deaths in children less than 17 years of age from Adelaide, SA, Australia (1969–2005) and from San Diego County, CA, United States (1988–2005) were compared. Forty-two pediatric gunshot fatalities occurred in South Australia (1.1 cases/year; M:F = 30:12). There were 6 accidents (14%), 14 suicides (33%), and 22 homicides (52%). In San Diego there were 185 cases ( c. 10 cases/year; M:F = 148:37). There were 6 accidents (3%), 42 suicides (23%), 130 homicides (70%), and 7 undetermined cases (4%). The incidence of homicide was significantly higher in San Diego County compared to Adelaide ( p  < 0.001), with a higher proportion of murder–suicides occurring in Adelaide. There were markedly more accidents and suicides involving males in Adelaide and a far higher number of male homicide victims in San Diego County compared to females. Rifles of 0.22-caliber were preferred weapons in South Australia, compared to handguns in San Diego County.     

Accidental sharp force injury fatalities.

The authors review all accidental sharp force injury deaths investigated at the Southwestern Institute of Forensic Sciences from 1990 to 1999. Twenty-two cases of accidental sharp force injury were identified, accounting for 0.29% of all accidental deaths (9,562) during the 10-year study period. Included in this series are 5 incised wounds, 11 stab wounds, 4 chop wounds, and 2 deaths caused by dog attacks. About half of the cases involved some type of motorized machinery. The victims' ages ranged from 2 years to 71 years, with most deaths occurring in older teenagers and younger adults. Male subjects (17) were involved much more frequently than female subjects (5). In 50% of the cases, ethanol or other drug use was a possible underlying contributing factor in the accident. The cases are briefly reviewed, and the importance of detailed investigation in manner-of-death certification is emphasized.