Homicide by sharp force in two Scandinavian capitals

In the Oslo and Copenhagen capital areas, 141 homicides by sharp force were committed in the ten-year period 1985-1994. This method accounted for 33% of the homicides in this period. Thirty-five percent of the victims were female, and most of the victims were between 20 and 50 years of age. The majority of the male victims were killed by an acquaintance, the females by their spouse. Sixty-five percent of the male and 37% of the female victims had alcohol in their blood. The majority of the female victims had lesions in 3-4 anatomical regions, while the males most often had lesions in only one anatomical region. Seventy-nine percent of the females and 36% of the males had self-defence injuries in the upper extremities. In 21 cases (15%) the offender was a woman, 19 of their victims being male; the weapon in these cases was most often a kitchen knife. Seventy-eight percent of the females and 49% of the males were killed in their own home. The most common circumstance was family row when the victim was female, while a fight was the most common circumstance when the victim was male. Three offenders committed suicide after having committed homicide(s) (seven victims; three offenders).

[Penetrating heart injuries in two butchers]

Two butchers, men aged 25 and 48 years, sustained a perforating heart injury when they made a vertical cut. They were rushed to hospital. The first patient was haemodynamically stable on arrival. The second had hypotension and cardiac ultrasonography revealed increased fluid in the pericardium; he was subjected to pericardiocentesis. The heart wounds in both patients were sutured via a left-sided anterolateral thoracotomy; the younger had a wound in the left ventricle, the older both a dorsal and a ventral transmural perforation of the right ventricle. Both patients could be discharged after a little over a week in good condition. Employers in abbattoirs should provide protective clothing fastening high enough to prevent heart wounds.

Sharp-force trauma analysis and the forensic anthropologist: techniques advocated by William R. Maples, Ph.D

Forensic anthropological tenets supported by William R. Maples, Ph.D. provide the bases for a case study from the C.A. Pound Human Identification Laboratory. Using a multidisciplinary team that included police investigators, pathologists, odontologists, entomologists, and anthropologists, a biological profile and trauma analysis was constructed. Our analysis determined that the decedent was a middle-aged Hispanic male, approximately 5'6"-5'7" in stature, who had died a minimum of three months before the discovery of his remains. Gross and microscopic analysis revealed 11 areas of sharp trauma to the skull and cervical vertebrae. To aid with analysis of the trauma, nonhuman trauma exemplars were created using a Tiger rear flail mower of the make known to have been used at the scene where the remains were recovered. This use of nonhuman trauma exemplars proved to be essential in the effort to exclude the rear flail mower as the possible trauma agent.

An assessment of human performance in stabbing

Stab-resistant body armour is now becoming a standard item of equipment for police officers in the United Kingdom. In the UK these are usually required to have a stab resistance as specified by the Police Scientific Development Branch KR42 standard [G. Parker, PSDB Stab Resistant Body Armour Test Procedure, Police Scientific Development Branch, Publication No 10/93, 1993]. There are several other test standards, all of which specify that body armour must resist penetration by a specific blade type delivered at a specific energy level or range of levels. However, the actual range of energy levels specified varies over almost an order of magnitude and the basis for these levels is not clearly defined. This paper describes tests to determine the energy range and characteristics of stabbing actions that might be directed against stab resistant body armour by an assailant. The energy and velocity that can be achieved in stabbing actions has been determined for a number of sample populations. Volunteers were asked to stab a target using an instrumented knife that measured the axial force and acceleration during the stabbing. The maximum energy obtained in underarm stabbing actions was 64 J whilst overarm stabbing actions could produce 115 J. The loads produced on contact with the target often approached 1000 N.

Massachusetts Weapon-Related Injury Surveillance System

CONTEXT

Surveillance data on nonfatal weapon-related injuries--particularly those treated only in the emergency department (ED)--have been largely unavailable.

OBJECTIVE

To develop a surveillance system for fatal and nonfatal gunshot wounds and sharp instrument assaults.

DESIGN

The Massachusetts Department of Public Health (DPH) developed an ED-based reporting system for weapon-related injuries. Inpatient discharges and mortality data were linked to ED data, and police data sources were evaluated.

SETTING

Statewide.

PARTICIPANTS

All 84 acute care hospital emergency departments. Uniform Hospital Discharge Data Set (UHDDS), mortality, and police data were obtained from existing systems.

MAIN OUTCOME MEASURES

System sensitivity, predictive value positive (PVP), representativeness, flexibility, usefulness, acceptability, and sustainability.

RESULTS

The ED reporting system captured 82% of firearm-related injuries and 74% of reportable sharp instrument wounds from 1994 to 1996. Case reporting by demographic characteristics of the victim was representative and largely complete. Reporting by characteristics of the incident (e.g., type of gun) was less reliable. Police data were used to augment the system. From 1994 to 1996, ED-treated gunshot wounds dropped 41%, from 662 in 1994 to 393 in 1996. Unintentional and self-inflicted gunshot wounds showed no declines. For every firearm-related homicide, 4.7 nonfatal firearm assaults were treated; 85% of self-inflicted gunshot wounds were fatal.

CONCLUSIONS

The system has proven timely (1996 ED data were available for release in March 1997), flexible (the reporting form has been revised several times), useful (DPH responds to 150 weapon injury data requests annually), acceptable (reporting is voluntary and no hospital declined participation), and sustainable (state funding is currently supporting the ED reporting system).

Are latex gloves a contributing cause of percutaneous injury in dentists?

Fifty dentists were examined to determine if (and how) latex gloves contributed to percutaneous injury, the leading cause of occupational AIDS/HIV transmission in health care workers. Latex glove wear is closely associated with a 16-fold increase in percutaneous injury with endodontic file manipulation than when subjects were tested barehanded. Dynamometer tests showed a 36 percent decrease in light-touch proprioception in subjects when they were gloved as compared to scores when they were tested barehanded. A 28 percent glove-related dermatitis rate among test subjects is also reported.

[Thoracic stab wounds]

Stab wounds are the most common cause of open chest wounds in our setting, with an incidence far higher than either wounds caused by firearms or bull horns. We describe a series of 49 patients, 44 (89.8%) men and 5 (10.2%) women. Mean age was 31 years. The 49 patients had suffered 72 stab wounds to the chest, of which 30 (41.6%) were penetrating and 42 (58.3%) were non penetrating. The lesions observed were 11 (22.4%) cases of pneumothorax, 10 (20.4%) of hemopneumothorax, 6 pulmonary lesions, 2 heart wounds and 1 extensively damaged diaphragm. Twenty-four patients with non penetrating wounds and 8 with penetrating wounds were treated conservatively. It was subsequently necessary to drain the chest of only one. Of the remaining penetrating wounds, drains were inserted in six immediately and 11 underwent surgery. Complications developed in only 9 cases. One patient died as a result of abdominal lesions resulting from stab wounds directly to the abdomen. We are in favor of conservative management. Indications for more aggressive intervention are hypovolemic shock, cardiac tamponade or significant loss of fluid through the thoracic drain.

Sharp force homicides in the Stockholm area, 1983-1992

A total of 133 males and 41 females were included in a consecutive study of homicides caused by sharp force injuries in the period 1982-1993. A comparison was made with 142 homicides in the previous 10-year period. Victims showed statistically significantly more injuries in the latter than in the previous period. The numbers of male victims had increased significantly in the combined 20-year period. The numbers of cuts and stabs inflicted on the victim were used as a variable to discriminate different groups of perpetrators. More than ten wounds were correlated to a close relation between perpetrator and victim and to assailants with mental illness. One single injury was often observed in cases where the relation between the perpetrator and the (often male) victim was based on alcohol. Between two and nine wounds were of ten seen in cases where the homicide was part of a fight among persons with lesser degree of relation. In addition almost all offenders in this group were males. More than ten wounds gave a statistically significantly lower probability that perpetrator and victim were strangers to each other. 27% of the perpetrators that had been physically examined shortly after the homicide had evidence of sharp force injuries on the hands. Perpetrators using sharp force violence showed a high mortality in accidents, deaths due to abuse, homicides and deaths due to suspicious circumstances. Laws restricting the carrying of knives in certain places did not significantly influence the number of sharp force homicides, since the absolute majority of them were carried out with knives found at the scene.

Suicide using a compound bow and arrow

Accidental, suicidal, and homicidal injuries have been caused by arrows fired from crossbows. To our knowledge, a case of suicide using a full-size compound bow to fire a projectile has not been reported in the English literature. Described is a case of a 17-year-old man who shot himself in the chest with a broadhead hunting arrow fired from a compound bow. Examination of the footwear suggests that the decedent drew the bowstring with his left foot while holding the bow in his hands. The mechanism of injury is discussed. When dealing with a longbow-related fatality, examination of the weaponry used and reenactment of the fatal methodology are critical in determining whether self-inflicted injury is a probability.

Penetrating neck trauma: lack of universal reporting guidelines

Penetrating neck injuries constitute a heterogeneous group. Two different classifications of zones of the neck exist in trauma literature. Injuries crossing the midline are not accurately reported. Records of 50 patients with stab wounds (30), gunshot wounds (GSWs; 17), and shotgun wounds (SGWs; 3) were reviewed. Injuries involved zone I in 8 patients, zone II in 37 patients, zone III in 8 patients, posterior triangle in 6 patients, and multiple zones in 5 patients. All 11 patients with transcervical GSWs and SGWs sustained vascular or aerodigestive injuries and had longer hospital stays (14.0 +/- 2.6 days) compared with patients with other GSWs (6.6 +/- 2.0 days) and stab wounds (3.6 +/- 0.5 days). We emphasize the lethal potential of transcervical GSWs and SGWs. We suggest that these particular injuries be reported separately. We recommend the universal adoption of one system of classification of neck zones.

An unusual chest impalement

We present the case of a 49-year old farmer, a combatant in communal clash over a piece of farmland on the Jos Plateau, who was impaled on his chest by a 13.5 cm long metal arrow, 56 hours prior to presentation. The arrow hit him tangentially on the left side of the chest and disappeared completely into his chest traversing the chest wall and lacerating the superior lingula segment of the lung but the tip of the arrow was only about 1.5 cm short of the pericardium. We are not aware of any report in literature on a patient in the West African sub-region who sustained and survived such serious chest impalement by a rigid object for more than two days before hospitalisation. Sustained public education and enforced legislature against the use of such lethal weapons will go a long way in preventing serious injuries of this nature.

Case report of metallic mercury injury

OBJECTIVE

Injury and poisoning from metallic mercury has become a rare event. Review of the literature and a case report of pediatric metallic mercury injury are presented.

DESIGN

A case report.

SETTING

The Emergency Department at St. Louis Children's Hospital.

PATIENTS OR PARTICIPANTS

A 15-year-old boy.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

None.

RESULTS

The 15-year-old boy fell on a broken mercury thermometer. A subcutaneous abscess formed on his left forearm during the next five days. He had no signs or symptoms of mercury toxicity. His wound was debrided in the operating room and healed completely after several months.

CONCLUSIONS

This case shows elemental mercury from a thermometer as a potential, if unusual, source of mercury toxicity.

[The surgical procedure in left-sided thoracoabdominal knife wounds]

An experience with surgical treatment of 136 patients with left-side thoracoabdominal knife wounds has shown that all the patients can be divided into two groups: transpleural wounds (111 cases or 81.7%) and extrapleural wounds (25 cases or 18.3%). Symptoms of extrapleural wounds (medial and lateral) are described. Injuries to organs of the abdominal cavity were shown to depend on the localization of the diaphragm wound. It was found that in patients with wounds to the posterior cupula there were only injuries of organs fixed in the subdiaphragmatic space.

Stab wounds in The Gambia

Over a 24-month period (January 1990 to December 1991) 337 cases of stab wounds were managed at the Royal Victoria Hospital, Banjul, The Gambia. All stabbing occurred in and around Banjul and victims were predominantly male (99.1%). Stabbed subjects were mostly involved in fights (98.2%). The mean age of the subjects was 27.6 +/- 10.5 years. 155 subjects (46%) required emergency room treatment only while 182 (54%) needed hospitalisation. Superficial lacerations predominated (94.3%) while other major complications included haemothorax/pneumothorax (2.4%), haemopericardium/pneumopericadium (0.3%), cardiac lacerations (0.6%), and haemoperitoneum (2.4%). Visceral injuries managed were: Heart lacerations (2%), Liver lacerations (1.2%), lung lacerations (2.4%), peritoneal lacerations (0.6%), gut perforation (0.6%) and pericardial complications of inadequate initial management. Anaesthetic techniques used for major procedures including Thoracotomies and Laparotomies were simple to ensure safety and assure quick post anaesthetic recovery. All patients had an uneventful recovery. In a situation of restricted medical facilities, we have recorded successful management outcomes without resorting to mandatory exploratory celiotomy and expensive diagnostic procedures.

Factors influencing outcome in stab wounds of the heart

BACKGROUND

The purpose of this study was to identify factors associated with unfavorable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from aggressive resuscitative efforts.

METHODS

Preoperative and operative variables were reviewed for all patients treated for cardiac stab wounds at a level I trauma center from 1987 to 1993 in an attempt to identify factors influencing survival.

RESULTS

Twenty-nine (53%) of the 55 patients who were resuscitated following stab wounds to the heart during the study period survived. Although profound hypotension (systolic blood pressure < 40 mm Hg), cardiopulmonary resuscitation, and emergency room thoracotomies were associated with poor outcome, none were uniformly predictive of death. Some patients survived with each of these characteristics.

CONCLUSIONS

We recommend that all patients suspected of having cardiac stab wounds be fully resuscitated and undergo thoracotomy, as significant survival can be achieved and death is not always the outcome.