Homicide-Suicide by Stabbing Study Over 10 Years in the Toulouse Region

Differentiating suicide from homicide in sharp-force fatalities with stab and/or incised wounds: A scoping review

The majority of sharp-force fatalities with stab and/or incised wounds are homicides. However, suicidal sharp-force fatalities with stab and/or incised wounds are also reported. Thus, distinguishing suicidal stab and/or incised wounds from homicidal stab and/or incised wounds is significant from the forensic perspective. This scoping review primarily summarizes the existing research findings on the differentiation of suicide from homicide in sharp-force fatalities with stab and/or incised wounds. The literature was systematically searched on February 28, 2023, using the PubMed database. A search string formed by a combination of keywords related to suicide, homicide, and stab and incised wounds yielded 23 records. After applying the eligibility criteria, six records/studies met the inclusion criteria and were included in the present scoping review. Results showed that the predictive strength of various parameters, either individually or collectively, in diagnosing the manner of sharp-force fatality as suicide or homicide is not always hundred percent accurate. Some of the important predictors of the homicidal manner of death in sharp-force fatalities include clothing damage, presence of defense injuries, presence of injuries caused by another type of violence other than sharp-force, vertically oriented chest stabs, and sharp-force injuries in the head and back anatomical sites. Some of the important predictors of the suicidal manner of death in sharp-force fatalities include the presence of tentative injuries, sharp-force injuries to the wrist, and the presence of a suicide note.

A Swedish nationwide forensic study of the manner of death in single stab injuries to the trunk

INTRODUCTION

Forensic pathologists are frequently confronted with questions about whether an injury is likely to have been inflicted by an assault or be self-inflicted. However, little is known of the epidemiological variables that might be applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk.

METHOD

Using the Swedish forensic autopsy register, we identified 94 homicides and 45 suicides between 2010 and 2021 in which death followed a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using the Mann-Whitney U test, Chi-square test and logistic regression model.

RESULTS

Victims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p < 0.05), and males were in the majority in both groups (93% vs. 82%). In numerous homicide victims, stab wounds were placed in the back and in axillar regions, unlike in suicides victims in which the stabs were all placed on the medial part of the anterior trunk. Vertical entrance wounds in the skin combined with a medially running injury channel (n = 13) showed a positive predictive value of 100% (95% CI 75.3-100) for homicide, although the sensitivity was low. Homicides were conclusively associated with an outdoor death scene (OR 19.0, 95% CI 7.6-47.1), injury to thoracic bone/cartilage (OR 3.8, 95% CI 1.6-9.0), influence of alcohol (OR 7.1, 95% Cl 2.9-17.7) and illicit drugs (OR 4.3, 95% CI 1.5-11.9).

DISCUSSION AND CONCLUSION

The observed forensic characteristics of stab injuries could be used as a tool when assessing the manner of death in single stabs. Further research on variables associated with manner of death are needed and we suggest also including characteristics of surviving victims in such analyses.

Review of patterns in homicides by sharp force: one institution's experience

This paper presents a retrospective review of patterns found in cases of homicides by sharp force over a 13-year period at the Department of Forensic Pathology of the Ostrava University Hospital, Czech Republic. The review summarizes all frequently discussed aspects of such cases including the number and localization of injuries, the presence of defensive wounds, the type of the offending weapon, the cause of death, the place of death, victims' and perpetrators' profiles, their relationship, or toxicological findings. Furthermore, special attention was paid to the evaluation of any accompanying blunt force trauma that may be indicative of an escalation of the assault. The set of data was statistically analyzed. Even though most of the results of this review are consistent with available published studies, noteworthy differences have emerged in some aspects such as the sex and age of the victims, the relationship between the number of injuries suffered and the victims' sex, or the severity of alcohol intoxication in victims.

Analyzing two decades of intimate partner femicide-suicides in Türkiye

Intimate partner femicide-suicide (IPF-S) is an understudied subgroup of homicide-suicide deaths. Limited research has been conducted on IPF-Ss in the Eastern Mediterranean region. This study thus aimed to evaluate the characteristics of IPF-Ss that occurred in Türkiye between 2000 and 2019. IPF-Ss (n = 226) were extracted from electronic news stories. Data on victims, perpetrators, their relationships, and incidents of murder and suicide were collected. Descriptive statistics were calculated, and logistic regression analysis, mortality rates, and proportion of IPF-S in femicide calculations were conducted, showing that 13.3% of the femicides (n = 1699) were IPF-Ss. The IPF-Ss increased in 5-year intervals and were the highest during the 2015-2019 period (62.5%). Victims were married in 48.2% of the cases and 56% were aged <35 years, while 51.3% of the perpetrators were married and 52.6% were aged >40 years. In 42.0% of the cases, the perpetrator lived with the victim. Most (79.2%) of the cases took place in urban settlements, and the perpetrators used firearms in 84.1% of femicide cases. Firearm use was the most common method in cases where IPF-S was planned (OR = 2.98), when the IPF-S method was the same (OR = 29.6), and when the perpetrator committed suicide (OR = 7.82). In addition, it was found that firearm ownership is an important risk factor for IPF-S in Türkiye. Therefore, we recommend legislation to restrict firearms, as well as new measures to prevent illegal access to weapons.

Sharp force fatalities: Differentiating homicide from suicide through a retrospective review (2012-2019) of autopsy findings in Lisbon (Portugal)

Sharp force fatalities may have a homicidal, suicidal or accidental manner of death. To aid in such differentiation this study aimed to identify medico-legal elements which were predictors of a given manner of death as well as to describe the characteristics of these deaths. A retrospective review was performed on all homicides and suicides due to sharp force injury admitted at the South Branch of the National Institute of Legal Medicine and Forensic Sciences between January 2012 and December 2019. Deaths with a performed external examination or forensic autopsy and with available demographic, circumstantial or necroscopic information were included. Each case was reviewed to collect said information and inferential analysis was employed with both parametric and non-parametric tests as well as binary logistic regression to identify independent predictors, with significance defined at α = 0.05. A total of 57 homicides and 20 suicides were identified, with the obtained demographic and circumstantial profile of the homicide victim being that of a young foreign male whose body was found outside home, with no weapon nearby and without a known psychiatric background. Homicides presented more prominently stab wounds, with these being conspicuous on the thorax and neck. Conversely suicides notably presented cut wounds, being critically present in the neck and upper limbs. Oblique thoracic stab wounds conveyed a homicidal death. Other findings that suggested homicide included the presence of clothing damage, additional traumatic lesions and injured lungs or bone/cartilage. Toxicologically, alcohol presence was associated with homicides while psychiatric drugs suggested suicide. The logistic regression identified the presence of additional traumatic lesions (OR 14.8, p = 0.032) and the absence of lethal neck (OR 0.109, p = 0.043) and lethal upper limb (OR 0.022, p = 0.015) wounds as independent autopsy predictors of a homicidal death. However, no single feature is infallible in establishing manner of death. To achieve a cogent conclusion, all investigative elements must be considered while attending to the specifics of each case.

A bizarre case of fatal main renal artery partial laceration without primary kidney injury due to a single stab wound in the chest

Reno-vascular injuries are a rare type of renal injury, and their second most frequent cause is penetrating wounds. The majority of the reports and of the studies are present in the urological and radiological literature and they focus on the clinical approach to such injuries. In the case here presented, an 18-year-old male died after being stabbed in the left hemithorax. During body examination, thoracic organs were found to be unremarkable (except for a small peripheral laceration of the left lung), but the diaphragm was transfixed and the upper wall of the left main renal artery was lacerated. The adjacent renal vein, the kidney, the aorta, the vena cava and the surrounding internal structures were not damaged (except for a small laceration of the pancreatic tail). A massive haemothorax and a large retroperitoneal haematoma in the left kidney area were observed. The cause of death was attributed to haemorrhagic shock following a partial laceration of the left main renal artery due to the stab wound to the chest. No other cases of similar fatal renovascular injuries due to stab wounds have been published in the current forensic literature.

Unusual attempted suicide or covered attempted homicide? A neck stabbing case report and review of literature

A medico-legal consult is frequently required in a clinical context in order to assess the eventual compatibility of specific wounds with a self- or hetero-infliction. Accordingly, the case of a 52-year-old man with a single, penetrating stab wound of the neck, reported as self-inflicted, is here presented. The forensic aspects, taken into account in order to determine the self- or hetero-infliction nature of the wound, are further discussed and compared to cases described in the literature.

A Case of Multiple Self-Inflicted Stab Wounds of the Neck Captured on Surveillance Video

Multiple sharp force injuries in a victim make it difficult to distinguish between homicide and suicide. Forensic pathologists also may be unable to determine the total survival time and the survival time with physical activity due to lack of evidence. The authors report here on a case of nineteen stab wounds of the neck, which led to an initial suspicion of homicide. The scene was however captured on surveillance video, which provided a precise description of the wound mechanism and led to the injuries being reclassified as suicidal. No other description of a suicide with such a high number of severe stab wounds has been documented in the literature. The video footage provided additional information concerning survival time. Physical activity was well documented during at least 4 min after the last stab wound and the total survival period was at least 6 min, despite the perforation of both jugular veins and the trachea. Vein injuries are less rapidly lethal than artery injuries. Injuries of the major airways are not immediately lethal and do not lead to immediate incapacitation. The benefit of the video evidence is to highlight wound features that may suggest a suicidal manner and inform forensic pathologists about survival intervals after severe stab wounds to the neck.

How taphonomic alteration affects the detection and imaging of striations in stab wounds

Stabbing with a kitchen knife is a common method of homicide in Europe. Serrated knives may leave tool markings (striations) in tissues. Documentation of striations is necessary for their use as forensic evidence. Traditional methods (physical casting and photography) have significant limitations, and micro-computed tomography (micro-CT) has been trialled in cartilage to “virtually cast” wounds. Previous research has shown the proportion of striations in cartilage falls following decomposition. This project has investigated the effects of taphonomic alteration and documentation methods of striations in porcine skin. Fresh, decomposed, mummified, burnt and waterlogged stab wounds in a porcine analogue were excised and imaged using photography, stereo-optical microscopy and micro-CT. The proportion of striations in each taphonomic group was determined from the images by independent analysts. Striations were observed more frequently in serrated blade wounds, although they were also identified in non-serrated blade wounds. The proportion of wounds showing striations declined following decomposition. An inversely proportional linear correlation between advancing decomposition and proportion of striations existed. Dehydration (mummification and burning) rendered serrated and non-serrated blade wounds indistinguishable. Water composition affected the preservation of striations. Identification of striations gradually declined after decomposition in tap water, but persisted to a point when left in brackish water. All three techniques imaged striations; however, the optimum technique was stereo-optical microscopy due to practical advantages and specific limitations affecting photography and micro-CT. This study demonstrates the effects of taphonomic alteration on striations and suggests stereo-optical microscopy is the optimum method for their documentation.

An unusual homicidal stab wound of the cervical spinal cord: A single case examined by post-mortem computed tomography angiography (PMCTA)

We report an unusual case of homicidal stab wound of the cervical spinal cord, which illustrates the value of post-mortem computed tomography angiography (PMCTA) in cases of vascular injury. First, we noted a posterior and horizontal trajectory to the neck with complete section of the cervical spinal cord between the first and second cervical vertebrae. This lesion was accompanied by section of the right vertebral and right deep cervical arteries. We also noted an anterior cervical trajectory with an injury to the right internal jugular vein and an anterior right chest wound with a lung trajectory and section of the internal mammary vessels. Cases of spinal cord injuries secondary to stab wounds are rare in the literature. Only one large series has been published from Cape Town. Complete section of the cervical spinal cord accounts for only 4.5% of all cases. Furthermore, lethal cases are rare and classically victims survive and present neurological sequelae. We found only one similar case but despite the transection of the cervical spinal cord the patient survived. Some studies suggest that PMCTA may be very helpful in visualizing vascular system injuries. Our observations are consistent with this proposal. The use of different-time acquisitions was essential for detection of the injured vessels.

Kitchen knives and homicide: a systematic study of people charged with murder in the Lothian and Borders region of Scotland

A recent English study demonstrated high rates of kitchen knife use in homicides by mentally disordered offenders subject to independent inquiries. Everyone accused of homicide in Scotland undergoes psychiatric examination; all such evaluations in a Scottish region between 2006 and 2011 were systematically analysed to identify homicide characteristics. It was hypothesised that kitchen knives would be the commonest sharp instruments used, and would be associated with unplanned domestic homicide against known victims, with no independent association with mental disorder. Kitchen knives were used in 32 of 55 homicides: 94% of 34 sharp object homicides (p < 0.05). No independent association was found between kitchen knife use and planning, location, relationship, intoxication or mental disorder. Kitchen knife use in homicide appears to be a significant public health issue, and not only in the mentally disordered population. Research is recommended into kitchen knife use in non-fatal violence, and weapon control in populations at increased risk of knife violence.

Fatal alcohol intoxication in women: a forensic autopsy study from Slovakia

BACKGROUND

Plenty of information related to alcoholism can be found in the literature, however, the studies have mostly dealt with the predominance of male alcoholism and data related to addiction in women are desperately scarce and difficult to find. Basic demographic data focusing on the impact of acute alcohol intoxication on the circumstances of death and social behaviour in the alcohol addicted female population are needed especially in the prevention of alcohol related mortality.

METHODS

A retrospective forensic autopsy study of all accidental deaths due to alcohol intoxication over a 12-year period was performed in order to evaluate the locations, circumstances, mechanisms and causes of death.

RESULTS

A sample of 171 cases of intoxicated women who died due to blood alcohol concentration (BAC) equal to or higher than 2 g/kg was selected. Among them 36.26% (62/171) of women died due to acute alcohol intoxication (AAI). We noted an increase in the number of deaths in women due to AAI from 2 in 1994 up to 5 in 2005 (an elevation of 150% between the years 1994-2005). The age structure of deaths in women due to BAC and AAI followed the Gaussian distribution with a dominant group of women aged 41-50 years (45.16% and 35.09% respectively). The most frequent place of death (98%) among women intoxicated by alcohol was their own home. The study suggests a close connection between AAI and violence against women.

CONCLUSIONS

The increasing number of cases of death of women suffering from AAI has drawn attention to the serious problem of alcoholism in women in the Slovak Republic during the process of integration into "western" lifestyle and culture.

Suicide by Extraordinarily Numerous Blade Wounds

A 42-year-old man with a history of suicidal ideation, was found dead in his garage, with over 54 stab wounds and with multiple cuts. The house was locked and the bay door of the attached garage was closed when his live-in girlfriend arrived home and found him. The scene was bloody and a knife was beside the body. Multiple stab wounds involved the neck and the left pectoral region of the chest, and a single stab wound involved the epigastrium. Incised wounds involved the neck and upper extremities. The head, back, genitalia, and lower extremities had no wounds. The blood smears and spatters in the garage, including a bloody footprint, all were attributable to the decedent. The combined consideration of the history, circumstances, and autopsy findings clearly pointed to self-infliction as the manner of death. Most reported cases of suicide by blade involve fewer than 15 stab wounds. This case report, with a brief review of the literature, underscores the concept that multiplicity of stab wounds does not preclude the diagnosis of suicide.

Macroscopic characteristics of screwdriver trauma

The main objective of the study was to determine the type of macroscopic trauma created by a flat-tipped and a cross-tipped screwdriver. The second objective was to determine if the trauma inflicted by the two screwdrivers could be macroscopically differentiated. Three tests were conducted, each by a male volunteer. Each test consisted of 12 samples of fleshed pig ribs; six were stabbed with a flat-tipped screwdriver and the remaining six with a cross-tipped screwdriver (Phillips). Each sample received 15 stab wounds during the process. The stabbings were conducted at perpendicular and oblique angles, with fabric variables being utilized. Results illustrate two main categories of macroscopic skeletal trauma, fractures, and puncture wounds. By studying the macroscopic appearance in tandem with differing trauma frequencies, these two screwdriver types can be differentiated.

Homicide in Tours (Indre-et-Loire, France): A four-year review

This retrospective study examined homicides in two French departments located in the West of France (Indre-et-Loire and Loir-et-Cher) for a four-year period from 2000 to 2003. During this period 63 homicidal deaths were investigated at the Institute of Forensic Science of Tours (Indre-et-Loire). There were 45 male and 18 female victims with an average homicide rate of 1.55 per 100,000 persons. The mean age of the victims was 42 years-old. Forty-five assailants were identified; their mean age was 38 years-old. The most common method of homicide was the use of firearms (40% of the cases), followed by blunt-force injury (36%) and sharp-force injury (16%). 51% of the victims knew their assailant, a family member in 26% of the cases. Spousal homicides occurred in 16% of the cases. Dyadic death occurred in six cases. A review of the literature compares these findings to other populations.