Forensic assessment of single stab injuries to the trunk

IntroductionForensic pathologists are frequently confronted with questions about the likelihood that an injury is inflicted by an assault or is self-inflicted. However, little is known of epidemiological variables applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk. MethodUsing the Swedish forensic autopsy register we identified 94 homicides and 45 suicides between 2010 and 2021 that died following a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using Mann-Whitney U and Chi-square test.ResultVictims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p < 0.05), and males were in majority in both groups (93% vs. 82%). Some homicidal stab wounds were placed on the posterior (12%) and axillar trunk (11%) unlike the suicidal stabs which were all placed on the anterior trunk. Most stab wounds of all examinations were placed on the left side of the anterior thorax (60%). In suicides, single stab injuries to the heart were more common than in homicides (67% vs. 48%, p < 0.05). Vasculature injuries were more common in homicides (51% vs. 9%, p < 0.05).DiscussionThe epidemiological variables 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 surviving victims in such analyses

Commentary on "Fatal cardiac air embolism after CT-guided percutaneous needle lung biopsy medical complication or medical malpractice?"

To differentiate between medical malpractice and expected, but rare, medical complication in a medicolegal autopsy context is often difficult. Such an assessment requires knowledge about the clinical practice associated with the procedure at hand, and that findings of the autopsy, including medical relevant information such as patient chart, radiological imaging, and statements from witnesses about the medical procedure itself, provides evidence that substantiate either conclusion. In a case report published in the journal such an assessment is discussed by presenting findings and circumstances surrounding the death of a patient during a percutaneous needle lung biopsy procedure. The authors conclude that the death was not due to medical malpractice. However, in this commentary it is highlighted that the reasoning behind the conclusion needs to be further substantiated

An evidence-based approach to forensic life-threat assessments using spleen injuries as an example

INTRODUCTION: During the judicial process of addressing violent crime, a forensic practitioner may need to assess whether an inflicted injury should be considered life-threatening. This could be important for the classification of the crime. To some extent, these assessments are arbitrary since the natural course of an injury might not be completely known. To guide the assessment, a quantitative and transparent method based on rates of mortality and acute interventions is suggested, using spleen injuries as an example.METHOD: The electronic database PubMed was searched using the term "spleen injuries" for articles reporting on rates of mortality and interventions such as surgery and angioembolization in spleen injuries. By combining these different rates, a method for a transparent and quantitative assessment of the risk to life across the natural course of spleen injuries is presented.RESULTS: A total of 301 articles were identified, and 33 of these were included in the study. The mortality rate of spleen injuries, as reported in studies, varied between 0% and 2.9% in children, and between 0% and 15.4% in adults. However, when combining the rates of acute interventions and the mortality rates, the risk of death across the natural course of spleen injuries was estimated as 9.7% in children, and 46.4% in adults.CONCLUSION: The calculated risk of death across the natural course of spleen injuries in adults was considerable higher than the observed mortality. A similar but smaller effect was observed in children. The forensic assessment of life-threat in cases involving spleen injury needs further research; however, the applied method is a step towards an evidence-based practice for forensic life-threat assessments

The Epidemiology of Childhood Celiac Disease: A Social Epidemiological Perspective on Perinatal Factors

Celiac disease is a chronic gastrointestinal disease affecting approximately 1% of the population. It is precipitated in genetically predisposed individuals by ingestion of food containing gluten or similar proteins that are present in wheat, rye and barley. The disease might present with symtoms such as malnutrition, diarrhea or abdominal bloating, but a large proportion of those afflicted by the disease are asymptomatic. We set out to study risk factors for celiac disease in children using a social epidemiological approach; besides the individual risk factors we also consider the importance of societal structures in conditioning disease risk. We investigated all children born in Sweden between 1987 and 1993 by linking several nationwide registers. We apply epidemiological methods such as multilevel analyses and sibling designs in order to approach causality. We observed that children exposed to adverse perinatal circumstances such as being born small for gestational age, born in families with lower socioeconomic position or having a congenital anomaly had a higher risk of CD. These associations were stronger in boys. We also observed that maternal CD seems not to be the cause of the previously reported increased risk of CD in girls. Furthermore, we observed that maternal length of stay in Sweden seems to affect the risk of CD in second-generation immigrant children. Future studies are needed to investigate risk factors for celiac disease in children; focusing especially on the mechanisms behind the observed associations

The association between obesity and lethal blood alcohol concentrations: A nationwide register-based study of medicolegal autopsy cases in Sweden.

Obesity is a global problem and in aspects of lethal ethanol intoxications virtually unexplored. The cause of death in ethanol intoxication is generally considered to be suppression of the respiratory function. Previous research indicates that respiratory function is more vulnerable in obese subjects than in those of normal weight. We hypothesized that lethal blood alcohol concentration (BAC) is lower in obese subjects compared to those of normal weight. We used the Swedish medicolegal autopsy register and identified all medicolegal autopsy cases in Sweden during the period from 1999 to 2013 (N=79,060), and identified 1545 cases with ethanol intoxication identified as the primary cause of death. We studied the association between body mass index and lethal BAC using logistic regression models that we adjusted using several potential confounders such as age, sex, drugs, and extent of decomposition. We observed an association between obesity and lower lethal BACs. The estimated adjusted odds ratio of the association between obesity and a lethal BAC >3‰, using subjects of normal weight as reference, was 0.54, 95% confidence interval: 0.39-0.74. The result indicates that in obese subjects the lethal BAC is lower than in those of normal weight