Sharp force homicides in the Stockholm area, 1983-1992

Intimate partner femicide (IPF): Medico-legal investigation at the Institutes of Legal Medicine of Freiburg (Germany) and Padova (Italy)

Violence against women is a significant public health concern, with femicide as its most extreme manifestation. This crime is often perpetrated by current or former intimate partners, thus taking the name of intimate partner femicide (IPF). Although international comparisons are essential for prevention policies, cross-country comparative studies are scarce in this context. The aim of this study was to evaluate and compare clinical, epidemiological and medico-legal characteristics of IPF autopsy cases investigated at the Institutes of Legal Medicine of two Western European cities, in order to identify a potential medico-legal pattern of IPF. Autopsy and police reports of IPF cases occurred in the judicial district of Freiburg (Germany) and Padova (Italy) from 2000 to 2022 were analyzed. Data relating to victims, perpetrators, relationship context, and circumstantial and pathological-forensic characteristics of the homicide were collected. Statistical analyses were performed to explore potential relationships between the data collected. Additionally, a review of the literature dealing with autopsy-based studies on IPF was performed. Overall, 82 cases of IPF were analyzed, 39 from Freiburg and 43 from Padova. A total of 6 papers fulfilled the review inclusion criteria. Our study identified a medico-legal pattern of IPF and demonstrated that it did not vary substantially between the two European Countries considered, suggesting that certain IPF characteristics are shared at the European level. However, a significant finding emerged regarding the higher prevalence of firearm-related IPFs in Italy compared to Germany. Forensic pathology research might contribute to developing targeted prevention policies to protect women from this lethal form of violence.

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.

Alcohol, Aggression, and Violence: From Public Health to Neuroscience

Alcohol has been associated with violent crimes and domestic violence across many nations. Various etiological factors were linked to chronic alcohol use and violence including psychiatric comorbidities of perpetrators such as personality disorders, mood disorders, and intermittent explosive disorders. Aggression is the precursor of violence and individuals prone to aggressive behaviors are more likely to commit impulsive violent crimes, especially under the influence of alcohol. Findings from brain studies indicate long-term alcohol consumption induced morphological changes in brain regions involved in self-control, decision-making, and emotional processing. In line with this, the inherent dopaminergic and serotonergic anomalies seen in aggressive individuals increase their susceptibility to commit violent crimes when alcohol present in their system. In relation to this, this article intends to investigate the influence of alcohol on aggression with sociopsychological and neuroscientific perspectives by looking into comorbidity of personality or mood disorders, state of the mind during alcohol consumption, types of beverages, environmental trigger, neurochemical changes, and gender differences that influence individual responses to alcohol intake and susceptibility to intoxicated aggression.

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.

Quantifying Homicide Injuries: A Swedish Time Trend Study Using the Homicide Injury Scale

Studies report that the homicide rate has decreased considerably in most Western countries since the 1990s. However, few studies have examined the level of injury in homicides. The injury severity in homicide victims was studied in the Stockholm area using both the Homicide Injury Scale (HIS) and the number of lethal injuries per victim. Cases were included from four periods; 1976-78, 1986-88, 1996-98, and 2006-08. The number of homicides with overkill according to the HIS was significantly higher in 1996-98 compared to 1976-78. Compared with 1976-78, the number of lethal injuries per victim was significantly higher both in 1996-98 and 2006-2008. There are various possible reasons for the changes, including a brutalization of lethal violence or a more effective trauma care. More in-depth analysis of individual cases together with research on victims of attempted homicides is needed to explain these shifts in injury severity.

Cutaneous wound metallic residues pattern analysis with SEM-EDX in a forensic case of overkill

The term overkill identifies the infliction of massive injuries that greatly exceed those needed to kill the victim both in number and intensity. We present the case of a Peruvian transsexual, who was choked and hit by 11 sharp-force wounds all in the facial area. The scanning electron microscopy with energy dispersion X-ray analysis carried out on the skin of the facial wounds proved crucial in proving that two different point-and-edge weapons were used, following the finding of metallic micro-traces of heterogeneous composition. This discovery and the autopsy highlighted the use of two distinct types of injury (mechanical asphyxia and sharp-force trauma) showed that this murder amounted to overkill.

Association between homicide injury severity and benzodiazepine influence

There are case reports of offenders inflicting excessive injuries on their victims when under the influence of benzodiazepines. However, the potential association between benzodiazepine influence on the offender and victim injury severity in a general homicide population has not been studied. We investigated associations between offender positive testing for benzodiazepines or z-drugs (zolpidem, zopiclone and zaleplon) and victim injury severity. Data were drawn from 95 Swedish homicide cases from 2007–2009 in which offenders had known toxicology. There were no significant differences in injury severity between cases in which the offender tested positive vs. negative for benzodiazepines/z-drugs. Thus, the findings do not support the hypothesis that there is an association between benzodiazepine influence on the offender and victim injury severity in a general homicide population.

Key points

Some previous studies have linked benzodiazepines to aggression, violence and excessive homicide injuries.

The present study analysed the association between homicide injury severity and benzodiazepine status of the offender.

Offenders who tested positive for benzodiazepines did not inflict more severe injuries on their victims.

These findings do not support the hypothesis that benzodiazepine influence generally causes offenders to inflict more severe injuries on homicide victims.

Perimortem sharp force trauma in an individual from the early medieval cemetery of Säben-Sabiona in South Tyrol, Italy

OBJECTIVE

To provide a detailed analysis and interpretation of cranial and postcranial lesions noted on an early medieval skeleton from the Italian Alps.

MATERIALS

Individual (SK63) was buried within the early Christian church (5^th-8^th centuries AD) of Säben-Sabiona in South Tyrol (Italy).

METHODS

The skeleton underwent macroscopic, microscopic and metric analyses.

RESULTS

SK63 was a 19-25 year old male, the analysis identified at least 29 lesions, consisting of three possible antemortem injuries and 26 perimortem sharp force injuries on the cranium (n = 4) and postcranium (n = 22).

CONCLUSIONS

The trauma pattern observed indicates that different bladed weapons were used and interpersonal violence rather than a large-scale conflict led to the death of SK63.

SIGNIFICANCE

The present findings provide novel information on violent interpersonal interactions in early medieval Säben-Sabiona, Italy.

LIMITATIONS

The sequence of the inflicted injuries was not reconstructed.

SUGGESTIONS FOR FURTHER RESEARCH

Future interdisciplinary investigations (i.e., 3D imaging and reconstructions) will provide a better understanding of the possible types of weapons used to inflict injuries, the required forces to create the lesions, as well as the directions of impact.

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 injury severity in association with the victim-offender relationship

There are previous studies that have found associations between specific injury patterns and different victim-offender relationships (VORs) in homicides. We have used quantitative injury severity scores to further investigate this issue. The amount and severity of injuries were assessed in 178 Swedish homicide victims, retrospectively included from the years 2007-2009. We analyzed whether different injury measures could be used to predict the VOR. In addition to a deeper understanding of violent behavior, such associations may be of help to homicide investigators for offender profiling. The victims' injuries were assessed with eleven different methods. The cases with known VORs were divided into four categories: partner, relative, acquaintance, and stranger. The injury severities were then compared between these categories. No relevant differences were found. Thus, the current study does not support the claim that the VOR can be predicted from the injury severity in a general homicide population. These findings are in contrast to the results of some previous studies but confirm those of others.

Suicidal self-stabbing: A report of 12 cases from Crete, Greece

Sharp-force trauma is a popular cause of homicide and suicide in many countries. Characterisation of the injuries between the two is crucial for a differential diagnosis. The current paper reviews 12 self-inflicted sharp-force trauma deaths from the island of Crete in Greece. Forensic reports between 1999 and 2015 were collated, and we studied the number and location of injuries, the demographic characteristics of the deceased, the sharp object and the medical history of the deceased. One third of the cases where the forensic reports were available (3/10) involved multiple injuries, and one case involved a combination of stabbing and hanging. Most injuries involved a kitchen knife. Ninety-two per cent (11/12) of the victims involved male Greek nationals aged >50 years. The type and location of injuries were not found to be specific to suicide alone. Thus, death-scene investigation remains crucial to the differential diagnosis between suicide and homicide. This is the first report on self-inflicted sharp-force fatalities in Greece.

Relationship of sharp force injuries to motivation

Forensic pathologists are often expected to provide an opinion on the intention of the assailant in sharp force fatalities. A retrospective study was carried out on reports of post-mortems of victims of sharp force trauma over five years. The position and type of injuries were recorded and related to the known motivation for murder. Victims of different motives of killing had an almost similar injury pattern. There is no significant association of the pathology of sharp force injuries with the motive of killing.

Fatal intimate partner violence against women in Portugal: a forensic medical national study

Intimate partner violence (IPV) is an important cause of women's health and socio-familial severe problems, the most extreme being the victims' homicide. This is the first nationwide Portuguese autopsy-based and judicial-proven study about female intimate partner homicide. At least 62 women over 15 years old were killed by current or former men-intimate partners, corresponding to an IPV-related female mortality rate of 0.44/100.000 women; intimate partner violence was the reason of homicide in 60.8% of all autopsied women. The typical Portuguese victim showed to be a young adult woman, employed, killed by a current husband in a long-term relationship, usually with children in common and with a history of previous IPV. The typical Portuguese perpetrator showed to be older than the victim, employed, owning a firearm and without criminal records. At the time of the fatal event 59.7% of the relationships were current. In 57.9% of the former relationships women were killed during the 1st year after its terminus. Near half of the perpetrators attempted or committed suicide afterward. Most women were killed by gunshot wounds (45.2%), especially in the thorax (48.4%), with multiple fatal injuries; 56.5% also presented non-fatal injuries. The detection of prior IPV and the risk evaluation seems to be fundamental to decrease these fatal outcomes, but also, the prevention of perpetrators' alcohol abuse and carrying weapons. This work emphasizes the need to deepen the research on this issue, aiming to contribute to prevent both fatal and non-fatal IPV-related cases.

Homicidal deaths in the Western suburbs of Paris: a 15-year-study

The aim of our study was to analyze the homicide pattern in the Western suburbs of Paris and its evolution between 1994 and 2008. All autopsy reports regarding homicides from the period January 1, 1994, to December 31, 2008, were retrospectively reviewed. Five hundred eleven homicide cases were selected of 4842 autopsy cases. The following data were recorded: assailants and victims characteristics, crime scene location, homicide motive, cause of death, and victim's postmortem toxicological results. Homicide rate steadily declined over the period at the exception of the number of homicide-suicide per year, which remained constant. Homicide victims remained unidentified after medicolegal investigations in 2% of the cases. Child and elder homicide cases represented, respectively, 10.7% and 8.2% of the cases. Offenders were male in 88% of the cases. Male and female assailants showed distinct homicide patterns: females were involved more frequently in familial quarrel and child abuse. They never killed a stranger and committed homicide exclusively in a private place with a predominance of sharp weapons. Males, in contrast, assaulted almost equally a stranger or an acquaintance, often in a public place with a predominance of firearm. Victim knew the assailant(s) in 57% of the cases. Homicides mostly took place at the residence of the assailant or the victim. Homicide motive was clearly determined in 71% of the cases. Argument was the most common motive in 44% of the cases. Sexual assault was rarely found (10 cases). Gunshot wounds were the most common cause of death (37%), followed by stab wounds (27%), blunt trauma (19%), and asphyxia (13%). A decrease of gunshot wounds as a cause of death was found over the studied period. Alcohol was the most common toxic detected in blood of the victim, in 48.5% of the cases when toxicological results were available. Blood alcohol concentration ranged from 1 to 500 mg/dL with a mean value of 150 mg/dL.

An experimental model of tool mark striations in soft tissues produced by serrated blades

Stab wounds produced by serrated blades are generally indistinguishable from stab wounds produced by non-serrated blades, except when visible tool mark striations are left on severed cartilage. We explored the possibility that similar striations may be produced on the soft tissues of internal organs. Loin of beef, bovine kidney, and pig heart, liver, and aorta were each stabbed 20 times with a coarsely serrated blade. The walls of the stab tracks were exposed and documented by photography, cast with dental impression material, and the casts photographed. Striations were identified in all of the tissues in every stabbing, but their consistency and quality varied between tissues. Striations were most easily seen in liver, heart, and aorta. Tool mark striations in soft tissues other than cartilage have not been described in homicidal stabbings, likely because they have not been sought. We suggest that the walls of stab wound tracks should be exposed, and tissue striations should be sought as a means of identifying the weapon as having a serrated blade.

Intimate partner homicide

Intimate partner homicides represent the most severe outcome of intimate partner violence, and constitute more than a quarter (26%) of all homicides in adults over 15 years of age in Southern Denmark. In our experience the victims of partner homicides are primarily women, often from socially disadvantaged families, and that these homicides usually are the result of an impulsive act, with the perpetrator often committing suicide after the act. The aim of this study was to investigate these hypotheses further, and to provide an up-to-date overview of intimate partner homicides in Southern Denmark.

A meta-analysis of marijuana, cocaine and opiate toxicology study findings among homicide victims

ABSTRACT Aim To synthesize the results of marijuana, cocaine and opiate drug toxicology studies of homicide victims and examine variation in results across person and setting characteristics. Methods A meta-analysis of 18 independent studies identified from an extensive review of 239 published articles that met the inclusion criteria of reporting marijuana, cocaine and/or opiate toxicology test results for homicide victims. A total of 28 868 toxicology test results derived from 30 482 homicide victims across five countries were examined. Results On average, 6% of homicide victims tested positive for marijuana, 11% tested positive for cocaine, and 5% tested positive for opiates. The proportion of homicide victims testing positive for illicit drugs has increased over time. Age had a strong curvilinear relationship with toxicology test results, but gender differences were not apparent. Hispanic and African American homicide victims were more likely to test positive for cocaine; Caucasians were most likely to test positive for opiates. Cocaine use appeared to be related to increased risk of death from a firearm and was a greater risk factor for violent victimization in the United States than in Newfoundland and Scandinavia. Conclusion There are relatively few studies of illicit drug toxicology reports from homicide victims that allow for cross-cultural comparisons. This study provides a basis for comparing future local toxicology test results to estimates from existing research.

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.

"Is this a dagger I see before me?"--an audit of stabbings and gunshot wounds in Limerick

BACKGROUND

According to a recent study in Cardiff, the incidence of stab wounds is 14 per 100,000 population per annum. No such figures are available for Ireland.

AIM

To evaluate the incidence, type of injury, medical consequences and outcome of patients with stab or gunshot wounds presenting to the Mid-Western Regional Hospital, Limerick, over a 12 month period.

METHOD

A retrospective case study of all stab and gunshot wounds presenting over a 12 month period.

RESULTS

Out of 62,000 new presentations to the Accident and Emergency (A&E) department, 101 (0.16%) were stabbings, giving an incidence of 33 per 100,000 population. Twenty-six patients required surgical intervention. There were three deaths. There were 10 gunshot wounds, of which 40% required surgical intervention, with no mortalities.

CONCLUSION

The incidence of stab wounds presenting to our institution is high. Although constituting a small percentage of presentations to the A&E department they result in considerable morbidity and surgical activity.

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

The authors conducted a retrospective study of 70 cases of homicide and suicide in the Toulouse region to identify the variables that enable us to determine whether a death is a homicide or a suicide. This work showed that the following characteristics-a female victim, numerous wounds, and the presence of 1 or more vertical chest wounds-suggest homicide. It also highlights the importance of inspecting clothing, in particular the position of clothing and the presence or absence of slashes.

Injuries inflicted on homicide victims. A longitudinal victiminologic study of lethal violence

For the purpose of studying homicidal violence from a victiminologic point of view, we have examined the number and nature of injuries inflicted on homicide victims examined at the Department of Forensic Medicine in Stockholm during the periods 1976-1978, 1986-1988 and 1996-1998. Evaluation of the total number of injuries (both lethal and non-lethal) revealed a break in the earlier trend during the last of these periods, which demonstrated a clear increase in the number of injuries probably caused by intense and prolonged violence. Thus, there were 14 victims with 40 or more injuries (the maximum being 101 injuries) in the 1996-1998 period, whereas there was only one such victim in each of the two earlier periods. Furthermore, the proportion of victims exhibiting multiple lethal injuries was greater during the last period than during the two preceding periods. These findings indicate a general enhancement in the level of aggression exerted by violent offenders, as well as an increase in the number homicide victims with injuries apparently inflicted by acts of aggression characterized by outrage.

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).

Multivariate analysis ('forensiometrics')--a new tool in forensic medicine. Findings on the victim of sharp-force homicide can predict the inter-relationship with the perpetrator

A multivariate 'forensiometric' technique (PLS-DA) was used to create a model to predict the relationship between homicide victim and perpetrator on a five-level scale: strangers, acquaintances, drinking companions, relatives and spouses. The model is based on findings on the victim and at the venue, and uses the following ten variables as 'predictors', listed in falling order of covariation with instances of close relationship between victim and perpetrator: Victim found in home, female victim, a single sharp injury, injuries to the upper extremity, superficial sharp injuries to the chest ('scratches'), ten or more sharp injuries, presence of defence injuries, total number of sharp injuries, male victim, and victim found outdoors. The model was based on 87 sharp-force homicides (the model-set) and was validated on another set of 43 sharp-force homicides (the test-set). In this test-set validation, 17 of 39 cases (44%) were correctly predicted according to the results of earlier combined forensic and police investigations, and a prediction one step away from the correct level was given in another 17 cases. These results were significantly better than would have been obtained by chance.