Homicide by sharp force in two Scandinavian capitals

Spatial relationships among offender, knife, and victim during slashing attacks: implications for crime scene reconstruction

BACKGROUND

The offender-victim spatial relationship is crucial in reconstructing a crime scene. The study aims to evaluate the spatial relationship of performing slashing attacks on a dummy using a Chinese kitchen knife, and thus to establish a scientific basis for crime scene reconstruction.

METHODS

Twenty-four participants (12 males and 12 females) slashed a dummy's neck or chest using a kitchen knife, and the kinematic data were obtained using a three-dimensional motion capture system. The spatial relationships among offender, knife, and victim during slashing attacks were analyzed.

RESULTS

Slashing distance and occupancy area are significantly influenced by gender (all P < 0.05), with males having higher values than females. Body parts significantly influence bevel angle, offender and victim azimuth angles, slashing distance, relative slashing distance, and occupancy area (all P < 0.01), with slashing the chest resulting in larger values than slashing the neck.

CONCLUSION

Gender and body position significantly influence the spatial relationships of slashing action. Our data indicate that males stand farther away and occupy a larger area during slashing attacks. When the chest is slashed, the wound orientation is more diagonal, the offender's standing position and slashing distance are farther, and the occupancy area is larger compared to the neck. The findings could help identify the spatial relationships among offender, knife, and victim, providing a scientific basis for criminal investigations and court trials.

Narabali: A rare case of human sacrifice

With modern civilization and the rise in literacy, cases of human sacrifice are rarely encountered by forensic practitioners. Human sacrifice, also called 'Narabali' in India, involves an act of deliberately killing an individual due to ritualistic beliefs for the appeasement of the Gods, spirits, or ancestors. Human sacrifice and ritual murder are often considered synonymous, but ritual murder further involves offering the body part to the deity after killing. Diverse methods were historically adopted for human sacrifice across the globe, strongly influenced by their superstitious, religious, and cultural beliefs. Cases of human sacrifice mostly involve children. We report the rare case of human sacrifice involving an adult victim assaulted by a sharp weapon over the posterior aspect of the neck. The deceased succumbed due to the transection of the cervical spine and corresponding spinal cord. Corroboration of circumstances of death and profiles of the deceased and the perpetrator with autopsy findings were essential in the investigation. This case report discusses extreme superstitions and beliefs, resulting in homicide.

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.

Intimate partner homicides in Denmark 1992-2016

Intimate partner homicide is one of the most common types of homicide and a significant contributor to domestic homicides worldwide, especially affecting females. We focus on the intimate partner homicides in Denmark during 1992-2016. Though gender identity data was unavailable, sex data from official documents enabled critical analysis. Of the 1417 homicides in the period, 26.5% were intimate partner homicides, i.e., 55.6% of female and 8.9% of male victims. The annual intimate partner homicide rate was 0.28 per 100,000 (0.44 for female victims and 0.12 for male victims), declining at a lower rate than other types of homicide. Most victims of intimate partner homicides were females (79.3%). The demographics of the victims and the characteristics of the homicides were markedly different depending on victim sex. Female victims were killed by more varied methods, with more severe injuries and followed by suicide in 26.5% and with multiple homicide victims in 8.1%.

Overkilling: A specific type of homicide - Constructing the definition: Perpetrator, weapon and circumstances

Overkilling in the Forensic Medicine is known as a specific type of homicide where the number of inflicted injuries greatly surpasses the number of fatal ones. Conducted research aimed to create a unified definition of the phenomenon and its classification criteria by analysing a vast majority of variables concerning its various characteristics. From the population of homicide victims autopsied in the authors' research facility a number of 167 cases were chosen consisting of both overkilling and other homicides. 70 cases were thoroughly analysed based on the completed court files, autopsy protocols and photographs. Second part of the research concerned the facts regarding the perpetrator, used weapon and the circumstances of the act. Conclusions of the conducted analysis allowed to add further characteristics to the overkilling definition: the perpetrators were almost exclusively men, around 35 of age, not related to the victim but might have been in a close relationship with them, often a conflicted one. They did not threaten the victim before the incident. Mostly perpetrators were not intoxicated, and they tried to cover up the homicide in various ways. Perpetrators of overkilling were in most cases mentally disturbed (and thus stated insane), had different levels of intelligence but also a low level of planning before the act - rarely taking actions as preparing the weapon in advance, choosing the scene or luring in the victim.

Trends in Homicide Hospitalization and Mortality in Taiwan, 1998-2015

In Taiwan, the national research on homicide is rare, mostly discussing the issue of child abuse. We sought to better understand the characteristics and risk factors of homicide through a retrospective cohort study from 1998 to 2015. “Child battering and other maltreatment” ranked first for the 0–4 age group and second for the 5–14 age group. The hospital mortality was 511 deaths. We found that the 25–44 age group had the highest risk and accounted for 44.76% of hospitalization. The most common causes were “fight, brawl, and rape” (49.12%), “cutting and piercing instruments,” (13.16%) and “child battering and other forms of maltreatment” (4.72%). Additionally, the percentages of “fight, brawl, and rape,” “firearms and explosives,” and “cutting and piercing instruments” were significantly higher among males than among females. The percentages of “hanging and strangulation,” “corrosive or caustic substance,” “child battering and other maltreatment,” “submersion,” and “poisoning” were significantly higher among females than males. Factors associated with homicide in-hospital mortality included gender, age, low income, catastrophic disease, Charlson comorbidity index score, urbanization level, hospital level, classification of hospitalization, and surgery. Overall, the trend of hospitalization rates due to homicide decreased both by gender and age group, except for the 0–4 age group: cause of homicide first, hanging and strangulation second, firearms and explosives third; type of injury, hospitalized patients with “vascular injuries” first, joint and muscle sprain, and intracranial, chest, and abdominal pelvic injuries second, and “burns” third with a higher risk of death. Homicide reduction requires a comprehensive strategy beyond specific victim groups. Interagency collaboration should be strengthened, especially between law enforcement/criminal justice and public health.

Criminal death by stabbing in the region of Kairouan, Tunisia: A retrospective study, 2008-2018

INTRODUCTION

Homicides by stabbing are the most common forensic form of criminal death in Tunisia. These homicides represent a type of violent death that requires investigation in a forensic setting.

AIM

To describe the epidemiological and forensic profile of stab wounds in the region of Kairouan, Tunisia Methods: We conducted a retrospective study of stab-wounds autopsy cases collected at the Forensic Department at the Ibn El Jazzar University Hospital in Kairouan over eleven years (01/01/2008 to 31/12/2018).

RESULTS

Forty-seven cases of homicide were retained. A male predominance was observed with a sex ratio of 22 (45H/2F, 96%). The mean age of the victims was 33.3±10.84 with ages ranging from 12 to 63 years. Most victims (79%) were of rural origin, singles (62%), and daily-laborers (89%). The months that recorded the highest numbers of homicides were November and August. The most common reason for the assault was a settling-score on the street. The perpetrator was known by the victim in 90% of cases, having used a knife as a weapon in 90% of cases. The thorax was the most frequently affected area, resulting in fatal heart wounds in 28 cases.

CONCLUSION

Autopsy remains an essential tool for drawing up a detailed injury assessment in homicides by stabbing and determining the injury mechanism of the wounds. The comparison of the autopsy findings with the data of the judicial investigation is of great help in the legal qualification of the facts and the determination of the responsibility of the aggressors.

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.

A histological comparison of non-human rib models suited for sharp force trauma analysis

Cut marks provide essential knowledge to interpret which and how tools were used, both in archaeological and forensic context. Lots of studies focused on experimentally produced cut marks on animal models to develop methods for stabbing incidents. However, animal models are criticized to be morphologically different in comparison to human bones. This study analyzed the bone composition and experimentally obtained cut marks done on ribs from humans, pigs and goats. Methods included a qualitative description of differences between the species and a quantitative analysis of the cut mark proportions in histological thin sections and micro CT scans. The results indicated that especially the cortical bone of non-human ribs was different in comparison to human bone tissue as they were more robust and usually juvenile. Plexiform bone dominates and remodeled lamellar bone is rarely visible. The knife impact tends to create debris inside the cut mark and stress fractures along lamellae and cement lines perpendicular to the cut mark. Moreover, entheses of the intercostal muscles are always affected by the incision. Pig ribs were shown to be better suited as a model for sharp force trauma than goat ribs in comparison to humans. Though, plexiform bone and non-remodeled bone made it not quite ideal. We suggested to use bone material from animals used for breeding instead of meat production as they are slaughtered at higher ages.

An evaluation of human stabbing performance to inform the standardisation of textile damage examinations: Do simulation trials correlate to reported stabbings?

Forensic textile damage examinations are commonly requested in cases such as stabbings. These requests often involve the testing of knives or other weapons submitted to determine if they could have caused the damage to the evidential garment. Currently a forensic practitioner conducts this testing by manually performing the stabbing action. A biomechanics performance trial was conducted to evaluate how a range of human factors contribute to the creation of textile damage by stabbing actions. Surveys of sharp force fatalities and clinical penetrative injuries reported the chest and abdomen as the most frequent target location for stab wounds. The location of the cut-type damage recorded during the trial was found to correlate to the location of stab injuries incurred during actual stabbing cases. The type of weapon had an impact on the actions undertaken. Participants mostly utilised the smaller utility and hunting knives in underarm thrusting or overarm hacking actions, whereas an overarm hacking action, or combined hacking/slashing action was performed when using the machete. The familiarity of the knife, shape of the handle and perceived risk of injury determined how the handle was held. Participants frequently stabbed into the target immediately in front of their dominant hand, however care should be taken in interpreting this in a casework scenario. The machete was used with the highest mean velocity, and the utility knife the lowest.

Criminological and Medico-legal Aspects in Homicidal and Suicidal Sharp Force Fatalities

The interpretation of sharp force fatality dynamics may be difficult in some cases, but a contribution to analysis of the phenomenon may be provided by case studies. Therefore, the purpose of our study is focused on identifying, in observed sharp force fatalities, reliable parameters that can differentiate a homicidal and suicidal manner of death, with particular reference to criminological parameters. Data derived from sharp force fatality cases in Padua and Venice from 1997 to 2019, anonymized and collected in Excel, included personal, circumstantial, clinical, and psychopathological-criminological data, as well as crime scene investigation, necroscopic, and toxicological data. Statistical analyses were performed using chi-square and Wilcoxon rank-sum tests. Possible predictors of homicide were analyzed by logistic regression. Six parameters (bloodstains distant from the body, clothing lacerations, hesitation/defense wounds, number of injuries, and potential motives) were significantly different in the two groups (p < 0.05). An independent statistical association between potential motives explaining the crime (p < 0.001; OR 27.533) and homicide on multiple logistic regression analysis was highlighted. The absence of clothing lacerations was inversely related to homicide (p = 0.002, OR 0.092). To the best of our knowledge, this is one of very few Italian studies concerning the differential diagnosis between homicidal and suicidal sharp force fatalities. The dynamics of the event is established in most cases by the integrated evaluation of data from crime scene investigation and the autopsy. Nevertheless, in an atypical scenario, a psychopathological-criminological analysis may provide essential elements, and particular attention should be given to the identification of potential explanatory motives.

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 patterns for the last 20 years in South and South East Delhi, India

Homicide patterns are a useful indicator of social stress in a community, and they provide law-enforcement authorities with helpful information. This study was undertaken at the All India Institute of Medical Sciences, New Delhi, India, in order to understand the regional pattern of homicide. Data from the last 20 years were analysed. There were a total of 1048 male and 323 female homicide cases. The male/female ratio was about 3:1, and the proportion of total autopsies was approximately 4% for both sexes. The most common age group was 11-40 years old. Female cases were more common during the monsoon season, but male cases did not show any such variation. Blunt-force head injury, stabbing, strangulation and shooting were the most common methods, and the head, neck and chest were the most commonly targeted areas. Defence injuries were seen in 7.9% cases, significantly more often amongst men, most of which were active and in the form of incised wounds. About 17% of cases survived in hospital for up to a month before succumbing to their injuries, with males being in their 50s and 60s and females in younger age groups. Most of these cases suffered a gunshot wound, followed by a head injury and a stab wound.

Differences between Homicides Committed by Lone and Multiple Offenders in Korea

The aim of this study was to differentiate between homicides committed by multiple offenders and homicides committed by lone offenders. Using data on homicide incidents that occurred in South Korea between 1985 and 2008, we compared 134 homicides committed by multiple offenders, with 369 homicides committed by lone offenders. A greater proportion of homicides committed by multiple offenders involved injuries to the victim's head compared to homicides by lone offenders. Homicides committed by multiple offenders were more likely to involve blunt instruments and ligatures, whereas homicides by lone offenders were more likely to involve sharp instruments. In addition, a majority of the homicides committed by multiple offenders were planned. The results of this study have practical implications for homicide investigations, as well as theoretical implications for homicide research on the difference in offense behaviors based on the number of offenders.

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.

Nineteen Victims of Homicide and Attempted Homicide in Sweden-Their Injuries, Cause of Death, and Offender Relationship

Victims of homicide and attempted homicide are not uncommon in Sweden. We therefore aimed to study these victims to understand their injuries, their cause of death, and their relationship to the offender. All cases during five years in a district court in Sweden, where an offender had been convicted for homicide or attempted homicide, were identified and the court documents reviewed. Nineteen victims were identified; 14 males and five females, with an average age of 39.1 years. Although knife/sharp weapon was the most common weapon used, the use of firearm caused more deaths. Our study shows higher rates of firearm use than many other countries. The most common anatomical site to be injured by knife/sharp weapon and firearm was the thorax followed by the head. The most common cause of death was hypovolemia, followed by intracranial injuries. The high rate of firearm use shows that firearms are common modus operandi in Sweden often causing lethal injuries, if the offender intends to kill the victim. Our results support other studies showing that it is foremost injuries to the vessels, intracranial injuries, and injuries to intrathoracic organs, which causes a victim's death when assaulted with knife/sharp weapon or firearm.

Patterns of homicide in North Tunisia: a 10-year study (2005–2014)

Background

In Tunisia and in the Arab world, few data are available about homicide patterns. The aim of our study was to analyse the victims' profiles and the general pattern.

Methods

636 homicide victims were autopsied at the Legal Medicine Department of Charles Nicolle Hospital in Tunis, over a period of 10 years (2005–2014).

Results

Victims were males in 79.7% with a male-to-female ratio of 3.93 and the average age was 37.7 years. The victim was generally from an urban area (66.7%), single (55.7%) and semiskilled (50.2%). The most common methods of homicide were sharp force (51.7%) and blunt trauma (24.8%).

Conclusions

This study suggests applying urgent preventive measures targeting essentially young males and the importance of a national ‘Violence Repository’.

Bony injuries in homicide cases (1994-2014). A retrospective study

Even when human skeletal remains are found in contexts indicative of body disposal after homicide, none of the bones may manifest injuries. When skeletons are incomplete, there are two possibilities, the injured bones are missing or none were injured. This leads to the question how frequently bones are injured during homicide, where the injuries tend to be placed, and whether the frequency of injury is related to the type of homicide. To answer these questions, the postmortem reports from all autopsies performed for homicide victims at the Institute of Legal Medicine at the University Hospital in Frankfurt am Main, Germany, between 1994 and 2014, were retrospectively evaluated for bony injuries discovered during autopsy. In 90 cases, a preliminary postmortem computed tomography (pmCT) examination had been performed. The cases were categorized into the following five groups by type of fatal trauma: blunt force, sharp force, gunshot injury, strangulation, or other. In total, the postmortem reports for 897 homicides (527 male, 370 female) were evaluated. The number of victims per trauma category were sharp force, 309; blunt force, 179; gunshot injury, 242; strangulation, 92; and other, 75. Bony injuries had been reported in 70.9 % of the homicides. The "gunshot" category contained the highest proportion of victims with bony injuries (92.6 %). With 80.4 %, the second-highest proportion of victims with bony injuries was in the "blunt force" category, followed by 66.3 % of victims in the "sharp force" group. In contrast, with 53.3 %, the second-lowest proportion of victims with bony injuries was in the "strangulation" category, which contained a preponderance of female victims, followed by 17.3 % of victims with bony injuries in the "other" category. Bony injuries thus occurred in the majority of homicides. Forensic osteological analysis should, therefore, always be performed on badly decomposed human remains. Where necessary, the additional use of visualization techniques, in particular, pmCT, or maceration may be considered. The absence of bony injuries does not rule out homicide; e.g., in strangulations, bony injuries are manifest in only half the victims, even when the skeleton is intact. The relevant structures are also easily lost to decomposition, scavenging, or scattering.

Discriminating factors in fatal blunt trauma from low level falls and homicide

PURPOSE

Determination of the manner of death is a major issue in forensic practice. Differentiating the injuries caused by falls from a low height from injuries due to the deliberate application of a blunt object can be difficult. A few studies suggested the use of certain criteria, such as the hat brim line rule, to help in differentiating between falls and blows. Unfortunately they are not consistent.

METHODS

All autopsy cases from a 16-year period (1996-2012) were analyzed retrospectively. Three groups were defined: homicide cases (n = 31), sudden natural deaths involving a fall (n = 103), and accidental fall cases (n = 30). The three groups were statistically compared across a wide range of parameters including general characteristics, presence, and characteristics of different types of wounds (lacerations, deep bruises, fractures, intracranial trauma, and defense injuries) as well as their respective anatomical site.

RESULTS

There were marked differences in wounds between homicide and fall cases, e.g., wounds were more numerous and larger in homicides. We did not confirm the hat brim line rule as a reliable discriminating parameter. A simple and highly effective multivariate model was found, which included the presence of lacerations, deep bruises, and intracranial trauma.

CONCLUSION

This study underlines the importance of autopsy findings in providing an indication of the manner of death. Conversely, the limitations of the hat brim line rule have been highlighted.

Prevalence of women's violent and nonviolent offending behavior: a comparison of self-reports, victims' reports, and third-party reports

This study assessed women's violent and nonviolent offending, using data from two online student samples (men and women: n = 344), reporting on either being a perpetrator and witness (women) or being a victim and witness (men). A comprehensive measure of general violence, intimate partner violence (IPV), and nonviolent offending was collected. From women's self-reports, 59.9% reported perpetrating general violent offenses, 58.1% reported perpetrating IPV offenses and 85.6% reported perpetrating nonviolent offenses. Correlations showed that women were involved in a variety of offenses and demonstrated the interrelatedness of general violence and IPV, and of violent and nonviolent offenses. Regression analysis confirmed the close association between partner and general violence, and found that drug offenses were also related to the former and criminal damage to the latter. Overall, the prevalence data demonstrated women's involvement in all types of offending, and a similar pattern of offending was supported across data sources. Limitations of the sampling method and measures are discussed.

Homicide/suspicious death statistics for cases submitted to the forensic science laboratory in the Republic of Ireland for 2004-2008

The purpose of this study was to examine the trends and patterns of homicide in the Republic of Ireland over a five-year period (2004-2008). In total, 293 cases are covered in the survey. The majority of the victims were men. The most common age group of victims was 20-29 years old. The majority of the suspects were also men. The most common age was also 20-29 years old. Stabbing was the most common method used to kill and this often featured multiple wounds to the head and body. Shooting and blunt force traumas were also common. Homicides are more likely to occur over the weekend period. This study also explored the relationship between the suspect and the victim, the motive and the location of the fatal assault. In the majority of cases, the victim and the perpetrator were known to each other. The site of the fatal assault was most likely to be a residence and the most frequent motive was an argument/quarrelling. A small number of cases involved multiple fatalities, often involving relatives. The figures were compared with other international studies; our findings are broadly in agreement with them.

Trauma systems and early management of severe injuries in Scandinavia: review of the current state

INTRODUCTION

Scandinavian countries face common challenges in trauma care. It has been suggested that Scandinavian trauma system development is immature compared to that of other regions. We wanted to assess the current status of Scandinavian trauma management and system development.

METHODS

An extensive search of the Medline/Pubmed, EMBASE and SweMed+ databases was conducted. Wide coverage was prioritized over systematic search strategies. Scandinavian publications from the last decade pertaining to trauma epidemiology, trauma systems and early trauma management were included.

RESULTS

The incidence of severe injury ranged from 30 to 52 per 100,000 inhabitants annually, with about 90% due to blunt trauma. Parts of Scandinavia are sparsely populated with long pre-hospital distances. In accordance with other European countries, pre-hospital physicians are widely employed and studies indicate that this practice imparts a survival benefit to trauma patients. More than 200 Scandinavian hospitals receive injured patients, increasingly via multidisciplinary trauma teams. Challenges remain concerning pre-hospital identification of the severely injured. Improved triage allows for a better match between patient needs and the level of resources available. Trauma management is threatened by the increasing sub-specialisation of professions and institutions. Scandinavian research is leading the development of team- and simulation-based trauma training. Several pan-Scandinavian efforts have facilitated research and provided guidelines for clinical management.

CONCLUSION

Scandinavian trauma research is characterised by an active collaboration across countries. The current challenges require a focus on the role of traumatology within an increasingly fragmented health care system. Regional networks of predictable and accountable pre- and in-hospital resources are needed for efficient trauma systems. Successful development requires both novel research and scientific assessment of imported principles of trauma care.

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.

Female impulsive aggression: a sleep research perspective

The rate of violent crimes among girls and women appears to be increasing. One in every five female prisoners has been reported to have antisocial personality disorder. However, it has been quite unclear whether the impulsive, aggressive behaviour among women is affected by the same biological mechanisms as among men. Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Most psychiatric disorders are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep (SWS), the physiologically significant, refreshing part of sleep. Among men with antisocial behaviour with severe aggression, on the contrary, increased SWS has been reported, reflecting either specific brain pathology or a delay in the normal development of human sleep patterns. In our preliminary study among medication-free, detoxified female homicidal offenders with antisocial personality disorder, the same profound abnormality in sleep architecture was found. From the perspective of sleep research, the biological correlates of severe impulsive aggression seem to share similar features in both sexes.

Sleep architecture in homicidal women with antisocial personality disorder--a preliminary study

The aim of the present study was to characterize sleep in severely violent women with antisocial personality disorder (ASP) as the primary diagnosis. Participants for this preliminary study were three drug-free female offenders ordered to undergo a forensic mental examination in a maximum security state mental hospital after committing homicide or attempted homicide. Ten healthy age- and gender-matched controls consisted of hospital staff with no history of physical violence. The most striking finding was the increased amount of slow wave sleep, particularly the deepest sleep stage, S4, in women with ASP. This finding is in agreement with previously reported results in habitually violent male criminals with ASP. Severe female aggression seems to be associated with profound changes in sleep architecture. Whether this reflects specific brain pathology, or a delay in the normal development of sleep patterns in the course of aging, needs to be clarified. From the perspective of sleep research, the biological correlates of severe impulsive violence seem to be similar in both sexes.

Bimodal distribution of violent assaults

The aim of the present study was to investigate the relationship between the number of injuries inflicted on victim during violent assault and other variables, characterizing the offender and the assault. The study is based on all the cases that were processed at the City Court of Tallinn, Estonia in 1986 and 1996. The number of assault-related injuries caused to the victim in Tallinn, Estonia, for 1986 and 1996 revealed bimodal distribution. About 2/3 of the assaults resulted in 1-5 injuries, in 1/3 of the cases the number of inflicted injuries was 10 or higher, with only a relatively small number of injuries in between. This distribution pattern was stable over the 10-year interval between the observations and was invariant to alcohol intoxication, consequences, and reasons for the assault. Comparison of the offenders' criminal record during the 15-year follow-up period showed that recidivism was more common among those who had committed a multi-injury assault as their first offence. The evident distribution of assaults into few- and multi-injury groups and the fact that the number of injuries caused during the first offence is a more reliable criterion for predicting the further criminal record of the offender than the consequences of the assault suggest that there are two discrete types of behaviour determined by a set of variables characteristic of the offender's psychology.

Sharp force injuries in clinical forensic medicine—Findings in victims and perpetrators

The injury findings in 58 perpetrators and 158 victims surviving bodily injuries due to sharp force are presented here. Defence injuries were found in 45.9% of the victims without any significant differences between males and females. There was no clear predominance of defence injuries on the left forearm and hand, as is known from autopsy studies; the right and the left hands were affected with an almost identical frequency. Regarding other parts of the victims' bodies, the topographic distribution of injuries showed a marked concentration on the left side (63.7%). The thorax, head and neck were frequently affected (45.9%, 15.3% and 15.3%, respectively), and less often the abdomen (11.1%), the lumbar and gluteal region (6.3%) and the lower extremities (6.1%). In surviving victims with only one singular stab apart from the upper limbs, the incidence of additional defence injuries on the hands and/or forearms was significantly higher (28.3%) than in fatalities. When the perpetrators had unintentionally cut their own hands, the frequency of these injuries on the right and left hands was almost equal.

Comparison of wound patterns in homicide by sharp and blunt force

A comparison of patterns of injuries between sharp force and blunt force homicide was performed. Male predominance was seen in both types of homicides. Most of the victims of sharp force were between 21 and 40 years and those of blunt force between 31 and 40 years. There was no difference in the incidence of victims below 20 years age, but blunt force was almost five times more than sharp force in victims of age above 60 years. Thorax was the commonest site to be involved in sharp force in contrast to head in blunt force. Hand and forearm were the commonest sites of defence injuries in sharp and blunt force homicides, respectively. The majority of the blunt force victims had lesions in only one region in contrast to involvement of 2-4 regions in sharp force. The majority of the victims were killed by acquaintances in blunt force, but criminals always prefer sharp force to kill their victims. Single weapon was more commonly used in blunt force as compared to sharp force. Knife and wooden/iron rods were the weapons of choice in their respective categories. Most of the victims of sharp force were killed outdoor in contrast to victim's own domicile in blunt force.

Victims of homicidal deaths – An analysis of variables

In the 11-year period from January 1993 to December 2003, 61 homicide victims were autopsied in the Department of Forensic Medicine, Kasturba Medical College, Manipal. Documents concerning the age and sex of the victims, time of assault, method used for assault, location of fatal injuries and number of offenders involved were analyzed. Of the 61 victims of homicide, majority were males and most of them were between 21 and 30 years. Most of the crimes occurred during the evening and night hours (52.4%) and winter was the commonest season for homicide. There were significantly more homicides over the weekends (Saturday and Sunday). 37.7% of the victims exhibited evidence of injuries due to sharp force trauma. Head injuries were more common. Multiple offenders were involved in 47.5% of cases whereas single offender was involved in 40.9%.