Suicidal Single Gunshot Injury to the Head

Are Facial Gunshot Wounds More Fatal When They Are Self-Inflicted or Other-Inflicted?

Study Design

This was a retrospective cohort study of the 2014 Nationwide Emergency Department Sample (NEDS).

Objective

Intraoral and submental projectile entry points may be less fatal than other facial entry points due to the indirect access to the intracranial structures and the protection offered by the intervening maxillofacial complex. Because intraoral and submental trajectories are almost always present in the setting of attempted suicide, this study sought to determine if intent (self-harm versus other-harm) influenced mortality in facial gunshot wound (GSW) patients.

Methods

All patients with a diagnosis of a facial fracture secondary to firearm injury were included in the study sample. The primary predictor was self-harm. Secondary predictors were derived from patient, injury, and hospitalization characteristics. The study outcome was death. Univariate time to event analyses were conducted for all study predictors. A multivariate regression model for mortality was created using all relevant predictors.

Results

The final sample included 668 facial GSW injuries, of which 19.3% were attributed to self-harm. Self-inflicted GSWs were more likely to involve the mandible (58.9 vs 46.0%, P < 0.01), ZMC/maxilla (47.3 vs 32.5%, P < 0.01), and intracranial cavity (48.1 vs 22.6%, P < 0.01). The overall mortality rate was 7.3%, and the mean time to death was 2.2 days. After controlling for pertinent covariates, the risk of mortality was independently decreased with mandibular injury (HR = 0.36, P = 0.03). However, mortality was increased by self-harm intent (HR = 3.94, P < 0.01) and intracranial involvement (HR = 11.24, P < 0.01).

Conclusions

Consistent with a pattern of intraoral and submental entry points, self-inflicted facial GSWs demonstrated higher rates of mandibular injury. Despite this finding, self-harm injuries still carried a higher incidence of intracranial injury and a greater independent risk of mortality. Our results refute any notion that the mechanism and trajectory of self-inflicted GSWs is less fatal.

An unusual exit wound as a result of a shotgun suicide to the head

The location of a gunshot entrance wound as well as the wound path trajectory are the main findings that help to determine the position from which a weapon was fired and thus distinguish firearm suicides from homicides and accidents. We present a case of a 28-year old man, who was found dead in his car. Because of an unusual position of the firearm, which was clamped into the steering wheel, and an unclear entrance/exit wound, an autopsy was performed. The deceased showed typical signs of a contact shotgun wound to the head with an entrance wound in the right temporal region and an exit wound in the midface. With the help of gunpowder attachments and a muzzle imprint at the entrance site, a wound channel from the right lower posterior part of the temporal region to the left anterior part of the mid-facial region could be reconstructed. The stellate wound in the midface was assessed as an atypical exit wound. The cause of death was a contact shotgun shot to the right temple with a consequent central regulatory failure due to extensive brain injury. The manner of death was concluded to be a suicide.

Suicide by Shotgun in Southeastern Minnesota

Suicide by shotgun is a common method of suicide with high regional variation. We sought to describe their distinct, challenging features and provide demographic and risk characteristics. We reviewed 228 gunshot wounds autopsied at Mayo Clinic from 1994 to 2014; of these, 75 (32.9%) were shotgun wounds. All were suicides and contact range. Ages ranged from 14 to 92 years old; of these, 97% were men. The majority involved the head (70.9%), were intraoral (48.2%), and had upward (73.2%) and backward (73.2%) directionality. Next most common was the chest (21.5%), with backward (94.1%) and downward (64.7%) directionality. Four involved multiple wounds. Wadding was recovered in 16 (21.3%) cases. Six (8.0%) had a survival period. Most (66.7%) took place at home. Seventy-one percent had a known psychiatric history; 32.4% had positive toxicology. Although contact range shotgun wounds cause severe destruction, entrance wound and other characteristic are identifiable with thorough scene, autopsy, and radiographic documentation.

Comparison of gunshot entrance morphologies caused by .40-caliber Smith & Wesson, .380-caliber, and 9-mm Luger bullets: a finite element analysis study

Firearms can cause fatal wounds, which can be identified by traces on or around the body. However, there are cases where neither the bullet nor gun is found at the crime scene. Ballistic research involving finite element models can reproduce computational biomechanical conditions, without compromising bioethics, as they involve no direct tests on animals or humans. This study aims to compare the morphologies of gunshot entrance holes caused by.40-caliber Smith & Wesson (S&W), .380-caliber, and 9×19-mm Luger bullets. A fully metal-jacketed.40 S&W projectile, a fully metal-jacketed.380 projectile, and a fully metal-jacketed 9×19-mm Luger projectile were computationally fired at the glabellar region of the finite element model from a distance of 10 cm, at perpendicular incidence. The results show different morphologies in the entrance holes produced by the three bullets, using the same skull at the same shot distance. The results and traits of the entrance holes are discussed. Finite element models allow feasible computational ballistic research, which may be useful to forensic experts when comparing and analyzing data related to gunshot wounds in the forehead.

Handgun wounds: a review of range and location as pertaining to manner of death

Citizens of the United States own more firearms than those in any other country, and the majority of the firearms owned are handguns. Given such prevalence, surprisingly few studies have been published describing the characteristics of deaths due to handguns. To address this gap, nonaccidental handgun deaths examined at the Bexar County Medical Examiner's Office between 2000 and 2010 were reviewed. A total of 1450 cases were identified, including 797 suicides and 653 homicides. Age, range of fire, location of wound, and manner of death were analyzed. The average age of suicide victims (46.7 years) was found to be greater than that of homicides (34.3 years). Suicidal wounds tended to be contact wounds to the head; abdominal, extremity, back, and multiple wound locations were more common in homicides as were distant and intermediate wounds. Handgun wounds to the forehead, side of head, submental, and intraoral locations were significantly more common in suicide, whereas those to the face, apex of the head, and back of the head were more common in homicides. Where possible, likelihood ratios were calculated to determine relative likelihood of suicide or homicide for specific wound locations and ranges. While each death should be analyzed based on its unique circumstances and not solely its statistical probability, these data may help inform the pathologist's conclusions.

Histopathological detection of entry and exit holes in human skin wounds caused by firearms

The judiciary needs forensic medicine to determine the difference between an entry hole and an exit hole in human skin caused by firearms for civilian use. This important information would be most useful if a practical and accurate method could be done with low-cost and minimal technological resources. Both macroscopic and microscopic analyses were performed on skin lesions caused by firearm projectiles, to establish histological features of 14 entry holes and 14 exit holes. Microscopically, in the abrasion area macroscopically observed, there were signs of burns (sub-epidermal cracks and keratinocyte necrosis) in the entrance holes in all cases. These signs were not found in three exit holes which showed an abrasion collar, nor in other exit holes. Some other microscopic features not found in every case were limited either to entry holes, such as cotton fibres, grease deposits, or tattooing in the dermis, or to exit holes, such as adipose tissue, bone or muscle tissue in the dermis. Coagulative necrosis of keratinocytes and sub-epidermal cracks are characteristic of entry holes. Despite the small sample size, it can be safely inferred that this is an important microscopic finding, among others less consistently found, to define an entry hole in questionable cases.