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Crudele GDL, Amadasi A, Franceschetti L, Cattaneo C. Pathological Findings in Hanging: Is the Traditional Knowledge Correct? Diagnostics (Basel) 2024; 14:318. [PMID: 38337834 PMCID: PMC10855091 DOI: 10.3390/diagnostics14030318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND In forensic pathology, asphyxia presents a problem as frequently as it is thorny and challenging. Some knowledge in forensic pathology is still considered to be traditionally acquired and is not critically assessed with modern statistical or technical tools. In this study, we seek to examine the injuries that are considered to be typical of cases of hanging (neck lesions, haemorrhages, and pleural and epicardial petechiae). METHODS We evaluated whether there was, indeed, a statistically significant association between these injuries and deaths from hanging as compared to non-hanging deaths. We collected 399 cases (32 deaths by hanging and 367 cases of non-hangings), built contingency tables and performed chi-square tests for each variable (lesion) examined; we also analysed this association in various subgroups of the sample (according to sex, age and weight ranges). RESULTS Our results did not deviate from the expected outcome based on traditional knowledge, although they do provide a more detailed demonstration and clarification of traditional knowledge regarding this topic. CONCLUSIONS These findings provide valuable insights for future discussion, examination and deepening of knowledge that is traditionally accepted but often undersupported in the literature.
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Affiliation(s)
- Graziano Domenico Luigi Crudele
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milan, Italy (C.C.)
| | - Alberto Amadasi
- Institute of Legal Medicine and Forensic Sciences, University Medical Centre Charité, University of Berlin, Turmstr. 21, Building N, 10559 Berlin, Germany
| | - Lorenzo Franceschetti
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milan, Italy (C.C.)
| | - Cristina Cattaneo
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milan, Italy (C.C.)
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Stellpflug SJ, Weber W, Dietrich A, Springer B, Polansky R, Sachs C, Hsu A, McGuire S, Gwinn C, Strack G, Riviello R. Approach considerations for the management of strangulation in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12711. [PMID: 35445212 PMCID: PMC9013263 DOI: 10.1002/emp2.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with a history of strangulation present to the emergency department with a variety of different circumstances and injury patterns. We review the terminology, pathophysiology, evaluation, management, and special considerations for strangulation injuries, including an overview of forensic considerations and legal framework for strangulation events.
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Affiliation(s)
| | - William Weber
- Section of Emergency Medicine The University of Chicago Chicago Illinois USA
| | - Ann Dietrich
- Department of Pediatrics and Emergency Medicine University of South Carolina School of Medicine Columbia South Carolina USA
| | - Brian Springer
- Department of Emergency Medicine Wright State University Dayton Ohio USA
| | - Robin Polansky
- Department of Emergency Medicine Cedars‐Sinai Medical Center Los Angeles California USA
| | - Carolyn Sachs
- Department of Emergency Medicine University of California, Los Angeles Los Angeles California USA
| | - Antony Hsu
- Department of Emergency Medicine St. Joseph Mercy Hospital Ann Arbor Michigan USA
| | - Sarayna McGuire
- Department of Emergency Medicine The Mayo Clinic Rochester Minnesota USA
| | - Casey Gwinn
- Training Institute on Strangulation Prevention Alliance for Hope International San Diego California USA
| | - Gael Strack
- Training Institute on Strangulation Prevention Alliance for Hope International San Diego California USA
| | - Ralph Riviello
- Department of Emergency Medicine The University of Texas: San Antonio San Antonio Texas USA
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Komar D, Denic N, Marsh B, Rumbolt N. Hangings in Newfoundland and Labrador: A 40-year retrospective analysis of medical examiner data. J Forensic Sci 2022; 67:1557-1564. [PMID: 35122244 DOI: 10.1111/1556-4029.15008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
A comprehensive review of medical examiner data was undertaken of all hanging deaths in the Canadian Maritime province of Newfoundland and Labrador from 1982 to 2021. A total of 811 cases were identified representing suicidal, accidental, and undetermined manners of death. Variables examined included age; sex; seasonality; ligature type; location; time since death; prior attempts/suicidal ideation; presence/absence of a suicide note; and presence/absence of alcohol and drugs. Data subsets were generated, and additional analysis was conducted for hangings involving females; suicidal hangings occurring in the region of Labrador; and those who hanged themselves outdoors. Results indicate that females are choosing to kill themselves by hanging in rapidly increasing numbers. Outdoor suicides by hanging were more common in Newfoundland and Labrador (22.1%) than previously reported in Alberta (11.5%), Texas (5%), and Turkey (12-13%). Unique trends in seasonality were revealed, as were repeated incidents of suicidal clusters. The age distribution was skewed strongly toward youths (10 to 22 years of age), particularly in Labrador. Although Labrador represents only 5% of the total provincial population, it produced 20.1% of the total suicidal hangings in the study. The suicide rate in Canada has decreased by 24% over the past 40 years, yet the rates of suicidal hangings nationally and in Newfoundland and Labrador have increased during the same time period. With a better understanding of the circumstances under which people commit suicide by hanging within the province, it may be possible to target at-risk groups to prevent future cases.
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Affiliation(s)
- Debra Komar
- Newfoundland and Labrador Office of the Chief Medical Examiner, Health Sciences Centre, St. John, Canada
| | - Nebojsa Denic
- Newfoundland and Labrador Office of the Chief Medical Examiner, Health Sciences Centre, St. John, Canada
| | - Bryan Marsh
- Newfoundland and Labrador Office of the Chief Medical Examiner, Health Sciences Centre, St. John, Canada
| | - Niki Rumbolt
- Newfoundland and Labrador Office of the Chief Medical Examiner, Health Sciences Centre, St. John, Canada
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Gentile G, Tambuzzi S, Andreola S, Zoja R. Histotopography of haemorrhagic infiltration in the hanging cutaneous furrow: Where to look for haemorrhagic infiltration in hanging. MEDICINE, SCIENCE, AND THE LAW 2022; 62:52-59. [PMID: 34162272 DOI: 10.1177/00258024211023246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The forensic evidence of hanging is based on the autopsy demonstration of the traces left by the noose or the ligature on the neck, as well as on the histological assessment of the hanging mark vitality. However, the specific topography of haemorrhagic infiltration in the context of the cervical damaged tissues involved in hanging is not known. We carried out an extensive microscopic examination to identify if haemorrhagic infiltration in hanging appeared in specific topographic locations that could have been considered as elective. From 102 victims of suicidal hanging, a skin fragment was sampled from the maximum compression area of the sulcus, including the skin portions immediately above and below it. The sampling was also extended to collect the subcutaneous adipose tissue and part of the striated muscle. A standard histological examination was performed on all the samples, and hematoxylin and Eosin, Weigert's resorcin-fuchsin and Goldner's Masson trichrome staining were performed. In all the cases assessed, the microscopic examination allowed the detection of haemorrhagic infiltration mainly in the deepest areas under the sulcus and especially in the deep dermis and at the transition point between the dermis and the subcutaneous adipose tissue, as well as in the context of its supporting connective tissue. Such areas could therefore be considered as regions in which the presence of haemorrhagic infiltration is more likely to be demonstrated. Accordingly, we recommend performing sampling similar to ours and focusing the search for haemorrhagic infiltration as suggested.
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Affiliation(s)
- Guendalina Gentile
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy
| | - Stefano Tambuzzi
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy
| | - Salvatore Andreola
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy
| | - Riccardo Zoja
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy
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Fukumoto W, Mitani H, Kuno Y, Higaki T, Tatsugami F, Nakamura Y, Nagao M, Awai K. Incidence and factor analysis of laryngohyoid fractures in hanging individuals-computed tomography study. Eur Radiol 2021; 31:7827-7833. [PMID: 33864138 DOI: 10.1007/s00330-021-07932-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Although laryngohyoid fracture indicates the applied neck pressure and is an important finding in hanging individuals, the reported rate varies widely and its true incidence remains controversial. We used computed tomography (CT) studies to investigate the incidence of laryngohyoid fracture in hanging individuals and identify factors contributing to such fractures. METHODS Considered for inclusion in this study were 107 attempted or successful hanging individuals subjected to CT studies between 2005 and 2019. After excluding 19 whose images were inadequate for evaluation, 88 subjects were included. Body suspension was complete in 20, partial in 49, and unknown in 19; 54 (61.4%) individuals died. Two radiologists performed image analysis and recorded the presence and site of laryngohyoid fractures. Multiple logistic regression analysis was used for factor analysis of laryngohyoid fractures; it included the gender, the age (< or ≧ 40 years), the type of suspension (complete or incomplete), and the outcome (death or survival). RESULTS Of the 88 subjects, 35 (39.8%) presented with laryngohyoid fractures on CT images; the superior horn of the thyroid cartilage was fractured in 32 (91.4%) of the 35. Age was the only factor significantly related to laryngohyoid fracture (odds ratio = 2.85, 95% confidence interval = 1.08-7.52). CONCLUSIONS In hanging individuals, the incidence of laryngohyoid fracture on CT images was 39.8%. The superior horn of the thyroid cartilage was the most frequent fracture site. KEY POINTS • The incidence of laryngohyoid fracture on CT images of hanging individuals was almost 40%; the superior horn of the thyroid cartilage was the most frequent fracture site. • In older hanging individuals, attention must be paid to laryngohyoid fractures on CT images.
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Affiliation(s)
- Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
- Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Hidenori Mitani
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuka Kuno
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Toru Higaki
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Masataka Nagao
- Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
- Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Smith Z. Death due to hanging: a retrospective descriptive study of the socioeconomic and demographic profiles of hanging victims in central South Africa. Forensic Sci Med Pathol 2021; 17:223-229. [PMID: 33492631 DOI: 10.1007/s12024-020-00352-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
Hanging by the neck is the leading method of suicide globally. The epidemiological risk factors for suicidal hanging can contribute to construct a socioeconomic and demographic profile of hanging victims. These profiles can then be used to identify individuals at the highest risk for committing suicide by hanging for referral to a suicide prevention program. The aim of this study was to describe the socioeconomic and demographic profiles of hanging victims in Bloemfontein, South Africa. A retrospective descriptive study was performed using data from the Bloemfontein Forensic Mortuary, for the period 1 January 2008 to 31 December 2015. In total, 9085 autopsies were performed during the study period; 355 (3.9%) were hanging victims. The median age of the victims was 31.4 (range 11-78) years, with 138 (38.9%) cases being 21-30 years of age. Three hundred and twenty-three (91.0%) of the victims were male, 227 (63.9%) were single, 201 (56.6%) were unemployed, and 129 (36.3%) completed their high school education. The most common location where the hanging occurred was at home. Single, unemployed males 21-40 years of age were found to have the highest risk for committing suicide by hanging. The group at the lowest risk were married and employed individuals older than 60 years, who had a tertiary education. We report the first socioeconomic and demographic profiles of individuals who commit suicide by hanging in central South Africa, emphasizing the need for a National Suicide Prevention Program via a multidisciplinary team approach.
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Affiliation(s)
- Zandré Smith
- Department of Forensic Medicine, University of the Free State and Bloemfontein Forensic Mortuary, 22 James Dick Street, 9300, Wilgehof, Bloemfontein, South Africa.
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Chisnall RC. Distinguishing between homicide and suicide knots and ligatures: A comparative analysis of case and survey data. J Forensic Sci 2020; 66:209-228. [PMID: 32966611 DOI: 10.1111/1556-4029.14567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
Distinguishing between suicide and homicide can be challenging owing to ambiguous and confusing case details. In particular, there is a paucity of useful information comparing homicide and suicide knots and ligatures in the literature. Multiple knot and ligature characteristics have not been recognized previously because complete and accurate information has been lacking. Ninety external tying cases (mainly homicide) and 56 cases involving self-tying (mainly suicide) were reviewed to compare multiple knot and ligature characteristics. Additionally, 189 survey volunteers performed four standardized external tying tasks and two self-tying tasks, yielding comparison data from more than 1500 knots. Using all available data, it was determined that the differences between external and self-tying included types of knots, ligature configurations, ligature tensions, wrist gaps, wend lengths, knot access, external anchoring, and other indicators. These differences are presented in a proposed analysis checklist inspired by medical and psychiatric protocols. The checklist contains 14 potential characteristics for head and neck bindings, 14 potential characteristics for wrists and arms, nine ankle and leg characteristics, and four linkage details. The proposed checklist can be expanded and fine-tuned as more data are accumulated. It offers experienced knot analysts an additional tool to assist in drawing conclusions, which then can be related to other case evidence by investigators.
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Zátopková L, Janík M, Urbanová P, Mottlová J, Hejna P. Laryngohyoid fractures in suicidal hanging: A prospective autopsy study with an updated review and critical appraisal. Forensic Sci Int 2018; 290:70-84. [DOI: 10.1016/j.forsciint.2018.05.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/19/2018] [Accepted: 05/26/2018] [Indexed: 11/25/2022]
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