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Simonit F, Da Broi U, Giudici F, Sciarappa OE, Innocenti D, Desinan L. Autopsy findings in fire deaths in relation to manner of death: Analysis of autopsy records in Friuli, Italy (1993-2020). Leg Med (Tokyo) 2024; 67:102372. [PMID: 38154314 DOI: 10.1016/j.legalmed.2023.102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
The determination of the cause and manner of death can be particularly difficult in burned and charred bodies and autopsy remains a key element in the investigation. In this study, 39 autopsy records of fire deaths were reviewed in relation to the manner of death (25 accidents, 8 suicides, 3 homicides and 3 instances in which the manner of death remained undetermined). The analysis focused on the study of the burns, the degree to which the bodies were consumed by fire and the evidence of signs of vital exposure to fire and of non-fire-related injuries. Total surface body area (TBSA) was found to be significantly higher (p = 0.02) in suicides than in accidents. Moreover, the degree of destruction according to the Crow-Glassman Scale and the presence of a pugilistic posture tended to be higher in suicides compared to accidental deaths, whereas such parameters were found to be variable in homicides. With regard to the anatomical distribution of burns, in contrast with the literature, the feet were affected by burning in all suicides, with a significantly higher prevalence than in accidents (p < 0.01). Traumatic non-fire related injuries were noted in all homicides (with no signs of vital exposure to fire), 1 complicated suicide, 1 undetermined death and 13 accidents. We found that very few studies have focused on the analysis of burn distribution and extension according to manner of death and that there is currently no standardised anatomical model with which to study these variables for forensic purposes.
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Affiliation(s)
- Francesco Simonit
- Università degli Studi di Udine, Dipartimento di Area Medica, Medicina Legale, Italy.
| | - Ugo Da Broi
- Università degli Studi di Udine, Dipartimento di Area Medica, Medicina Legale, Italy
| | - Fabiola Giudici
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Orazio Elia Sciarappa
- Università degli Studi di Udine, Dipartimento di Area Medica, Medicina Legale, Italy
| | - Dario Innocenti
- Università degli Studi di Udine, Dipartimento di Studi Umanistici, Italy
| | - Lorenzo Desinan
- Università degli Studi di Udine, Dipartimento di Area Medica, Medicina Legale, Italy
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Amirize E, Kankam HKN, Abdulsalam A, Choudhary R, Walker H, Moiemen N. Self-inflicted Burns: The Experience of a UK Regional Burns Center. J Burn Care Res 2024; 45:80-84. [PMID: 37864840 PMCID: PMC11023247 DOI: 10.1093/jbcr/irad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Indexed: 10/23/2023]
Abstract
Self-inflicted burns (SIBs) are preventable injuries that often occur due to suicidal intent or deliberate self-harm. The incidence of SIB and demographics vary across different countries. This study highlights our regional experience of SIB over almost 2 decades, assessing characteristics and outcomes. A retrospective chart review of all patients assessed at a UK regional burns center, presenting with SIB, from 2003 to 2021, was performed. Subgroup analyses based on gender, the presence or absence of pre-existing psychiatric disorders, and in-hospital patient mortality were undertaken. The relationship between annual mental health funding and the incidence of SIB was assessed. Over the study period, a total of 285 SIB cases, with a median age of 42.84 years, were presented to our center. The majority of patients were male (63.2%) and had a pre-existing psychiatric disorder (74.7%). Flame burns were the most frequent type of injury (82.1%) and the median total BSA (TBSA) was 10.25%. The average length of hospital stay was 10 days and the inpatient mortality rate was 20.7%, significantly greater than the mortality of the rest of the cohort (3.7%, P < .01). SIB survivors were younger and had less severe burns, relative to non-survivors. There was no statistically significant correlation between the incidence of SIBs and mental health funding. SIBs account for a minority of referrals to our regional burns center. Adequately funded regional and national measures should be implemented to reduce the incidence and impact of these injuries, alongside appropriate mental health support.
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Affiliation(s)
- Ezekwe Amirize
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
- Scar Free Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Hadyn K N Kankam
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Abdulrazak Abdulsalam
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
- Scar Free Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Rajan Choudhary
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Harriet Walker
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
| | - Naiem Moiemen
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
- Scar Free Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
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Simonit F, Da Broi U, Furioso C, Desinan L. A burned body with a gunshot wound in the mouth and a suicide note: A complex or complicated suicide? J Forensic Leg Med 2020; 72:101958. [PMID: 32452448 DOI: 10.1016/j.jflm.2020.101958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
The body of a 53-year-old man was found in a burning car. The ignition key was in start position and the accelerator pedal was held down by his right foot. Autopsy revealed a gunshot entrance wound in the hard palate, a bullet track through the anterior cranial fossa and a projectile lodged in the left frontal lobe. The brain stem was free of lesions and any signs of secondary brain injury, such as brain oedema and intracranial haemorrhage, were not significant. Soot deposits and thermal injury to the mucosa were observed in the airways below the glottis and carboxyhaemoglobin (COHb) saturation was 40%. A single bullet case and a handgun were recovered next to the driver's seat. Fire investigators identified the motor as the beginning of the burning: therefore, the conclusion was that the car had caught fire due to overheating of the engine. Differential diagnosis between complex and complicated suicide was essential. The cause of death was identified as carbon monoxide intoxication, and the injuries to the brain were not felt to be immediately fatal. The case has been classified as a complicated suicide. There are no other published cases of a complicated suicide involving exposure to fire or the use of firearms.
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Affiliation(s)
- Francesco Simonit
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, p. le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Ugo Da Broi
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, p. le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Cristina Furioso
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Dipartimento di Prevenzione, Servizi di Medicina Legale, via del Farneto 3, 34142, Trieste, Italy.
| | - Lorenzo Desinan
- Dipartimento di Area Medica, Medicina Legale, Università degli Studi di Udine, p. le S. Maria della Misericordia 15, 33100, Udine, Italy.
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Simonit F, Da Broi U, Desinan L. The role of self-immolation in complex suicides: A neglected topic in current literature. Forensic Sci Int 2020; 306:110073. [DOI: 10.1016/j.forsciint.2019.110073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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Sayma M, Booth S, Weller D, Dheansa B. A retrospective study: Can we differentiate between repeat self-inflicted burn patients and those who commit a self-inflicted burn as an individual occurrence? J Plast Reconstr Aesthet Surg 2017; 70:1675-1680. [DOI: 10.1016/j.bjps.2017.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/06/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
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Ben Khelil M, Zgarni A, Zaafrane M, Chkribane Y, Gharbaoui M, Harzallah H, Banasr A, Hamdoun M. Suicide by self-immolation in Tunisia: A 10 year study (2005–2014). Burns 2016; 42:1593-1599. [DOI: 10.1016/j.burns.2016.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/29/2016] [Indexed: 11/16/2022]
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Ozsoy S, Kara K, Teke HY, Turker T, Congologlu MA, Sezigen S, Renklidag T, Karapirli M, Javan GT. Relationship Between Self-Injurious Behaviors and Levels of Aggression in Children and Adolescents Who Were Subject to Medicolegal Examination. J Forensic Sci 2016; 61:382-387. [PMID: 27404611 DOI: 10.1111/1556-4029.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 02/16/2015] [Accepted: 02/28/2015] [Indexed: 11/29/2022]
Abstract
Aggression, which is defined as a behavior causing harm or pain, is a behavioral pattern typically expected in children and adolescents who are involved in criminal activities. The aim of this study was to examine the relationship between aggression and self-injurious behavior (SIB) in children and adolescents. The study was performed in 295 cases which were sent for medicolegal examination. The mean age of the subjects was 14.27 ± 1.05 years (age range 10-18 years). The aggression levels of the subjects were determined using the Aggression Questionnaire (AQ), which is an updated form of the Buss-Durkee Hostility Inventory. The mean total AQ score of the subjects with and without SIB was 78.04 ± 21.0 and 62.75 ± 18.05, respectively (p < 0.01). There were significant statistical differences between the two groups with respect to their subscale scores (p < 0.01). It was concluded that the levels of aggression increased in children and adolescents who were involved in criminal activities when the SIBs increased.
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Affiliation(s)
- Sait Ozsoy
- Department of Forensic Medicine, Gulhane Military Medical Academy Medical School, Ankara, 06018, Turkey
| | - Koray Kara
- Department of Forensic Medicine, Gulhane Military Medical Academy Medical School, Ankara, 06018, Turkey
| | - Hacer Y Teke
- Forensic Science Department, Ministry of Justice, Ankara, 06300, Turkey
| | - Turker Turker
- Department of Forensic Medicine, Gulhane Military Medical Academy Medical School, Ankara, 06018, Turkey
| | - Mehmet A Congologlu
- Department of Forensic Medicine, Gulhane Military Medical Academy Medical School, Ankara, 06018, Turkey
| | - Sermet Sezigen
- Department of Forensic Medicine, Gulhane Military Medical Academy Medical School, Ankara, 06018, Turkey
| | - Tulay Renklidag
- Forensic Science Department, Ministry of Justice, Ankara, 06300, Turkey
| | - Mustafa Karapirli
- Forensic Science Department, Ministry of Justice, Ankara, 06300, Turkey
| | - Gulnaz T Javan
- Department of Physical Sciences, Forensic Science Program, Alabama State University, Montgomery, AL, 36104
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Caine PL, Tan A, Barnes D, Dziewulski P. Self-inflicted Burns: 10 year review and comparison to national guidelines. Burns 2015; 42:215-221. [PMID: 26603912 DOI: 10.1016/j.burns.2015.09.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/27/2015] [Accepted: 09/23/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is an increasing trend of self-inflicted burns noted in the literature, often seen in patients with complex psychosocial backgrounds. These patients are challenging to manage as the recovery from the acute burn may be compounded by difficult rehabilitation and suboptimal coping strategies. We aimed to review patients presenting to our burns unit with self-inflicted burns, the management strategies and examine the complexities surrounding their management. We assessed patient outcomes with a particular interest in psychosocial support given. METHODS A retrospective review of all patients presenting with self-inflicted burns over a 10 year period (2005-2014 inclusive) was conducted. Patients were identified through IBID database coded as either 'self-inflicted' or 'suicidal.' We reviewed patient and burn demographics, the clinical management, psychosocial management and patient outcomes such as wound healing, re-admission rates, and survival. RESULTS We identified 118 self-inflicted burns in total. 50/118 (42%) were admitted. 64 (54%) were male and the total body surface burn area ranged from <0.5% to 99% with a median of 14%. 60/118 (51%) had TBSA <10% and 58/118 (49%) had TBSA >10%. 24 (48%) underwent admission to the Burn Intensive Care Unit (BITU). All patients admitted to BITU had TBSA >10%. Of those admitted to BITU 6 were palliative, 18 had full resuscitation and surgical management. Of those 18 patients who had active treatment, 10/18 (56%) died. Mean total length of stay was 31 days, range 1-130 days. 9% of patients sustained injuries whilst being a current inpatient at a psychiatric institution. Of all patients reviewed, 16% (n=19) had a previous history of deliberate self-harm through burns. Of those patients admitted, 98% of were reviewed by the mental health team during their admission with time to psychological review varying depending on fitness for assessment. The overall mean length of stay for all admitted patients who were actively treated but who subsequently died was 53 days. 84% of admitted patients were managed surgically. CONCLUSION Self-inflicted burns patients would benefit from a more complex pathway of treatment as their management aims to achieve not only physical health but also psychological health. They would benefit from enhanced care to manage the acute burn but also psychiatric support to ensure patients do not re-offend.
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Affiliation(s)
- P L Caine
- St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom.
| | - A Tan
- St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - D Barnes
- St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - P Dziewulski
- St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
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Gauthier S, Reisch T, Bartsch C. Self-burning – A rare suicide method in Switzerland and other industrialised nations – A review. Burns 2014; 40:1720-6. [DOI: 10.1016/j.burns.2014.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/06/2014] [Accepted: 02/11/2014] [Indexed: 11/17/2022]
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A case-control study of psychosocial risk and protective factors of self-immolation in Iran. Burns 2014; 41:386-93. [PMID: 25406886 DOI: 10.1016/j.burns.2014.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/20/2022]
Abstract
Self-immolation is the third leading cause of years of life lost (YLL) among women in Iran. The aim of this study is to investigate self-immolation-related risk and protective factors in the western region of Iran, a province with the highest prevalent of self-immolation in the country. Using a case-control design, we compared 151 cases of self-immolation attempters who were admitted to a burn center in Kermanshah with 302-matched control group from the same community/locality between March 21st, 2009, and March 20th, 2012. We conducted descriptive, bivariate, and multivariate analysis to examine the associations of self-immolation with demographic and familial risk factors, adverse life events, mental disorders, as well as potential protective factors. According to our findings, the highest percentage of self-immolation was in the 16-25 year-old age group (60%) and in females (76%). Of the potential risk factors in the study, major depression, adjustment disorders, individual history of suicide attempts and opium dependence, were statistically significant predictors of self-immolation. Suggestions for translating the local picture of self-immolation portrayed by our findings, into meaningful prevention strategies that have a good fit with the social and interpersonal context within which self-immolation takes place are discussed.
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Alunni V, Grevin G, Buchet L, Gaillard Y, Quatrehomme G. An amazing case of fatal self-immolation. Forensic Sci Int 2014; 244:e30-3. [PMID: 25238968 DOI: 10.1016/j.forsciint.2014.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/09/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
We present a surprising case of suicide by self-immolation. A surveillance camera filmed the victim's agony. We were able to ascertain that he survived 13 min after ignition. This case was the starting point for a review of the literature of the forensic elements required to correctly analyze cases of suicide by self-immolation and to establish the causal link between the burn lesions and death. The authors will focus on the forensic and medical aspects in favor of suicide by self-immolation and on the forensic aspects required to understand the ignition process, the circumstances surrounding the fire with a particular emphasis on determining whether an accelerant was doused on the victim before ignition.
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Affiliation(s)
- Veronique Alunni
- Laboratoire de Médecine Légale et d'Anthropologie médico-légale, Université de Nice Sophia Antipolis, Faculté de Médecine, 28 Avenue de Valombrose, 06107 Nice Cedex 2, France.
| | - Gilles Grevin
- CEPAM (Cultures et Environnements, Préhistoire, Antiquité, Moyen Âge), UMR7264-CNRS Université Nice Sophia Antipolis, Campus Saint-Jean d'Angély 3, 24, avenue des Diables Bleus, 06357 Nice Cedex 4, France.
| | - Luc Buchet
- CEPAM (Cultures et Environnements, Préhistoire, Antiquité, Moyen Âge), UMR7264-CNRS Université Nice Sophia Antipolis, Campus Saint-Jean d'Angély 3, 24, avenue des Diables Bleus, 06357 Nice Cedex 4, France.
| | - Yvan Gaillard
- Laboratory of Analytical Toxicology LAT LUMTOX, 800 avenue marie Curie, La Voulte sur Rhône, France.
| | - Gérald Quatrehomme
- Laboratoire de Médecine Légale et d'Anthropologie médico-légale, Université de Nice Sophia Antipolis, Faculté de Médecine, 28 Avenue de Valombrose, 06107 Nice Cedex 2, France.
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