Unit for Forensic Medicine, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden; Swedish National Board of Forensic Medicine, Unit for Forensic Medicine, Sölvegatan 25, 223 62 Lund, Sweden.
Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Ruth Lundskogsgatan 10, 205 02 Malmö, Sweden.
Forensic Sci Int. 2024 Jan;354:111910. doi: 10.1016/j.forsciint.2023.111910. Epub 2023 Dec 10.
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.
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.
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).
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.
法医病理学家经常面临这样的问题，即某一伤害是由攻击造成的，还是由自己造成的。然而，对于可能适用于区分由单一刺伤引起的躯干死亡案件中的凶杀和自杀的流行病学变量知之甚少。
我们使用瑞典法医尸检登记处，确定了 2010 年至 2021 年期间 94 例凶杀和 45 例自杀案例，这些死亡均由单一刺伤躯干引起。我们从案例中提取特征，并使用曼-惠特尼 U 检验、卡方检验和逻辑回归模型进行统计分析。
凶杀案受害者比自杀案受害者年轻（中位数年龄 33 岁 vs. 52 岁，p<0.05），且两组均以男性为主（93% vs. 82%）。在许多凶杀案受害者中，刺伤位于背部和腋窝区域，而自杀案受害者的刺伤则全部位于前躯干的内侧。皮肤的垂直入口伤口与内侧运行的损伤通道（n=13）结合显示出凶杀案的阳性预测值为 100%（95%CI 75.3-100），尽管敏感性较低。凶杀案与户外死亡现场（OR 19.0，95%CI 7.6-47.1）、胸骨/软骨损伤（OR 3.8，95%CI 1.6-9.0）、酒精影响（OR 7.1，95%CI 2.9-17.7）和非法药物（OR 4.3，95%CI 1.5-11.9）之间存在明确关联。
观察到的单一刺伤的法医学特征可用于评估单一刺伤的死亡方式。需要进一步研究与死亡方式相关的变量，我们还建议在这些分析中包括幸存受害者的特征。
