Department of Forensic Medicine and Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea.
Graduate School of Public Health, Seoul National University, Seoul, Korea.
J Korean Med Sci. 2024 Nov 18;39(44):e281. doi: 10.3346/jkms.2024.39.e281.
Suicide remains a significant global public health challenge, with hanging as the most prevalent suicide method in South Korea. This study aimed to determine diagnostic markers confirming suicidal hanging-associated deaths.
In this prospective study, hemorrhages at the periosteal-clavicular origin of the sternocleidomastoid (SCM) muscles were compared among suicidal hanging, manual strangulation, and ligature strangulation cases. This study included 211 cases of suicide by hanging, and a control group of 50 individuals who underwent cardiopulmonary resuscitation but died of other causes. Additionally, nine cases of ligature strangulation and six cases of manual strangulation were analyzed. Postmortem examinations were conducted, and clavicular hemorrhages were histologically evaluated. Statistical analyses were performed using the χ² test.
Hemorrhages at the periosteal-clavicular origin of the SCM were observed in 178 of the 211 hanging cases (84.4%). The highest frequency of clavicular hemorrhage was found in typical hanging cases with complete suspension. Among the 50 control cases, only three showed hemorrhages in the clavicular region, but these were extravasations in the adjoining soft tissue, not in the periosteum. In cases of manual and ligature strangulation, SCM hemorrhages were found within the muscle tissue and were not of periosteal-clavicular origin.
Hemorrhage at the periosteal-clavicular origin of the SCM is a significant finding in suicidal hanging and serves as a potential pathognomonic marker for confirming cases of suicidal hanging. The study revealed a statistically significant association between the type of hanging, completeness of body suspension, and the occurrence of these hemorrhages. Cardiopulmonary resuscitation does not cause a hemorrhage at this location.
自杀仍是一个严重的全球公共卫生挑战，在韩国，上吊是最常见的自杀方式。本研究旨在确定确认与自杀性上吊相关死亡的诊断标志物。
在这项前瞻性研究中，我们比较了自杀性上吊、手动勒颈和绞索勒颈病例中胸锁乳突肌（SCM）骨膜-锁骨起点的出血情况。本研究纳入了 211 例上吊自杀案例，并纳入了 50 例因其他原因行心肺复苏但死亡的对照者。此外，还分析了 9 例绞索勒颈和 6 例手动勒颈案例。进行了尸体检查，并对锁骨出血进行了组织学评估。使用 χ²检验进行统计分析。
在 211 例上吊案例中，有 178 例（84.4%）观察到 SCM 骨膜-锁骨起点的出血。在完全悬空的典型上吊案例中，锁骨出血的频率最高。在 50 例对照者中，只有 3 例在锁骨区域出现出血，但这些是毗邻软组织的外渗，而非骨膜。在手勒颈和绞索勒颈案例中，SCM 出血位于肌肉组织内，而不是骨膜-锁骨起源处。
SCM 骨膜-锁骨起点的出血是自杀性上吊的一个重要发现，是确认自杀性上吊案例的潜在特征性标志物。研究表明，悬挂类型、身体悬空的完整性与这些出血的发生之间存在统计学显著关联。心肺复苏不会导致该部位出血。
