Homicide-associated burning in Cape Town, South Africa.

To describe the features of homicide-associated burnings (HAB) and examine factors that distinguish between intentional and accidental fatal burn injury, we undertook a review of all burn cases admitted to the Salt River State Mortuary, Cape Town, South Africa, between January 1, 1991, and December 31, 1992. Of 358 burn-related deaths, 35 (10%) were homicides; five (14%) of these were described as "necklacings." No significant difference existed in age, sex, residential status, or extent of burn injury between the HAB and adult residential fire victims (ARFV). Of the HAB, 44% had soot in the trachea and main bronchi, whereas soot was present in 83% of the ARFV (p = 0.001). The median blood carbon monoxide saturation was 12% in the HAB and 30% in the ARFV (p = 0.001). Of the HAB, 48% had a blood alcohol concentration > 0.1 g/100 ml, whereas this concentration was noted in 70% of ARFV (p = 0.02). Evidence of either gunshot, stabbing, or blunt force injury was seen in 82% of the HAB. Although some significant autopsy parameters characterize HAB, we conclude that the forensic pathologist should diligently seek evidence of homicidal injury in all fatal burn cases.