Intimate partner homicides in Denmark 1992-2016.

Intimate partner homicide is one of the most common types of homicide and a significant contributor to domestic homicides worldwide, especially affecting females. We focus on the intimate partner homicides in Denmark during 1992-2016. Though gender identity data was unavailable, sex data from official documents enabled critical analysis. Of the 1417 homicides in the period, 26.5% were intimate partner homicides, i.e., 55.6% of female and 8.9% of male victims. The annual intimate partner homicide rate was 0.28 per 100,000 (0.44 for female victims and 0.12 for male victims), declining at a lower rate than other types of homicide. Most victims of intimate partner homicides were females (79.3%). The demographics of the victims and the characteristics of the homicides were markedly different depending on victim sex. Female victims were killed by more varied methods, with more severe injuries and followed by suicide in 26.5% and with multiple homicide victims in 8.1%.

Blunt force homicides in Denmark 1992-2016.

Blunt force trauma is a common homicide method, inflicted in three different ways: bodily force, assault with blunt objects of various types and falls from height. The objective of this study is to provide thorough information on blunt force homicides with data on the victims, the offenders, the surrounding circumstances, the injury methods, the extent of injuries, and survival time, which will help inform the inexperienced as well as the seasoned forensic pathologist in their daily work with death investigation and as expert witnesses in court. We have analyzed autopsy reports and available case files of 311 blunt force homicides, making up 21.9% of all homicides in Denmark during 1992-2016. Most victims and offenders were male. Altercation in the setting of nightlife and intoxication was common in male victims, while most female victims were killed in a domestic setting. Bodily force was the most common primary homicide method, followed by assault with a blunt object and fall from height. The head was the region that most often had external injuries, with no noteworthy difference between cases with bodily force and blunt objects. Two out of three victims had one or more lacerations, most often located on the head and more often on the front. Brain injury was the primary cause of death in at least 72.0% victims. Compared to bodily force victims of blunt object assault were especially prone to skull and brain injuries, had a higher trauma score, and more died at the crime scene and had a shorter survival time.

Asphyxia homicides in Denmark 1992-2016.

In this retrospective study , we present the findings in 250 homicides by asphyxia in Denmark in a 25-year period, with a particular focus on the autopsy findings in strangulation. Our intention is for the results to be used in future death investigations, where difficulties in interpretation of findings in potential asphyxial deaths arise. Asphyxia homicides showed a strong bias with respect to sex, age, and homicide type. The frequent female victim was typically an adult, whereas the rarer male victim was most often a child. Female offenders most often killed their children, and male offenders most often killed their female partner. Generally, most asphyxia homicides took place in a domestic setting. Manual strangulation and ligature strangulation were the most common mechanisms of asphyxia homicides (81.6%). A lack of petechial hemorrhages, especially in the conjunctiva, was rare in homicidal strangulation, but there were exceptions, especially when there was postmortem decomposition, making it impossible to verify them. Most victims of strangulation had skin lesions in the face (including the jawline) or on the neck, with accompanying hemorrhages in muscle and connective tissue, but the findings could be subtle or compounded by decomposition. Fractures of the laryngo-hyoid complex were common in strangulation, particularly in manual strangulation (chi-sq = 4.0993, df = 1, P < 0.05) and were clearly related to the age of the victim (chi-sq = 82.193, df = 4, P < 0.001). In children and young adults dying from homicidal strangulation, a lack of fractures is to be expected, while a lack of fractures is unusual, but not entirely unexpected, for adults and aged people.

Gunshot homicides in Denmark 1992-2016.

The majority of homicides in the world are caused by firearms and a good understanding of gunshot wounds is important for the forensic pathologist. We have analyzed all 315 homicides by gunshots in Denmark during 1992-2016 with focus on information relevant to forensic pathologists. Of the 1417 homicides in Denmark in 1992-2016, 315 (22.2%) had gunshot trauma as the primary homicide method. During 1992-2016, there has been a significant decrease in the number of gunshot homicides overall, of homicides committed with hunting weapons, and of domestic gunshot homicides. Most victims (70.5%) and offenders (93.7% of homicides with known offenders) were males. Male victims were significantly younger than female victims. Most victims were killed with handguns (43.8%) or shotguns (41.0%). Compared to all other weapons, the victims killed with shotguns had fewer entry wounds, a higher New Injury Severity Score (NISS), and a higher proportion of contact/close-range entry wounds. The head (58.1%) and thorax (46.7%) were often injured, with injuries to the head being more common in contact/close-range entry wounds. The results show that gunshot injuries in homicides are different from suicides and accidents and clearly are affected by the homicide type, the sex of the victim, and the weapon used and that these entities are intertwined. Our findings provide an evidence-based foundation for use in death investigations and for policy development in the area of interpersonal violence.

Improved medical treatment could explain a decrease in homicides with a single stab wound.

Since the 1990s, there has been a reduction in the homicide rate in Denmark and other Western countries. Our hypothesis is that part of the decrease in the sharp force homicide rate can be explained by better and faster medical treatment over time, and we explore this via stab wound homicides, the largest group of homicides in Denmark. To investigate our hypothesis we undertook an epidemiological study of 428 stab wound homicides in Denmark 1992-2016 based on autopsy reports with registration of stab wounds, quantification of injury severity, treatment intensity and survival time. During 1992-2016, there was a significant reduction in the annual number of victims with a single stab wound, but no reduction in victims with multiple stab wounds. Victims with single stab wounds reached the hospital more often, survived longer and had less severe injuries (New Injury Severity Score (NISS)) than victims with multiple stab wounds. Higher NISS correlated with shorter survival time for all the stab wound victims and for the subgroup that underwent medical treatment. During the 25-year study period, the proportion of victims who underwent surgery before dying increased threefold. The victims in the first half of the study period had shorter survival times than the victims in the last half. We concluded that better and faster medical treatment could partly be responsible for the observed decrease in the number of single stab wound homicides and thereby possibly also in the total number of stab wound homicides.

Suicidal ligature strangulation: a systematic review of the published literature.

To summarize the published forensic pathology evidence base in deaths concluded to be the result of suicidal ligature strangulation, an uncommon entity. Four electronic bibliographic databases Medline Ovid, Embase, Scopus, HEINonline were screened for relevant literature. No date restrictions were applied. All English language case reports or case series were included. Articles were evaluated and key data extracted according to predefined criteria. A total of 1554 references eventually yielded 24 papers with 31 eligible case reports. The location of the deaths and background circumstances and history mirror broadly those of suicide generally. The range of ligature types was diverse. 19/31 cases reported one or more knots present. In the remaining 12 cases, the ligatures did not lend themselves to knots. In only one case were laryngeal fractures reported, but the available material does not justify confidence in that report given the significance of the finding. This systematic review has identified and synthesized the evidence from 31 case reports of suicidal ligature strangulation. A forensic pathologist faced with a possible case can locate it within the spectrum of reported cases and therefore identify its common and distinguishing features. Inherent difficulties for research in forensic pathology mean that case reports are an important source of learning and evidence for the discipline. Opportunities for improvement exist especially in harmonizing terminology and standardizing techniques generally, and in reports of suicidal ligature strangulation in particular.

Sharp Force Homicide in Denmark 1992-2016.

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992-2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.

Homicide in Denmark 1992-2016.

We present the findings for homicides in Denmark for 1992-2016. There were 1417 homicide victims (62.2% males, 37.8% females) that were killed in 1321 homicide events. The most common methods were sharp force trauma (33.2%), gunshot (22.2%), blunt force trauma (21.9%) and asphyxia (17.6%), and all methods exhibited a reduction during the study period. The homicide rate was 1.05 per 100,000, 1.32 per 100,000 for males, and 0.78 per 100,000 for females. Domestic homicides were the largest main group of homicides (76.5% of all female victims vs. 23.6% of male victims). Of the non-domestic homicides, 84.2% of victims were male, the largest group being in the setting of nightlife and/or intoxication. Most female victims (76.9%) were killed by someone in their family, while the largest share of male victims (34.5%) were killed by a friend or acquaintance. The offenders were males in 87.9% of all homicides.

Homicide in Greenland 1985-2010.

PURPOSE: Homicide in Greenland has not often been investigated. The latest published study documented a dramatic rise in the homicide rate from around 1/100,000 inhabitants to more than 23/100,000 inhabitants from 1946 to 1984. The aim of our study was to characterize homicides in Greenland from 1985 to 2010 and to compare trends during this period with those in previous studies and with homicide characteristics in Denmark, northern Europe, and other Arctic regions. METHODS: We identified a total of 281 homicides by legal definition and 194 by medical definition, the latter from the years 1990 to 2010. We procured case files for a total of 129 victims (71 male, 58 female) and 117 perpetrators (85 male, 32 female). RESULTS: We identified an overall decrease in the homicide rate during our study period. The decrease in the medical homicide rate was significant (p = 0.007). The homicide rate ranged from 25/100,000 inhabitants to 13/100,000 inhabitants when results were grouped within 5-year periods. There were significantly more male perpetrators (p < 0.001) and among female perpetrators there were significantly more male victims (p < 0.001). Sharp force and gunshot-related killings dominated homicide methods (41 and 29% respectively), with sharp force deaths increasing throughout the investigation period. Altercations were the main motive (49%). Alcohol-related homicides decreased in our study period. CONCLUSIONS: While the Greenlandic homicide rate has decreased, it is markedly higher compared to that seen in Denmark and northern Europe. However, it resembles the rate seen in the rest of the Arctic. Liberal gun laws do not affect the proportion of gun-related killings. Despite the high homicide rate, women account for almost half the victims.

Esophageal injury in fatal rear-impact collisions.

Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma.

Traumatic death in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic rheumatic disease that causes spinal rigidity with an increased risk of spinal fractures. We present a case report where a middle-aged man, in apparent good health, died following a fall from his bike. Postmortem computed tomography (CT) showed several fractures in the cervical and thoracic spine, with displacement into the spinal canal as well as spinal changes consistent with AS. The cause of death was determined to be upper spinal cord injury caused by cervical spinal fractures that were facilitated by spinal rigidity from AS. Further investigation into the medical records revealed that the decedent had previously been treated for AS. This case report illustrates the importance of obtaining a detailed medical history when investigating deaths, including nonfatal conditions, such as AS. Furthermore, it shows the value of CT in the evaluation of the mechanism and manner of death.

An alternative approach to computerized tomography (CT) in forensic pathology.

Computerized Tomography (CT) is used by some forensic pathology departments as a supplement to the forensic autopsy. Departments with a limited number of autopsies may find it relatively expensive to acquire and operate a CT-scanner. Furthermore, it requires a great deal of training and experience to interpret the radiological data. We are currently evaluating CT in order to decide whether the benefits match the efforts. In selected death-investigations the Department of Radiology at Aarhus University Hospital performs CT of the body on behalf of the Institute of Forensic Medicine at Aarhus University and a skilled radiologist interprets the data. We present our radiological findings in the 20 cases where we have used CT and compare them to the autopsy findings. The cases include fatalities from beatings, stabbings, gunshots, fires and traffic accidents. CT is an excellent tool for documenting and illustrating certain lesions, such as gunshot wounds and bone fractures, where we can obtain information that possibly would have been missed at the autopsy. We believe, however, that further research is required before we can recommend CT as a part of a standard forensic autopsy. The cooperation between forensic and radiological departments is a good approach for smaller forensic departments that insures a skilled interpretation without having to divert a lot of resources to equipment and training.

Suicide by carbon monoxide from car exhaust-gas in Denmark 1995-1999.

In the period 1995-1999 there were 388 car exhaust-gas suicides in Denmark. Of these 343 (88.4%) were men and 45 (11.6%) were women, the average age being 47 years. The car exhaust-gas suicides made up 9.3% of all suicides in Denmark in the period. The corresponding rate was 11.7% for men and 3.7% for women. In rural areas a larger part of all suicides were committed with car exhaust-gas compared to the more densely populated areas. Mental disease was diagnosed in 124 (32.0%) cases. A suicide note was found in 165 (42.5%) cases. A hose was fitted to the exhaust pipe in 334 (86.1%) cases. Of these the 234 (60.3%) occurred outside, typically in a forest area, while 76 (19.6%) occurred in a closed garage. All the 54 (13.9%) cases with no hose fitted to the exhaust pipe occurred in a garage. Seven (1.8%) victims were found in a burning or burnt-out car, where the following investigation revealed that it was actually a car exhaust-gas suicide. Carboxyhemoglobin was measured in 26 (6.7%) victims. In two of these victims no carboxyhemoglobin was found, as they had survived for some time after the poisoning. The average saturation of the remaining victims was 67%, the lowest saturation being 20% and the highest being 84%. In the period 1969-1987 the number of car exhaust-gas suicides in Denmark increased from 50 to approximately 190 per year and the rate of car exhaust-gas suicides compared to all suicides increased from approximately 5% to approximately 13%. In 1987-1999 these figures decreased from approximately 190 to 63 per year and from 13% to approximately 8%. During these 30 years the number of passenger cars in Denmark doubled, which explains the increase in car exhaust-gas suicides during 1969-1987. A possible explanation for the decrease in 1987-1999 is the introduction of the catalytic converter, which was made mandatory in 1990. We anticipate that car exhaust-gas suicides will continue to decrease in numbers, as more cars are equipped with catalytic converters.