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

Thomsen, Asser H.; Villesen, Palle; Brink, Ole; Leth, Peter Mygind; Hougen, Hans Petter

doi:10.1007/s12024-020-00246-z

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…Technological advances such as improved health care and telecommunication, has led to better and faster trauma treatment, improving survival rates in victims of violence [ 3 , 17 , 19 , 20 , 21 , 22 ]. While the availability of knives and firearms in public can be controlled via legislation, this is not possible for all of blunt objects and certainly not for fists, knees, and feet, so the reduction in blunt force homicides must be part of a general trend in violence and perhaps also influenced by faster and better trauma treatment [ 16 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The homicides were grouped based on the typology of the European Homicide Monitor, which emphasizes the importance of victim‐offender relation [ 14 ]. In a second database, we registered every injury on the skin and in organs using the Abbreviated Injury Scale (AIS) framework with localizers [ 15 , 16 , 17 ]. One author (AHT) has completed the AIS‐training program and collected all the data.…”

Section: Methodsmentioning

confidence: 99%

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Blunt force homicides in Denmark 1992–2016

Thomsen

Leth

Hougen

et al. 2022

Journal of Forensic Sciences

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Blunt force homicides in Denmark 1992–2016

Thomsen

Leth

Hougen

et al. 2022

Journal of Forensic Sciences

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“…Another important strength is that the snapshots regarding the CFM-examined the individual's health state, which the forensic assessments are based on, and this can be supported by the frequently recalibrated and evidence-based PS score, which predicts the patient outcome 30 days after the trauma [15]. This is important because of on-going improvements in treatment [8,25]. However, the continuous updates and recalibrations make the PS score time dependent, as a forensic case from 2012 might have had a different PS score if it had been evaluated after 2014 where PMC was included [14].…”

Section: Discussionmentioning

confidence: 99%

“…Several forensic studies have examined the applicability of trauma scoring for postmortem documentation of injuries by quantifying the injury severity at autopsy [3][4][5][6][7][8]. However, few studies have examined the potential of trauma scoring for the prediction of mortality in the CFM setting.…”

Section: Introductionmentioning

confidence: 99%

The usefulness of a trauma probability of survival model for forensic life-threatening danger assessments

et al. 2021

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Clinical forensic medical examinations constitute an increasing proportion of our institution’s tasks, and, concomitantly, the authorities are now requesting forensic life-threatening danger assessments based on our examinations. The aim of this retrospective study was to assess if a probability of survival (PS) trauma score could be useful for these forensic life-threatening danger assessments and to identify a cut-off PS score as a supporting tool for the forensic practice of assessing life-threatening danger. We compared a forensic database and a trauma database and identified 161 individuals (aged 15 years or older) who had both a forensic life-threatening danger assessment and a PS score. The life-threatening danger assessments comprised the following statements: was not in life-threatening danger (NLD); could have been in life-threatening danger (CLD); or was in life-threatening danger (LD). The inclusion period was 2012–2016. A statistically significant difference was found in the PS scores between NLD, CLD and LD (chi-square test: p < 0.0001). The usefulness of the PS score for categorizing life-threatening danger assessments was determined by a receiver-operator characteristic (ROC) curve. The area under the curve was 0.76 (95% CI, 0.69 to 0.84) and the ROC curve revealed that a cut-off PS score of 95.8 would appropriately identify LD. Therefore, a PS score below 95.8 would indicate life-threatening danger. We propose a further exploration of how the evidence-based PS score, including a cut-off value, might be implemented in clinical forensic medical statements to add to the scientific strength of these statements.

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“…mit einer PERT hätten mutmaßlich lebensrettend behandelt werden können, sind hingegen bis dato absolute Einzelfälle und werden auch als solche publiziert [5]. In einer aktuellen rechtsmedizinischen Arbeit dänischer Kollegen [6] wird die Abnahme homizidaler Messerverletzungen seit den 1990er-Jahren zwar auch auf eine verbesserte medizinische Versorgung solcher Patienten zurückgeführt, wenngleich detaillierte Angaben zur notfallmedizinischen Therapie im Allgemeinen und PERT-Inzidenzen im Speziellen im Artikel fehlen. Es findet sich dort lediglich die Erwähnung, dass die Prognose bei Traumapatienten besser sei, wenn diese direkt in adäquate Traumazentren zur Damage-Control-Surgery transferiert würden (was ja praktisch-notfallmedizinischer und auch wissenschaftlicher Konsens ist).…”

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