Homicidal and suicidal sharp force fatalities: autopsy parameters in relation to the manner of death

A retrospective, comparative study was carried out on 118 sharp force fatalities, including 70 homicides and 48 suicides, and covering a 22-year period from 1986 to 2008. The objective was to identify relevant parameters that may be used to distinguish between these two manners of death. The following parameters were analysed: age, gender, number of wounds, type of wounds, anatomical sites of the wounds, presence of wounds affecting bones or cartilage, the longitudinal axis of stab wounds located at the anterior part of the trunk, Injury Severity Score (ISS) and associated traumatic injuries. Our statistical analyses revealed several relevant parameters that may help differentiate the two manners of death. Homicide victims were younger than those who had committed suicide. Homicide cases showed associated stab and cut wounds, whereas suicide cases predominantly showed isolated cut wounds. Wounds located at the head, limbs, hands, nape of the neck, or back were predictive of a homicide, whereas wounds located solely at the anterior parts of the trunk, neck, or forearms were predictive of a suicide. The presence of bone or cartilage wounds was predictive of a homicide and their absence was predictive of a suicide. A vertical longitudinal axis of stab wounds located at the anterior part of the trunk was predictive of a homicide whereas a horizontal axis was predictive of a suicide. ISS was found to be significantly higher in homicide cases than in suicide cases. The presence of defensive or violence-associated traumatic wounds was predictive of a homicide whereas the presence of hesitation-associated wounds or the absence of associated traumatic wounds was predictive of a suicide.