Homicide by Unspecified Means: Cleveland 2008 to 2019

Area of Science:

• Forensic Pathology
• Medical Toxicology
• Criminalistics

Background:

• Homicide by unspecified means (HUM) is diagnosed when deaths are suspicious but the specific cause is unidentifiable.
• Previous diagnostic criteria for HUM were proposed in 2010 but lacked validation.
• Assessing the accuracy of existing HUM diagnostic criteria is crucial for consistent death investigations.

Purpose of the Study:

• To validate the 2010 diagnostic criteria for homicide by unspecified means (HUM).
• To assess the accuracy and limitations of the existing HUM diagnostic criteria using a real-world case series.
• To propose modifications to the HUM diagnostic criteria for improved clinical utility.

Main Methods:

• A retrospective review of Cuyahoga County Medical Examiner's Office records from 2008-2019 was conducted.
• Thirteen cases certified as homicide by unspecified means (HUM) were identified and analyzed.
• Cases were evaluated against the 5 diagnostic criteria proposed by Matshes and Lew in 2010.

Main Results:

• All 13 reviewed cases met criteria 1, 4, and 5. Only one case met criterion 2 (anatomic cause of death).
• Criterion 3 (toxicology) posed challenges, excluding cases due to skeletonization or positive toxicology in proximity to other identified homicides.
• Despite strict adherence to criterion 3, confessions confirmed homicide in 7 cases, including 5 that would have been excluded by toxicology findings.

Conclusions:

• The 2010 diagnostic criteria for HUM serve as a reasonable framework for death investigations.
• Modification of criterion 3 is recommended to enhance diagnostic flexibility and incorporate clinical judgment.
• Revised HUM criteria can improve the accurate classification of suspicious deaths where a specific cause remains elusive.