A scoring system for assessing the Manner of Death in Stab Injuries to the Trunk (The MODSIT score)

Distinguishing between homicide and suicide in cases of single stab injuries to the trunk can be challenging, particularly in the absence of clear contextual information. This study aims to address this issue by developing the MODSIT score (Manner of Death in Stab Injuries to the Trunk)-an evidence-based scoring system designed to standardise forensic manner of death assessments.

We developed four score models based on: 1) autopsy findings alone; 2) autopsy findings and toxicology; 3) autopsy findings, toxicology, and circumstances at the death scene; and 4) autopsy findings, toxicology, death scene circumstances, and demographics. The diagnostic performance of the models was evaluated through Receiver Operating Characteristic (ROC) curve analysis.

Model 3, including autopsy findings, toxicology, and circumstances at the death scene, established the best diagnostic performance (AUC 0.99, 95 % CI 0.97-1.00). The optimal cut-off of 2 score points showed 91.8 % sensitivity and 97.6 % specificity for predicting homicide, and cut-off of -1 point showed 85.7 % sensitivity and 98.8 % specificity for predicting suicide.

The score needs to be validated in other populations to confirm its generalisability. The MODSIT score has the potential to become a valuable tool for evidence-based forensic practice.