Petechiae in non-fatal strangulation: Prevalence, predictors and time-dependent detectability in forensic assessment

Area of Science:

• Forensic Medicine
• Pathology
• Clinical Toxicology

Background:

• Petechiae are inconsistently observed after non-fatal strangulation.
• Variability in petechiae detection complicates forensic evaluations.
• Understanding factors influencing petechiae presence is crucial for accurate assessment.

Purpose of the Study:

• To analyze the influence of anatomical location and time on petechiae detection post-strangulation.
• To identify clinical symptoms and external signs associated with petechiae.
• To develop a practical tool for forensic assessment of strangulation cases.

Main Methods:

• Retrospective cohort study of 541 adult cases.
• Evaluation of petechiae presence based on location and time interval to examination.
• Logistic regression, generalized estimating equations, and ROC analysis were used.

Main Results:

• Petechiae were observed in 10% of cases.
• Shorter intervals between event and examination were significantly associated with petechiae presence (mean 26h vs. 61h).
• Conjunctival petechiae were detected early, while posterior ear petechiae persisted longer (OR=27.65). Dyspnea, hoarseness, and dysphagia were associated with petechiae.

Conclusions:

• Petechiae detection is time- and site-dependent.
• Clinical symptoms and external signs aid in early identification.
• A two-item risk score (dyspnea, absence of external skin findings) showed potential for forensic assessment (AUC=0.72).