Abstract：
BACKGROUND: Homicides using knives or other sharp objects are the most common type of homicide in Europe, and the second most common type of homicide worldwide. In contrast, suicides using sharp objects are rarer, constituting only a few per cent of all suicides in western countries. We investigated single stab injuries to the trunk in both homicides and suicides to assess differences in extent of injuries and in medical care, which could be of value for trauma management, public health and forensic assessment.
METHODS: We identified all cases in Sweden between 2010 and 2021 that died of a single stab to the trunk, in either a homicide (n = 94) or a suicide (n = 45), and that were the subject of a forensic autopsy. We obtained data on demographics, hospital care and injured structures. To assess the severity of injuries, we applied AIS (Abbreviated Injury Score) and NISS (New Injury Severity Score). The inter-rater reliability of NISS between two raters was evaluated with intra-class correlation (ICC), with 95 % confidence intervals (CI). The data was analysed using Fisher\'s exact test, Mann-Whitney U test and logistic regression models.
RESULTS: The inter-rater reliability between the two NISS raters showed an ICC of 0.87 (95 % CI 0.68-0.95). We observed a larger variation of injuries in suicides, with a higher proportion of both unsurvivable (NISS 75) and minor injuries (NISS ≤ 8) (66.7 % and 8.9 % respectively) compared to in homicides (46.8 % and 0 % respectively). We observed a larger proportion of injuries to the heart in suicides (68.9% vs. 46.8 %, p = 0.018). In homicides, injuries involving vessels (52.1% vs. 13.3 %, p < 0.001) and hospital care (56.4 % vs. 8.9 %, p < 0.001) were significantly more common compared to suicides.
CONCLUSIONS: Causation (self-inflicted or assaults) seems to be associated with characteristics of injury and the likelihood of receiving hospital care. These findings could potentially be valuable for trauma management and forensic assessment of manner of death, however, determining the mortality of the injuries would require a comparison group comprising injured survivors.
METHODS: We identified all cases in Sweden between 2010 and 2021 that died of a single stab to the trunk, in either a homicide (n = 94) or a suicide (n = 45), and that were the subject of a forensic autopsy. We obtained data on demographics, hospital care and injured structures. To assess the severity of injuries, we applied AIS (Abbreviated Injury Score) and NISS (New Injury Severity Score). The inter-rater reliability of NISS between two raters was evaluated with intra-class correlation (ICC), with 95 % confidence intervals (CI). The data was analysed using Fisher\'s exact test, Mann-Whitney U test and logistic regression models.
RESULTS: The inter-rater reliability between the two NISS raters showed an ICC of 0.87 (95 % CI 0.68-0.95). We observed a larger variation of injuries in suicides, with a higher proportion of both unsurvivable (NISS 75) and minor injuries (NISS ≤ 8) (66.7 % and 8.9 % respectively) compared to in homicides (46.8 % and 0 % respectively). We observed a larger proportion of injuries to the heart in suicides (68.9% vs. 46.8 %, p = 0.018). In homicides, injuries involving vessels (52.1% vs. 13.3 %, p < 0.001) and hospital care (56.4 % vs. 8.9 %, p < 0.001) were significantly more common compared to suicides.
CONCLUSIONS: Causation (self-inflicted or assaults) seems to be associated with characteristics of injury and the likelihood of receiving hospital care. These findings could potentially be valuable for trauma management and forensic assessment of manner of death, however, determining the mortality of the injuries would require a comparison group comprising injured survivors.
摘要：
背景：使用刀具或其他尖锐物体的凶杀是欧洲最常见的凶杀类型，也是全球第二常见的凶杀案.相比之下,使用尖锐物体自杀更罕见，仅占西方国家所有自杀行为的百分之几。我们调查了凶杀和自杀中躯干的单次刺伤，以评估伤害程度和医疗护理方面的差异，这可能对创伤管理有价值，公共卫生和法医评估。
方法：我们确定了2010年至2021年之间瑞典所有死于躯干一次刺伤的病例，无论是凶杀(n=94)还是自杀(n=45)，那是法医尸检的主题。我们获得了人口统计数据，医院护理和受伤的结构。评估损伤的严重程度,我们应用AIS（缩写损伤评分）和NISS（新损伤严重程度评分）。用类内相关性(ICC)评估了两个评估者之间NISS的评估者间可靠性，95%置信区间(CI)。数据使用Fisher精确检验进行分析，Mann-WhitneyU检验和逻辑回归模型。
结果：两个NISS评估者之间的评估者间可靠性显示ICC为0.87（95％CI0.68-0.95）。我们观察到自杀的伤害变化更大，与凶杀案（分别为46.8％和0％）相比，无法生存（NISS75）和轻伤（NISS≤8）的比例更高（分别为66.7％和8.9％）。我们观察到自杀中心脏损伤的比例更大(68.9%vs.46.8%,p=0.018)。在凶杀案中，涉及血管的损伤(52.1%vs.13.3%,p<0.001）和医院护理（56.4%vs.8.9%,p<0.001）与自杀相比明显更常见。
结论：因果关系（自我伤害或攻击）似乎与受伤的特征和接受医院护理的可能性有关。这些发现可能对创伤管理和死亡方式的法医评估有潜在价值，然而,确定损伤的死亡率需要一个由损伤幸存者组成的对照组.
方法：我们确定了2010年至2021年之间瑞典所有死于躯干一次刺伤的病例，无论是凶杀(n=94)还是自杀(n=45)，那是法医尸检的主题。我们获得了人口统计数据，医院护理和受伤的结构。评估损伤的严重程度,我们应用AIS（缩写损伤评分）和NISS（新损伤严重程度评分）。用类内相关性(ICC)评估了两个评估者之间NISS的评估者间可靠性，95%置信区间(CI)。数据使用Fisher精确检验进行分析，Mann-WhitneyU检验和逻辑回归模型。
结果：两个NISS评估者之间的评估者间可靠性显示ICC为0.87（95％CI0.68-0.95）。我们观察到自杀的伤害变化更大，与凶杀案（分别为46.8％和0％）相比，无法生存（NISS75）和轻伤（NISS≤8）的比例更高（分别为66.7％和8.9％）。我们观察到自杀中心脏损伤的比例更大(68.9%vs.46.8%,p=0.018)。在凶杀案中，涉及血管的损伤(52.1%vs.13.3%,p<0.001）和医院护理（56.4%vs.8.9%,p<0.001）与自杀相比明显更常见。
结论：因果关系（自我伤害或攻击）似乎与受伤的特征和接受医院护理的可能性有关。这些发现可能对创伤管理和死亡方式的法医评估有潜在价值，然而,确定损伤的死亡率需要一个由损伤幸存者组成的对照组.
