Medical and Dental Consultantsí Association of Nigeria
Home - About us - Editorial board - Search - Ahead of print - Current issue - Archives - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 3454   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 

  Table of Contents 
ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 6  |  Page : 777-781

Assessment of cases with sharp and penetrating object injuries


1 Department of Forensic Medicine, Adiyaman Univesity, Adiyaman, Turkey
2 Department of Radiology, Adiyaman Univesity, Adiyaman, Turkey

Date of Acceptance01-Mar-2019
Date of Web Publication12-Jun-2019

Correspondence Address:
Dr. H Kafadar
Department of Forensic Medicine, Adiyaman Univesity, Adiyaman - 02100
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_625_18

Rights and Permissions
   Abstract 


Background: Sharp and penetrating object injuries (SPOIs) are seen frequently in forensic medicine practice. In this study, we aimed to retrospectively investigate cases with SPOIs. Materials and Methods: This study investigated the charts of patients treated at Adiyaman University Education and Research Hospital between January 1, 2013, and December 31, 2017. A total of 934 inpatients with sharp object injuries were included in the study. Data were assessed using a suitable computer-aided package program. Cases were examined in terms of age, gender, injury body site, suicide or homicide, radiologic findings, presence of vital danger, and severity of injury. Results: In this study, we examined the charts for 934 inpatients with stab wounds. It was stated that 124 (13.27%) of those injured were female and 810 (86.63%) male; the average age of the injured persons was 29.8 ± 18.2 years. It was found that 214 (22.91%) people were exposed to vital danger and that 720 (77.09%) suffered from soft tissue injuries (penetrating skin and muscle injuries). Also, 69.27% of the cases (n = 647) involved people less than 35 years of age. Conclusion: Considering that stab injuries are more frequent in the lower age groups, we believe that such injuries could be reduced by increasing training programs for young people.

Keywords: Forensic medicine, injury, stab wound


How to cite this article:
Kafadar H, Kafadar S. Assessment of cases with sharp and penetrating object injuries. Niger J Clin Pract 2019;22:777-81

How to cite this URL:
Kafadar H, Kafadar S. Assessment of cases with sharp and penetrating object injuries. Niger J Clin Pract [serial online] 2019 [cited 2019 Sep 17];22:777-81. Available from: http://www.njcponline.com/text.asp?2019/22/6/777/260047




   Introduction Top


Injuries and deaths that are caused by sharp and penetrating objects have an important place in forensic medicine practice.[1],[2],[3] The examination of wounds is very important for distinguishing suicide attempts from homicide attempts.[4] In the first place, the presence of many sharp and penetrating object wounds in the body could be evaluated as attempted homicide. However, a detailed examination of the wounds is required. A suicide note, depression, previous suicide attempts, and the presence of other marks on the body such as tentative injuries should also be investigated.[2],[4],[5],[6],[7],[8],[9],[10] According to previous studies, tentative cuts (frequently on the wrists) and unclothed body site were evaluated as suicide marks.[11] Use of cross-sectional imaging such as computed tomography (CT) is crucial in the initial evaluation of these patients for diagnosis.[12]

Today, sharp and penetrating objects are commonly used for different purposes in workplaces and in the home, and they are also kept and used in official organizations.[1],[13] Except for some special types that are subject to regulations, these tools are always available and do not require any legal sanction unless they are misused. However, such tools are frequently used for defense or attack, and even for homicide and suicide.[13],[14],[15] It has been reported that 6.56% of all injury cases are stab injuries, and this type of injury is in third place among all injury cases.[16] Altun et al. reported in their study that sharp and penetrating object injuries (SPOIs) are the fourth most frequent, at 4.7%.[9] There has been an increase in stab injuries lately, and most of the cases involve young males.[1],[14],[17],[18] Possible life-threatening injuries are commonly incurred, with bleeding from the lesions of intrathoracic and/or intraabdominal organs and vessel injury.[19] Fatal SPOIs usually are those that involve penetrating injuries to the thoracic and abdominal areas, whereas injuries to the head, neck, back, and extremities have lower risk of death.[20]

Consequently, the purpose of this study is to point out that sharp and penetrating objects are easily available; many types may be kept without any legal barrier; and they have fatal weapon characteristics when misused.


   Materials and Methods Top


The study was started after the approval of the university ethics committee. Patient data were reached through the electronic archive system. This study investigated retrospectively the charts of patients treated at Adiyaman University Education and Research Hospital between January 1, 2013, and December 31, 2017. A total of 934 inpatients with SPOIs were incorporated in this study. Data were assessed using a suitable computer-aided package program. Cases were examined in terms of age, gender, injury site, presence of vital danger, and severity of injury. The severity of injury was assessed according to the penal code and clinical findings. Furthermore, domestic violence cases were obtained through anamnesis in patient chart.

All statistical analyses were performed using the Excel program (Microsoft® Excel©; Windows 2010; Microsoft, USA). Categorical variables were grouped as frequency and percentage and given descriptive statistics, and continuous variables were grouped as mean ± standard deviation. Percentages were calculated, and Pearson's Chi-square or Fisher's exact test was used to compare frequencies according to suitability. Relationships or differences between groups were explained statistically. A statistically significant P < 0.05 was accepted as a significant value.


   Results Top


Of the 934 cases included in the study, 124 (13.27%) were females and 810 (86.63%) males [Figure 1], and the average age of the injured persons was 29.8 ± 18.2 years. The differences between genders were found to be significant statistically (P < 0.05).
Figure 1: Distribution according to gender

Click here to view


It was stated that 214 (22.91%) people were exposed to vital danger and 720 (77.09%) suffered from soft tissue injuries (penetrating skin and muscle injuries). When injury sites were examined in all cases, it was revealed that extremities were the most frequently injured anatomic site, in 484 (51.82%) cases, followed by abdomen injury in 256 (27.41%) cases, chest injury in 162 (17.35%) cases, and head–neck injury in 32 (3.42%) cases (P < 0.02804) [Table 1]. It was observed that 647 (69.2%) of the injured patients were below 35 years of age, and 322 (34.47%) of the cases involved individuals between 15 and 24 years of age. Furthermore, it was found that 287 (30.72%) of the injured patients were above 35 years.
Table 1: Distribution of body sites of injury according to age groups

Click here to view


It was found that 661 (70.77%) of the injuries occurred during a fight (P < 0.05), 136 (14.56%) injuries were a result of accident, 13 (1.39%) injuries were a result of suicide attempt, and in 124 (13.28%) cases the injury was self-inflicted [Figure 2]. The differences between fight and other groups were found to be significant statistically (P < 0.05).
Figure 2: Distribution according to injury causes

Click here to view


It was stated that 214 (22.91%) people were exposed to vital danger and that 720 (77.09%) suffered from soft tissue injuries (penetrating skin and muscle injuries). When the life-threatening cases were examined in terms of injury regions, the most common was abdominal injuries (92 patients, 42.99%), followed by thorax injuries in 70 cases (32.71%) and extremity vessel injuries in 52 cases (24.29%). It was found that 21 cases (22.6%) had intestinal injury, 18 cases (19.4%) liver injury, 14 cases (15.1%) splenic injuries, 13 cases (14.1%) colon injuries, and 12 cases (13.0%) hemoperitoneum. Of 31 cases (44.3%) of hemothorax, 37 cases (52.9%) were lung injuries and only 2 cases (2.8%) were cardiac injuries [Table 2] and [Image 1].
Table 2: Life-threatening cases

Click here to view



When 52 (5.56%) cases were investigated in terms of domestic violence, it was found that 28 (2.99%) cases involved injuries to males and 24 (2.57%) involved injuries to females. It was stated that 13 males were injured by their siblings, 9 by an uncle or nephew who lived with them, 4 by their sons, and 2 by their wives, whereas 18 females were injured by their husbands and 6 by their brothers.


   Discussion Top


Sharp object injuries take an important place in forensic medicine practice. Injuries are caused when these objects are used for attack and defense purposes in most cases and, more rarely, for self-injury. However, the use of sharp objects for suicide attempts is indeed observed in forensic medicine practice. Furthermore, sharp object injury may be observed in industrial workers, in butchers, and as a result of kitchen accidents.[13],[14],[15] It was found that in 661 (70.77%) cases, injury occurred during a fight, in 136 (14.56%) cases as a result of accident, in 13 (1.39%) cases as a result of suicide attempts, and in 124 (13.28%) cases the injury was self-inflicted. In our study, findings were consistent with the data.

Sharp object injuries have been reported more often in males.[1],[18],[21],[22],[23],[24],[25],[26] This occurs because men are more active in daily life, they spend more time in external environments, and they have more aggressive behavior models than women.[1] It has been reported in several studies that most sharp object injuries occur in the young population. Weeb et al. reported that most of the cases in their study involved individuals between 15 and 34 years of age; however, the peak age was 25–29 years.[18] In their study, Aktun et al. reported that most of the cases were in the 21–30 years age group.[26] Arslan et al. specified that 53 (25.5%) cases occurred in the 15–19 years age group. In addition, they reported that 85 (41%) cases were in the 15–24 years age group.[1] Although peak ages were in different age ranges in these studies, the average age was between 15 and 35 years of age.[1],[18],[26] The reason for more sharp object injury incidents in the young age group has been explained by self-protection and making an appearance in the community as well as the perception of power by knife carrying.[1]

In this study, the 934 cases presented included 124 (13.28%) females and 810 (86.72%) males; 647 (69.27%) cases were below 35 years and 322 (34.47%) cases were between 15 and 24 years of age. Data obtained in our study were consistent with the literature. We believe that the reason for higher frequency in the 15–24 years age group is the sociocultural factors.

In Arslan et al.'s study, carried out on 389 cases, it was found that lower extremity injuries were the most common, with 134 (34.44%) cases.[1] Similarly, in this study, the most frequently injured anatomic areas with 484 cases (51.82%) were the extremities. The differences between extremity and other body site injury were found to be statistically significant (P < 0.05).

It was reported that life-threatening injuries among SOIs were from abdominal and penetrating chest injuries.[4],[5],[6],[7],[8],[18],[27] In a study conducted by Arslan et al., 22 (10.6%) cases were exposed to life-threatening injuries.[1] Dülger[25] and Altun et al.[26] reported in their study that in 48 (38.4%) of 125 cases and 45 (35.2%) of 128 cases, respectively, life-threatening injuries were sustained. In a different study conducted by Altun et al., 16% of the 432 cases involved injuries that exposed individuals to vital danger. They reported in that study that 37.1% of injuries were in the chest area in SPOI-induced deaths.[26] In this study, it was stated that 214 (22.91%) cases involved life-threatening injury. There were penetrating abdomen and/or chest injuries in 162 cases. Also, 52 cases involved vessel injury; the most common vascular injury was to the radial artery with 16 cases (30.8%), and the second was to the ulnar artery and popliteal artery with 9 cases (17.4%).

A different imaging method, such as magnetic resonance, ultrasound (US, and CT, can be used in patients with stab wounds. Use of cross-sectional imaging such as CT is crucial in the initial evaluation of these patients for diagnosis in the emergency department.[12] Also, determination of the findings is very important for forensic medicine. Skin and solid organs (liver, spleen, etc.) may retain the characteristics of a sharp object causing a wound. For instance, these wounds could be reach to the information obtained from an examination of the surface characteristics of the sharp object.[27]

In this study, 934 patients with stab wounds underwent CT scans and US, and life-threatening cases were identified in 214 of the scans. Subcutaneous and/or intramuscular hematoma was identified in 720 patients. There were 92 patients with an intraabdominal lesion, of which 12 (13.0%) patients had intraabdominal hemorrhage without organ injury. Eighteen (19.4%) patients suffered liver injuries. Fourteen (15.1%) patients had splenic injuries. Renal trauma occurred in eight (9.4%) patients. Colon and intestinal injuries were seen in 34 (36.7%) patients. There were 70 patients with intrathoracic lesion. Hemothorax was determined in 31 patients, pulmonary contusion in 37 (52.9%) patients, and cardiac injury and cardiac tamponade in 2 patients (2.8%). In addition, all the patients with pulmonary contusion and cardiac injury had hemothorax and/or pneumothorax.

Self-inflicted injury could be described as self-mutilation, self-injury, self-abuse, parasuicidal behavior, deliberate self-harm, and nonsuicidal self-injury. The injuries frequently happen on the arms, the legs, and the front of the body because these are easier to reach and hide under clothing. But these injuries could also be seen on any other part of the body.[28] The wounds should be examined very carefully so that a distinction can be made between self-inflicted injuries and accidental self-injuries. In this study, we found self-inflicted injuries in 124 (13.27%) cases.

Stab injury is a rare suicide method in Eastern Turkey. Kafadar et al., in a 12-year study, did not find completed suicides through stabbing in the adolescent age group.[29] In our study, 13 patients (1.39%) were stated to have made suicide attempts, but these attempts did not result in dead.

Unlike in other studies, domestic violence cases were investigated in this study, and 52 (5.56%) domestic violence cases with SPOI were detected. Among domestic violence cases, 28 (2.99%) involved males and 24 (2.57%) involved females.

Considering that injuries caused by sharp objects are more frequent in the young age group, we believe that increasing training and awareness programs for young people and limiting exposure to programs and TV shows that glorify violence would be useful.

Ethical approval

The study was approved by Adiyaman University ethical committee.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Arslan MM, Akçan R, Hilal A, Kar H,Çekin N. The evaluation of stab wound cases attended to council of forensic medicine in Adana. J Forensic Med 2005;19:17-22.  Back to cited text no. 1
    
2.
Tokdemir M, Kafadar H, Turkoglu A. Death of an inmate following multiple suicide attempts with razor blade: A case report. IJFP 2014;2:1-3.  Back to cited text no. 2
    
3.
Venara A, Jousset N, Airagnes G, Arnaud JP, Rouge-Mailler C. Abdominal stab wounds: Self-inflicted wounds versus assault wounds. J Forensic Legal Med2013;20:270-3.  Back to cited text no. 3
    
4.
Kaliszan M. Multiple severe stab wounds to chest with cuts to the ribs. Suicide or homicide? Case report. J Forensic Legal Med 2011:18;26-9.  Back to cited text no. 4
    
5.
Karger B, Niemeyer J, Brinkmann B. Suicides by sharp force: Typical and atypical features. Int J Leg Med 2000;113:259-62.  Back to cited text no. 5
    
6.
Schnider J, Thali MJ, Ross S, Oesterhelweg L, Spendlove D, Bolliger SA. Injuries due to sharp trauma detected by post-mortem multislice computed tomography (MSCT): A feasibility study. Leg Med 2009;11:4-9.  Back to cited text no. 6
    
7.
Abdullah F, Nuernberg A, Rabinovici R. Self-inflicted abdominal stab wounds. Injury 2003;34:35-9.  Back to cited text no. 7
    
8.
Singh VD, Lathrop SL. Youth suicide in New Mexico: A 26-year retrospective review. J Forensic Sci 2008;53:703-8.  Back to cited text no. 8
    
9.
Fukube S, Hayashi T, Ishida Y, Kamon H, Kawaguchi M, Kimura A, et al. Retrospective study on suicidal cases by sharp force injuries. J Forensic Legal Med 2008;15:163-7.  Back to cited text no. 9
    
10.
Viel G, Cechetto G, Montisci M. An unusual case of suicide by sharp force. Forensic SciInt 2009;184:12-5.  Back to cited text no. 10
    
11.
Mazzolo GM, Desinan L. Sharp force fatalities: Suicide, homicide or accident? A series of 21 cases. Forensic SciInt 2005;147:S33-5.  Back to cited text no. 11
    
12.
Berardoni NE, Kopelman TR, O'Neil PJ. Use of computed tomography in the initial evaluation of anterior abdominal stab wounds. Am JSurg 2011;202:690-6.  Back to cited text no. 12
    
13.
Gören S, Tıraşçı Y. Evaluation of deaths due to sharp object injuries retrospectively. IIIrd forensic science congress poster. Forensic Med Bull 1999;4:1236.  Back to cited text no. 13
    
14.
Çoltu A, Durak D. Retrospective examination of autopsy of 109 death cases because of sharp object injury. Forensic Med J1992;8:61-3.  Back to cited text no. 14
    
15.
Polat O, İnanıcı MA, Aksoy ME. Forensic Medicine Textbook. Nobel Medical Publishing; 1997.p. 46-170.  Back to cited text no. 15
    
16.
Savran B, Hilal A, Eren T, Çekin N. Retrospective evaluation of cases of Adana forensic medicine district office in 2000. Annual Forensic Medicine Meetings Book; 2001.  Back to cited text no. 16
    
17.
Altun G, Azmak D, Yılmaz A, Yılmaz G. The characteristics of the cases which admitted to emergency department of Trakya university medical faculty. Forensic Med Bull 1997;2:62-6.  Back to cited text no. 17
    
18.
Weeb E, Wyatt JP, Henry J, Busuttil A. A comparison of fatal with non-fatal knife injuries in Edinburgh. Forensic SciInt1999;99:179-87.  Back to cited text no. 18
    
19.
Bartoloni G, Trio F, Bartoloni A, Giorlandino A, Pucci A. A fatal stab wound causing selective injury to the left anterior descending coronary artery, myocardial infarction and delayed cardiac tamponade. Forensic SciInt2013;229:16-8.  Back to cited text no. 19
    
20.
Pal Singh V, Sharma BR, Harish D, Vij K. A crıtıcal analysıs of stab wound on the chest: A case report. JIAFM 2004;26:77-9.  Back to cited text no. 20
    
21.
Fedakar R. Evaluation of sharp object injuries whose autopsies have been performed in Bursa between 1997-2001. Annual Forensic Medicine Meetings Book, Antalya; 2002.  Back to cited text no. 21
    
22.
Alper B, Gülmen MK, Çekin N, Bilgin N, Salaçin S. Deaths occurred as result of penetrating sharp object injuries to the head: Case report. Forensic Med Bull 1999;4:20-3.  Back to cited text no. 22
    
23.
Sayın A, Özer M, Karaözbek Y, Erdaǧ A, Aktan K, Tüzün H. Vascular injuries: Assessment of 208 cases. Forensic Med J 1987;3:34-44.  Back to cited text no. 23
    
24.
Türkmen N, Fedakar R, Çetin V, Durak D. Role of alcohol in death cases because of sharp object injuries. Forensic Med Bull 2002;7:45-50.  Back to cited text no. 24
    
25.
Dülger HE. Retrospective examination of sharp object injuries. Forensic Med J 1994;10:69-72.  Back to cited text no. 25
    
26.
Altun G, Azmak D, Yılmaz A. Sharp object injuries in living cases. Forensic Med Bull 2000;5:52-5.  Back to cited text no. 26
    
27.
Karlsson T. Homicidal and suicidal sharp force fatalities in Stockholm, Sweden: Orientation of entrance wounds in stabs gives information in the classification. Forensic SciInt 1998;93:21-32.  Back to cited text no. 27
    
28.
Heide S, Kleiber M. Self-inflicted injuries: A forensic medical perspective. DtschArztebl 2006;103:2627-33.  Back to cited text no. 28
    
29.
Kafadar H, Kafadar S, Tokdemir M. Suicides in adolescence: A twelve-year study from Eastern Turkey. J Forensic Legal Med 2014;27:6-8.  Back to cited text no. 29
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed226    
    Printed4    
    Emailed0    
    PDF Downloaded68    
    Comments [Add]    

Recommend this journal