|Year : 2019 | Volume
| Issue : 6 | Page : 777-781
Assessment of cases with sharp and penetrating object injuries
H Kafadar1, S Kafadar2
1 Department of Forensic Medicine, Adiyaman Univesity, Adiyaman, Turkey
2 Department of Radiology, Adiyaman Univesity, Adiyaman, Turkey
|Date of Acceptance||01-Mar-2019|
|Date of Web Publication||12-Jun-2019|
Dr. H Kafadar
Department of Forensic Medicine, Adiyaman Univesity, Adiyaman - 02100
Source of Support: None, Conflict of Interest: None
| 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
| Introduction|| |
Injuries and deaths that are caused by sharp and penetrating objects have an important place in forensic medicine practice.,, The examination of wounds is very important for distinguishing suicide attempts from homicide attempts. 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.,,,,,,, According to previous studies, tentative cuts (frequently on the wrists) and unclothed body site were evaluated as suicide marks. Use of cross-sectional imaging such as computed tomography (CT) is crucial in the initial evaluation of these patients for diagnosis.
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., 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.,, 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. Altun et al. reported in their study that sharp and penetrating object injuries (SPOIs) are the fourth most frequent, at 4.7%. There has been an increase in stab injuries lately, and most of the cases involve young males.,,, Possible life-threatening injuries are commonly incurred, with bleeding from the lesions of intrathoracic and/or intraabdominal organs and vessel injury. 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.
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|| |
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|| |
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).
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.
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).
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].
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|| |
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.,, 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.,,,,,,, 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. 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. In their study, Aktun et al. reported that most of the cases were in the 21–30 years age group. 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. Although peak ages were in different age ranges in these studies, the average age was between 15 and 35 years of age.,, 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.
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. 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.,,,,,, In a study conducted by Arslan et al., 22 (10.6%) cases were exposed to life-threatening injuries. Dülger and Altun et al. 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. 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. 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.
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. 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. 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.
The study was approved by Adiyaman University ethical committee.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]