Skip to main content
Top
Published in: Forensic Science, Medicine and Pathology 3/2020

01-09-2020 | Autopsy | Original Article

Improved medical treatment could explain a decrease in homicides with a single stab wound

Authors: Asser H. Thomsen, Palle Villesen, Ole Brink, Peter M. Leth, Hans Petter Hougen

Published in: Forensic Science, Medicine and Pathology | Issue 3/2020

Login to get access

Abstract

Since the 1990s, there has been a reduction in the homicide rate in Denmark and other Western countries. Our hypothesis is that part of the decrease in the sharp force homicide rate can be explained by better and faster medical treatment over time, and we explore this via stab wound homicides, the largest group of homicides in Denmark. To investigate our hypothesis we undertook an epidemiological study of 428 stab wound homicides in Denmark 1992–2016 based on autopsy reports with registration of stab wounds, quantification of injury severity, treatment intensity and survival time. During 1992–2016, there was a significant reduction in the annual number of victims with a single stab wound, but no reduction in victims with multiple stab wounds. Victims with single stab wounds reached the hospital more often, survived longer and had less severe injuries (New Injury Severity Score (NISS)) than victims with multiple stab wounds. Higher NISS correlated with shorter survival time for all the stab wound victims and for the subgroup that underwent medical treatment. During the 25-year study period, the proportion of victims who underwent surgery before dying increased threefold. The victims in the first half of the study period had shorter survival times than the victims in the last half. We concluded that better and faster medical treatment could partly be responsible for the observed decrease in the number of single stab wound homicides and thereby possibly also in the total number of stab wound homicides.
Appendix
Available only for authorised users
Literature
1.
go back to reference Eisner M. Modernity strikes back? A historical perspective on the latest increase in interpersonal violence (1960–1990). Int J Confl Violence. 2008;2:288–316. Eisner M. Modernity strikes back? A historical perspective on the latest increase in interpersonal violence (1960–1990). Int J Confl Violence. 2008;2:288–316.
2.
go back to reference Tuttle J, McCall PL, Land KC. Latent trajectories of cross-national homicide trends: structural characteristics of underlying groups. Homicide Stud. 2018;22:343–69.CrossRef Tuttle J, McCall PL, Land KC. Latent trajectories of cross-national homicide trends: structural characteristics of underlying groups. Homicide Stud. 2018;22:343–69.CrossRef
3.
go back to reference Ganpat SM, Granath S, Hagstedt J, Kivivuori J. Homicide in Finland, the Netherlands and Sweden: a first study on the European homicide monitor data. 2011. Ganpat SM, Granath S, Hagstedt J, Kivivuori J. Homicide in Finland, the Netherlands and Sweden: a first study on the European homicide monitor data. 2011.
4.
go back to reference Thomsen AH, Leth PM, Hougen HP, Villesen P, Brink O. Homicide in Denmark 1992–2016. Forensic Sci Int Synergy. 2019;1:275–82.CrossRef Thomsen AH, Leth PM, Hougen HP, Villesen P, Brink O. Homicide in Denmark 1992–2016. Forensic Sci Int Synergy. 2019;1:275–82.CrossRef
5.
go back to reference Savolainen J, Lehti M, Kivivuori J. Historical origins of a cross-national puzzle: homicide in Finland, 1750 to 2000. Homicide Stud. 2008;12:67–89.CrossRef Savolainen J, Lehti M, Kivivuori J. Historical origins of a cross-national puzzle: homicide in Finland, 1750 to 2000. Homicide Stud. 2008;12:67–89.CrossRef
6.
go back to reference Kuhns JB, Wilson DB, Clodfelter TA, Maguire ER, Ainsworth SA. A meta-analysis of alcohol toxicology study findings among homicide victims. Addiction. 2011;106:62–72.CrossRef Kuhns JB, Wilson DB, Clodfelter TA, Maguire ER, Ainsworth SA. A meta-analysis of alcohol toxicology study findings among homicide victims. Addiction. 2011;106:62–72.CrossRef
7.
go back to reference Kuhns JB, Wilson DB, Maguire ER, Ainsworth SA, Clodfelter TA. A meta-analysis of marijuana, cocaine and opiate toxicology study findings among homicide victims. Addiction. 2009;104:1122–31.CrossRef Kuhns JB, Wilson DB, Maguire ER, Ainsworth SA, Clodfelter TA. A meta-analysis of marijuana, cocaine and opiate toxicology study findings among homicide victims. Addiction. 2009;104:1122–31.CrossRef
8.
go back to reference Seamon MJ, Shiroff AM, Franco M, Stawicki SP, Molina EJ, Gaughan JP, et al. Emergency department thoracotomy for penetrating injuries of the heart and great vessels: an appraisal of 283 consecutive cases from two urban trauma centers. J Trauma. 2009;67:1250–7.CrossRef Seamon MJ, Shiroff AM, Franco M, Stawicki SP, Molina EJ, Gaughan JP, et al. Emergency department thoracotomy for penetrating injuries of the heart and great vessels: an appraisal of 283 consecutive cases from two urban trauma centers. J Trauma. 2009;67:1250–7.CrossRef
9.
go back to reference Berg RJ, Karamanos E, Inaba K, Okoye O, Teixeira PG, Demetriades D. The persistent diagnostic challenge of thoracoabdominal stab wounds. J Trauma Acute Care Surg. 2014;76:418–23.CrossRef Berg RJ, Karamanos E, Inaba K, Okoye O, Teixeira PG, Demetriades D. The persistent diagnostic challenge of thoracoabdominal stab wounds. J Trauma Acute Care Surg. 2014;76:418–23.CrossRef
10.
go back to reference Brink O, Borris LC, Hougaard K. Effective treatment at a Danish trauma Centre. Dan Med J. 2012;59:A4393.PubMed Brink O, Borris LC, Hougaard K. Effective treatment at a Danish trauma Centre. Dan Med J. 2012;59:A4393.PubMed
11.
go back to reference Mikkelsen R, Moller Hansen O, Brink O. Non-survivors after admission to trauma Centre. Dan Med J. 2014;61:A4928.PubMed Mikkelsen R, Moller Hansen O, Brink O. Non-survivors after admission to trauma Centre. Dan Med J. 2014;61:A4928.PubMed
12.
go back to reference MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–78.CrossRef MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–78.CrossRef
13.
go back to reference Garwe T, Cowan LD, Neas BR, Sacra JC, Albrecht RM. Directness of transport of major trauma patients to a level I trauma center: a propensity-adjusted survival analysis of the impact on short-term mortality. J Trauma. 2011;70:1118–27.CrossRef Garwe T, Cowan LD, Neas BR, Sacra JC, Albrecht RM. Directness of transport of major trauma patients to a level I trauma center: a propensity-adjusted survival analysis of the impact on short-term mortality. J Trauma. 2011;70:1118–27.CrossRef
14.
go back to reference Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma. 2010;69:595–9 discussion 9-601.CrossRef Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma. 2010;69:595–9 discussion 9-601.CrossRef
15.
go back to reference Kong VY, Sartorius B, Clarke DL. The accuracy of physical examination in identifying significant pathologies in penetrating thoracic trauma. Eur J Trauma Emerg Surg. 2015;41:647–50.CrossRef Kong VY, Sartorius B, Clarke DL. The accuracy of physical examination in identifying significant pathologies in penetrating thoracic trauma. Eur J Trauma Emerg Surg. 2015;41:647–50.CrossRef
16.
go back to reference Davis JS, Satahoo SS, Butler FK, Dermer H, Naranjo D, Julien K, et al. An analysis of prehospital deaths: who can we save? J Trauma Acute Care Surg. 2014;77:213–8.CrossRef Davis JS, Satahoo SS, Butler FK, Dermer H, Naranjo D, Julien K, et al. An analysis of prehospital deaths: who can we save? J Trauma Acute Care Surg. 2014;77:213–8.CrossRef
17.
go back to reference Weile J, Nielsen K, Primdahl SC, Frederiksen CA, Laursen CB, Sloth E, et al. Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation. Scand J Trauma Resusc Emerg Med. 2018;26:22.CrossRef Weile J, Nielsen K, Primdahl SC, Frederiksen CA, Laursen CB, Sloth E, et al. Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation. Scand J Trauma Resusc Emerg Med. 2018;26:22.CrossRef
18.
go back to reference Harris AR, Thomas SH, Fisher GA, Hirsch DJ. Murder and medicine: the lethality of criminal assault 1960-1999. Homicide Stud. 2002;6:128–66.CrossRef Harris AR, Thomas SH, Fisher GA, Hirsch DJ. Murder and medicine: the lethality of criminal assault 1960-1999. Homicide Stud. 2002;6:128–66.CrossRef
19.
go back to reference Gennarelli TA, Wodzin E, Association for the Advancement of Automotive Medicine. Abbreviated injury scale 2005: update 2008. Barrington, Ill.: Association for the Advancement of Automative Medicine; 2008. Gennarelli TA, Wodzin E, Association for the Advancement of Automotive Medicine. Abbreviated injury scale 2005: update 2008. Barrington, Ill.: Association for the Advancement of Automative Medicine; 2008.
20.
go back to reference Rowell SE, Barbosa RR, Diggs BS, Schreiber MA, Trauma Outcomes G, Holcomb JB, et al. Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score. J Trauma. 2011;71(2 Suppl 3):S384–8.CrossRef Rowell SE, Barbosa RR, Diggs BS, Schreiber MA, Trauma Outcomes G, Holcomb JB, et al. Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score. J Trauma. 2011;71(2 Suppl 3):S384–8.CrossRef
21.
go back to reference Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Inj Prev. 2001;7:10–3.CrossRef Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Inj Prev. 2001;7:10–3.CrossRef
22.
go back to reference Peng J, Wheeler K, Shi J, Groner JI, Haley KJ, Xiang H. Trauma with injury severity score of 75: are these unsurvivable injuries? PLoS One. 2015;10:e0134821.CrossRef Peng J, Wheeler K, Shi J, Groner JI, Haley KJ, Xiang H. Trauma with injury severity score of 75: are these unsurvivable injuries? PLoS One. 2015;10:e0134821.CrossRef
23.
go back to reference Cros J, Alvarez JC, Sbidian E, Charlier P, de la Grandmaison GL. Survival time estimation using injury severity score (ISS) in homicide cases. Forensic Sci Int. 2013;233:99–103.CrossRef Cros J, Alvarez JC, Sbidian E, Charlier P, de la Grandmaison GL. Survival time estimation using injury severity score (ISS) in homicide cases. Forensic Sci Int. 2013;233:99–103.CrossRef
24.
go back to reference Tamsen F, Logan FK, Thiblin I. Homicide injury quantification: correlations and reliability of injury severity scores applied to homicide victims. Homicide Stud. 2014;19:88–100.CrossRef Tamsen F, Logan FK, Thiblin I. Homicide injury quantification: correlations and reliability of injury severity scores applied to homicide victims. Homicide Stud. 2014;19:88–100.CrossRef
25.
go back to reference Tamsen F, Sturup J, Thiblin I. Homicide injury severity in association with the victim-offender relationship. Forensic Sci Int. 2019;300:151–6.CrossRef Tamsen F, Sturup J, Thiblin I. Homicide injury severity in association with the victim-offender relationship. Forensic Sci Int. 2019;300:151–6.CrossRef
26.
go back to reference Friedman Z, Kugel C, Hiss J, Marganit B, Stein M, Shapira SC. The abbreviated injury scale. A valuable tool for forensic documentation of trauma. Am J Forensic Med Pathol. 1996;17:233–8.CrossRef Friedman Z, Kugel C, Hiss J, Marganit B, Stein M, Shapira SC. The abbreviated injury scale. A valuable tool for forensic documentation of trauma. Am J Forensic Med Pathol. 1996;17:233–8.CrossRef
27.
go back to reference Adams VI, Carrubba C. The abbreviated injury scale: application to autopsy data. Am J Forensic Med Pathol. 1998;19:246–51.CrossRef Adams VI, Carrubba C. The abbreviated injury scale: application to autopsy data. Am J Forensic Med Pathol. 1998;19:246–51.CrossRef
30.
go back to reference Ericsson A, Thiblin I. Injuries inflicted on homicide victims. A longitudinal victiminologic study of lethal violence. Forensic Sci Int. 2002;130:133–9.CrossRef Ericsson A, Thiblin I. Injuries inflicted on homicide victims. A longitudinal victiminologic study of lethal violence. Forensic Sci Int. 2002;130:133–9.CrossRef
31.
go back to reference Pedersen AJB, Kyvsgaard B, Balvig F. Vulnerability to violence and other crime. Justitsministeriet. 2018; Report No. ISBN 978-87-93469-25-9. Pedersen AJB, Kyvsgaard B, Balvig F. Vulnerability to violence and other crime. Justitsministeriet. 2018; Report No. ISBN 978-87-93469-25-9.
32.
go back to reference Råd DK. Violence in Denmark 2017. 2018; Report No. ISBN 978-87-92966-55-1. Råd DK. Violence in Denmark 2017. 2018; Report No. ISBN 978-87-92966-55-1.
33.
go back to reference Leth PM. Lethal stabbings in southern Denmark during the last 25 years. NTfK. 2008:279–86. Leth PM. Lethal stabbings in southern Denmark during the last 25 years. NTfK. 2008:279–86.
35.
go back to reference Funder KS, Petersen JA, Steinmetz J. On-scene time and outcome after penetrating trauma: an observational study. Emerg Med J. 2011;28:797–801.CrossRef Funder KS, Petersen JA, Steinmetz J. On-scene time and outcome after penetrating trauma: an observational study. Emerg Med J. 2011;28:797–801.CrossRef
36.
go back to reference Seamon MJ, Fisher CA, Gaughan J, Lloyd M, Bradley KM, Santora TA, et al. Prehospital procedures before emergency department thoracotomy: “scoop and run” saves lives. J Trauma. 2007;63:113–20.CrossRef Seamon MJ, Fisher CA, Gaughan J, Lloyd M, Bradley KM, Santora TA, et al. Prehospital procedures before emergency department thoracotomy: “scoop and run” saves lives. J Trauma. 2007;63:113–20.CrossRef
Metadata
Title
Improved medical treatment could explain a decrease in homicides with a single stab wound
Authors
Asser H. Thomsen
Palle Villesen
Ole Brink
Peter M. Leth
Hans Petter Hougen
Publication date
01-09-2020
Publisher
Springer US
Keyword
Autopsy
Published in
Forensic Science, Medicine and Pathology / Issue 3/2020
Print ISSN: 1547-769X
Electronic ISSN: 1556-2891
DOI
https://doi.org/10.1007/s12024-020-00246-z

Other articles of this Issue 3/2020

Forensic Science, Medicine and Pathology 3/2020 Go to the issue