Kesici alet yaralanmalarına bağlı ölümlerde orijin tespiti parametrelerinin değerlendirilmesi

Yıl 2017, Cilt: 31 Sayı: 1, 6 - 16, 01.04.2017

Hatice Gülbeyaz İpek Esen Melez Deniz Oğuzhan Melez İbrahim Üzün

https://izlik.org/JA94TB58FU

Öz

AMAÇ: Özellikle çoklu veya atipik yerleşimli kesici alet yaralanmalarının orijin tespitinde adli süreçler açısından zorluklar yaşanmaktadır. Bu nedenle, kesici alet yaralanmalarının orijin tespitinde dikkate alınan parametreleri ayrıntılı şekilde incelemek amaçlanmıştır. YÖNTEM: Çalışmanın örneklem grubuna, 01.01.2008 - 31.12.2012 tarihleri arasında mevcut yaralanmanın kişinin kendisi tarafından meydana getirilip getirilmediği sorusu ile merkezimize gönderilen kesici alet yaralanmasına bağlı ölüm olguları dahil edildi. Olgular, demografik-olay yeri-tıbbi kayıtlar, kesici alet özelliği, yara lokalizasyonu, yara tarifi, tereddüt-savunma-kemik kesilerinin varlığı-yerleri ve toksikolojik inceleme parametreleri çerçevesinde incelenerek tanımlayıcı istatistik karşılaştırmalar üzerinden tartışıldı. BULGULAR: Tanımlanan özellikleri taşıyan 35 olgu tespit edildi. Olguların 25’inde ölüme neden olan kesici alet yaralanmasının kişinin kendisi tarafından oluşturabileceği, ikisinde oluşturamayacağı, sekizinde ise ayırım yapılamadığı belirlendi. Yaralanmanın kişinin kendisi tarafından oluşturulabileceği yönünde karar verilen olgularda grup 1 erkek/kadın oranının 2: 1 ve yaş ortalamasının 44,04±18,39 olduğu, psikiyatrik patoloji %48 ve olay yerinde intihar notu varlığı %36 oranlarının daha yüksek olması önemli bulundu. Yaralanmasının kişinin kendisi tarafından oluşturulamayacağı yönünde karar verilen olgularda grup 2 ise olayın evde meydana gelme %100 , kullanılan aletin bıçak olma %100 , savunma kesisi bulunma %50 oranları ve tüm kesi türlerinin kemik doku dahil daha yüksek oranları dikkat çekici bulundu. SONUÇ: Ölenin erkek ve ileri yaşlarda olduğu, psikiyatrik patoloji, intihar notu, tereddüt kesilerinin varlığını ve savunma kesilerinin bulunmayışını içeren kesici alet yaralanmasına bağlı ölüm olaylarında, orijin yüksek ihtimalle intihar yönünde değerlendirilebilmektedir.

Anahtar Kelimeler

Kesici alet yaralanması , intihar notu , tereddüt kesisi , savunma kesisi , orijin

Evaluation of manner of death determination parameters in deaths related to sharp force injury

https://izlik.org/JA94TB58FU

Öz

OBJECTIVE: Detailed evaluation on the parameters considered in the manner of death determination of sharp force injuries is aimed in this study.METHODS: Death cases due to sharp force injuries that had been referred to our center between January 1, 2008 – December 31, 2012, with the questions whether the injury had been generated by the individual itself or not, were included in the sample group of the study. Cases were evaluated through the parameters of demographic-incident scene-medical records, features of the sharp object, localization-description of the wound, presence-localization of tentative-defense-bone cuts, toxicological analysis; and discussed through descriptive statistical comparisons.RESULTS: Thirty-five cases were included to the study. Of these cases, injury was determined as to be able to self inflicted in 25 cases while it was not in two, in 8 cases could not be determines either it was self inflicted or not. Male to female ratio of 2: 1, mean age of 44.04±18.39, and higher ratios of the presence of psychiatric pathology 48% and presence of a suicide note 36% were found to be important in cases reported in the direction of the fact that injury had been able to be generated by the individual itself grup 1 . Higher ratios of occurrence of the incident at home 100% , knife being the sharp object used %100 , presence of defense cuts 50% and all types of cuts including bone tissue were remarkable in cases reported in the direction of the fact that injury had not been able to be generated by the individual itself.CONCLUSION: Manner of death can be able to be estimated most likely in the direction of suicide when the incidents of sharp force injury related death involve an old aged male victim, presence of psychiatric pathology, suicide note, tentative cuts and absence of defense cuts.

Anahtar Kelimeler

Sharp force injury , suicide note , tentative cut , defense cut , manner of death

Kaynakça

• Lyn-Sue J, Siram S, Williams D, Mezghebe H. Epidemiology of trauma deaths in an urban level-1 trauma center predomi- nantly among African Americans--implications for preven- tion. J Natl Med Assoc 2006;98 12 :1940.
• Karch DL, Dahlberg LL, Patel N, Davis TW, Logan JE, Hill HA, Ortega L. Surveillance for violent deaths—national vio- lent death reporting system, 16 States, 2006. MMWR Surveill Summ 2009;58 1 :1-44.
• Soysal Z, Eke SM, Çağdır AS. Forensic Autopsy Vol III. in: Soysal Z, Eke SM, Çağdır AS, editors. Suicidal Death [in Turk- ish]. 1. ed. İstanbul: İstanbul Üniversitesi Basımevi ve Film Merkezi, 1999. p 1147-9.
• Saukko P, Knight B. Forensic Pathology: Self-inflicted Inju- ry. 3 ed. Saukko P, Knight B, editors. London: Edward Arnold, p 235-44.
• Çetin G. Yaralar. In: Çetin G, editor. Forensic Textbook [in Turkish]. Istanbul: Istanbul Üniversitesi İstanbul Basım ve Yayınevi Müdürlüğü, 2011. p 255-81.
• Fukube S, Hayashi T, Ishida Y, Kamon H, Kawaguchi M, Kimura A, Kondo T. Retrospective study on suicidal cases by sharp force injuries. J Forensic Leg Med 2008;15 3 :163-7.
• Brunel C, Fermanian C, Durigon M, de la Grandmaison GL. Homicidal and suicidal sharp force fatalities: Autopsy pa- rameters in relation to the manner of death. Forensic Sci Int ;198 1 :150-4.
• Fukumoto K. A case of suicidal stabbing with cuts on the right palm. Acta Crim Med Leg Japon 1970;36:144-54.
• Assunção LA, Santos A, Magalhães T. Suicide by sharp force injuries–A study in Oporto. Leg Med 2009;11 sl :216-9.
• Viel G, Cecchetto G, Montisci M. An unusual case of suicide by sharp force. Forensic Sci Int 2009;184 1 :e12-e5.
• Gill JR, Catanese C. Sharp injury fatalities in New York City. J Forensic Sci 2002;47 3 :554-7.
• Karlsson T. Homicidal and suicidal sharp force fatalities in Stockholm, Sweden: Orientation of entrance wounds in stabs gives information in the classification. Forensic Sci Int 1998;93 1 :21-32.
• Karger B, Niemeyer J, Brinkmann B. Suicides by sharp force: typical and atypical features. Int J Legal Med 2000;113 5 :259-62.
• Shkrum MJ, Ramsay DA. Forensic Pathology of Trauma Common Problems for the Pathologist. Shkrum MJ, Ramsay DA, editors. Totowa, New Jersey: Humana Press, 2007. p 357- 403.
• Prahlow JA, Ross KF, Lene WJ, Kirby DB. Accidental sharp force injury fatalities. Am J Forensic Med Pathol 2001;22 4 :358-66.
• Erkol Z, Eşiyok B, Büken B, Turla A. The evaluation of deaths due to stab wounds in Kahramanmaraş. Adli Bilimler Dergisi 2007;6 2 :42-9.
• Özdemir B, Celbiş O, Kaya A. Cut throat injuries and honor killings: Review of 15 cases in eastern Turkey. J Forensic Leg Med 2013;20 4 :198-203.
• Ohshima T, Kondo T. Eight cases of suicide by self-cutting or-stabbing: consideration from medico-legal viewpoints of differentiation between suicide and homicide. J Clin Forensic Med 1997;4 3 :127-32.
• Byard RW, Klitte Å, Gilbert JD, James RA. Clinicopathologic features of fatal self-inflicted incised and stab wounds: a 20-year study. Am J Forensic Med Pathol 2002;23 1 :15-8.
• Scolan V, Telmon N, Blanc A, Allery JP, Charlet D, Rouge D. Homicide-suicide by stabbing study over 10 years in the toulouse region. Am J Forensic Med Pathol 2004;25 1 :33-6.
• Racette S, Kremer C, Desjarlais A, Sauvageau A. Suicidal and homicidal sharp force injury: a 5-year retrospective comparative study of hesitation marks and defense wounds. Forensic Sci Med Pathol 2008;4 4 :221-7.
• Kemal CJ, Patterson T, Molina DK. Deaths due to sharp force injuries in Bexar County, Texas, with respect to manner of death. Am J Forensic Med Pathol 2013:253-9.
• Ambade VN, Godbole HV. Comparison of wound patterns in homicide by sharp and blunt force. Forensic Sci Int 2006;156 2 :166-70.
• Värnik P. Suicide in the world. Int J Environ Res Public Health 2012;9 3 :760-71.
• Arslan M, Akçan R, Hilal A, Batuk H, Çekin N. Suicide among children and adolescents: data from Cukurova, Turkey. Child Psychiatry Hum Dev 2007;38 4 :271-7.
• Karbeyaz K, Akkaya H, Balcı Y, Urazel B. Analysis of suicide notes: An experience in Eskişehir city. Arch Neuropsychiatry 2014;51:275-9.
• Demirci S, Dogan KH, Erkol Z, Gunaydin G. Unusual suicide note written on the body: two case reports. Am J Forensic Med Pathol 2009;30 3 :276-9.
• Rothschild M, Raatschen H-J, Schneider V. Suicide by self-immolation in Berlin from 1990 to 2000. Forensic Sci Int 2001;124 2 :163-6.
• Salib E, Cawley S, Healy R. The significance of suicide notes in the elderly. Aging Ment Health 2002;6:186-90.
• Ho T, Yip PS, Chiu C, Halliday P. Suicide notes: what do they tell us? Acta Psychiatr Scand 1998;98 6 :467-73.
• Bhatia MS, Verma SK, Murty O. Suicide notes: psychological and clinical profile. Int J Psychiatry Med 2006;36 2 :163-70.
• TURKSTAT. Women in Statistics, 2015. Available at: http:// www.turkstat.gov.tr/PreHaberBultenleri.do?id=21519. cited: 28 June 2016 .
• De‐Giorgio F, Lodise M, Quaranta G, Spagnolo AG, d’Aloja E, Pascali VL, Grassi VM. Suicidal or homicidal sharp force injuries? A review and critical analysis of the heterogeneity in the forensic literature. J Forensic Sci 2015;60 sl :97-107.
• Karlsson T, Ormstad K, Rajs J. Patterns in sharp force fatalities--a comprehensive forensic medical study: Part 2. Suicidal sharp force injury in the Stockholm area 1972-1984. J Forensic Sci 1988;33 2 :448.
• Rogde S, Hougen HP, Poulsen K. Homicide by sharp force in two Scandinavian capitals. Forensic Sci Int 2000;109 2 :135- 45.
• Viel G, Cecchetto G, Montisci M. An unusual case of suicide by sharp force. Forensic Sci Int 2009;184 1 :e12-e5.
• Karger B, Vennemann B. Suicide by more than 90 stab wounds including perforation of the skull. Int J Legal Med ;115 3 :167-9.
• Lee-Gorman M, Mac Neill S, Rizet D, McDermott SD. Homicide/suspicious death statistics for cases submitted to the forensic science laboratory in the Republic of Ireland for 2008. Med Sci Law 2011;51 3 :146-50.
• Henderson JP, Morgan SE, Patel F, Tiplady ME. Patterns of non-firearm homicide. J Clin Forensic Med 2005;12 3 :128-38.
• De-Giorgio F, Lodise M, Quaranta G, Spagnolo AG, d’Aloja E, Pascali VL, Grassi VM. Suicidal or homicidal sharp force injuries? A review and critical analysis of the heterogeneity in the forensic literature. J Forensic Sci 2015;60 S1 :97-107.
• Abdullah F, Nuernberg A, Rabinovici R. Self-inflicted ab- dominal stab wounds. Injury 2003;34 1 :35-9.
• Srisont S, Peonim AV, Chirachariyavej T. An autopsy case report of suicide by multiple self-cutting and self-stabbing over the chest and neck. J Med Assoc Thai 2009;92 6 :861-4.
• Bleetman A, Watson CH, Horsfall I, Champion SM. Wound- ing patterns and human performance in knife attacks: opti- mising the protection provided by knife-resistant body ar- mour. J Clin Forensic Med 2003;10 4 :243-8.
• Ekizoğlu O, Arıcan N. Injuries. In: Koç S, Can M, editors. Forensic Medicine in Primary Care [in Turkish]. 2 ed. İstanbul: İstanbul Tabip Odası, 2011. p 57-73.
• Demirel B, Akar T, Özsoy S, Dinç H, Ağrıtmış H, Çitici I. Evaluation of defense injuries caused by stabbing tools. J For Med 2006;20 1 :29-34.
• Erkol ZZ, Büken B, Yılmaz R, Erkol H. Suicide by sharp and stab instruments two case reports. The Bulletin of Legal Medicine 2007;12 1 :36-40.
• Betz P, Tutsch-Bauer E, Eisenmenger W. “Tentative” inju- ries in a homicide. Am J Forensic Med Pathol 1995;16 3 :246-8.
• Herbst J, Haffner HT. Tentative injuries to exposed skin in a homicide case. Forensic Sci Int 1999;102 2-3 :193-6.
• Türkmen N, Fedakar R, Çetin V, Durak D. The role of alco- hol in deaths due to stab wound injuries. The Bulletin of Legal Medicine 2002;7 2 :45-50.