Abstract
PurposeInjury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes and circumstances of asphyxia in children and adolescents.MethodsAll cases of asphyxia in children and adolescents (0–21 years of age) among the Hamburg Legal Medical Department’s autopsy cases from 1998 to 2017 were retrospectively analyzed with special focus on how often external findings were completely absent.ResultsAmong 249 cases of fatal asphyxia, 68% were accidents, 14% were suicides, and 13% were homicides. Most of the cases involved boys. Adolescents and young adults aged 15–21 years represented the main age group. Drowning was the leading mechanism of asphyxia. Younger age was associated with less frequent detection of external signs of asphyxia in the postmortem external examination. Petechial hemorrhages were the most common visible external indication of asphyxia. No external findings indicative of asphyxia were present in 14% of the cases.ConclusionAsphyxia in children and adolescents often involves accidents. However, postmortem external examination alone is insufficient to identify asphyxia and the manner of death.
Highlights
Selected classifications 10: Forensics10.010: Pathology 10.020: Medicine 10.030: Sciene10.140: Crime Scene
Our findings present the spectrum of different mechanisms of asphyxia and the circumstances of death in various age groups, and the rates of diagnosis of asphyxia during the postmortem external examination
Death caused by asphyxia was identified in 249 autopsies (1% of all autopsies; 242 medicolegal autopsies and private autopsies) in children and adolescents
Summary
The IfR performed 23,638 autopsies from 1998 to 2017. Death caused by asphyxia was identified in 249 autopsies (1% of all autopsies; 242 medicolegal autopsies and private autopsies) in children and adolescents The postmortem external examination revealed indications of drowning in 71 cases (87%), Suicide. The postmortem external examination showed indications of asphyxia in 29 cases (83%). The postmortem external examination revealed indications of asphyxia in 28 cases (93%); petechial hemorrhages were found in 20 cases (67%), and strangulation marks were found in 26. Indications of asphyxia were found during the postmortem external examination in seven cases (70%), and most were in the form of petechial hemorrhages (4 cases, 40%). Ligature strangulation occurred in six cases (2%), and postmortem external examination showed findings of asphyxia in all cases. The following additional mechanisms of asphyxia occurred (3 cases, 1%): dislocation of a tracheal cannula at home (preexisting medical condition: respiratory distress syndrome), status asthmaticus, and complication during tracheotomy at the hospital (pre-existing medical condition: Duchenne muscular dystrophy with the development of acute pneumonia).
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