Characteristics and outcomes of homicidal and accidental stab wounds in emergency hospitals: A medicolegal comparative study

Abstract

Differentiation between the various manner of stab cases is challenging in forensic medicine. Although the distinction between homicidal and suicidal stabbing is well defined, there is a lack of discrimination between accidental and homicidal cases. Therefore, this study aimed to assess the characteristics of and outcomes for stab patients admitted to multiple emergency hospitals to highlight the distinction between accidental and homicidal stab wounds. This prospective cohort study assessed all patients with stab wounds admitted to multiple emergency hospitals from February 2021 to October 2021. Data collected on admission were demographics, trauma circumstances, internal organ damage, and patients' outcomes. Afterward, patients were categorized into homicidal or accidental stabs. Most of the included 51 stab cases were homicidal (78.4%). Most homicidal stabs were in middle-aged male drivers; were caused by sharp weapons, such as a penknife; and occurred in fights outdoors during the summer daytime. In contrast, most accidental stabs were occupational among building carpenters. Although homicidal stab wounds were significantly associated with a regular elliptical shape, oblique orientation, and defense wounds, the existence of a regular elliptical wound shape increased the likelihood of a homicidal stab. Additionally, penetrating stab type and a higher Injury Severity Score (ISS) were the dominant predictors of complications and mortality in stab patients, respectively. For fatal vague stab cases scenarios, the presence of an elliptical wound suggests the probability of homicidal injury than accidental. The initial ISS and stab wound type should be assessed to stratify stab patients who need intensive management in emergency hospitals.