Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    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.

    Google Scholar 

  2. 2.

    Tuttle J, McCall PL, Land KC. Latent trajectories of cross-national homicide trends: structural characteristics of underlying groups. Homicide Stud. 2018;22:343–69.

    Article  Google Scholar 

  3. 3.

    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. 4.

    Thomsen AH, Leth PM, Hougen HP, Villesen P, Brink O. Homicide in Denmark 1992–2016. Forensic Sci Int Synergy. 2019;1:275–82.

    Article  Google Scholar 

  5. 5.

    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.

    Article  Google Scholar 

  6. 6.

    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.

    Article  Google Scholar 

  7. 7.

    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.

    Article  Google Scholar 

  8. 8.

    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.

    Article  Google Scholar 

  9. 9.

    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.

    Article  Google Scholar 

  10. 10.

    Brink O, Borris LC, Hougaard K. Effective treatment at a Danish trauma Centre. Dan Med J. 2012;59:A4393.

    PubMed  Google Scholar 

  11. 11.

    Mikkelsen R, Moller Hansen O, Brink O. Non-survivors after admission to trauma Centre. Dan Med J. 2014;61:A4928.

    PubMed  Google Scholar 

  12. 12.

    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.

    Article  CAS  Google Scholar 

  13. 13.

    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.

    Article  Google Scholar 

  14. 14.

    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.

    Article  Google Scholar 

  15. 15.

    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.

    Article  CAS  Google Scholar 

  16. 16.

    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.

    Article  Google Scholar 

  17. 17.

    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.

    Article  Google Scholar 

  18. 18.

    Harris AR, Thomas SH, Fisher GA, Hirsch DJ. Murder and medicine: the lethality of criminal assault 1960-1999. Homicide Stud. 2002;6:128–66.

    Article  Google Scholar 

  19. 19.

    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. 20.

    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.

    Article  Google Scholar 

  21. 21.

    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.

    Article  CAS  Google Scholar 

  22. 22.

    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.

    Article  CAS  Google Scholar 

  23. 23.

    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.

    Article  Google Scholar 

  24. 24.

    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.

    Article  Google Scholar 

  25. 25.

    Tamsen F, Sturup J, Thiblin I. Homicide injury severity in association with the victim-offender relationship. Forensic Sci Int. 2019;300:151–6.

    Article  Google Scholar 

  26. 26.

    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.

    Article  CAS  Google Scholar 

  27. 27.

    Adams VI, Carrubba C. The abbreviated injury scale: application to autopsy data. Am J Forensic Med Pathol. 1998;19:246–51.

    Article  Google Scholar 

  28. 28.

    Tamsen F, Sturup J, Thiblin I. Quantifying homicide injuries: a Swedish time trend study using the homicide injury scale. Scand J Forensic Sci. 2018. https://doi.org/10.1515/sjfs-2017-0005.

  29. 29.

    Thomsen AH, Hougen HP, Villesen P, Brink O, Leth PM. Sharp force homicide in Denmark 1992-2016. J Forensic Sci. 2019. https://doi.org/10.1111/1556-4029.14244.

  30. 30.

    Ericsson A, Thiblin I. Injuries inflicted on homicide victims. A longitudinal victiminologic study of lethal violence. Forensic Sci Int. 2002;130:133–9.

    Article  Google Scholar 

  31. 31.

    Pedersen AJB, Kyvsgaard B, Balvig F. Vulnerability to violence and other crime. Justitsministeriet. 2018; Report No. ISBN 978-87-93469-25-9.

  32. 32.

    Råd DK. Violence in Denmark 2017. 2018; Report No. ISBN 978-87-92966-55-1.

  33. 33.

    Leth PM. Lethal stabbings in southern Denmark during the last 25 years. NTfK. 2008:279–86.

  34. 34.

    Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev. 2013:CD007438. https://doi.org/10.1002/14651858.CD007438.pub3.

  35. 35.

    Funder KS, Petersen JA, Steinmetz J. On-scene time and outcome after penetrating trauma: an observational study. Emerg Med J. 2011;28:797–801.

    Article  Google Scholar 

  36. 36.

    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.

    Article  Google Scholar 

Download references

Acknowledgements

This study was kindly been supported by Brødrene Hartmanns Fond (A26707).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Asser H. Thomsen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This study contains no identifiable information.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(PDF 258 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Thomsen, A.H., Villesen, P., Brink, O. et al. Improved medical treatment could explain a decrease in homicides with a single stab wound. Forensic Sci Med Pathol 16, 415–422 (2020). https://doi.org/10.1007/s12024-020-00246-z

Download citation

Keywords

  • Homicide
  • Sharp force trauma
  • Interpersonal violence
  • Forensic pathology
  • Trauma severity