Correlation of Circumstances with Pathological Findings in Asphyxial Deaths by Hanging: A Prospective Study of 61 Cases from Seattle, WA

Abstract

Correlation of the circumstances of death with the pathologic findings in this prospective study of deaths by hanging affords insight pertaining to certain of the pathophysiologic mechanisms involved in fatalities of this type. The presence of conjunctival and facial/periorbital petechial hemorrhages correlates with increasing levels of body support below the point of ligature suspension. Hyoid bone and/or thyroid cartilage fractures (found in 26% of cases) are most frequently identified in those persons found completely suspended and in victims in the older age ranges. No hyoid bone/thyroid cartilage fractures, internal soft tissue injury, or petechiae were present in 13 (21%) of the study cases.

Characterization of haemorrhages at the origin of the sternocleidomastoid muscles in hanging

“…It can be said in conjunction with the available data that these haemorrhages are the most common finding in the cervical region in cases of fatal hanging. Nonetheless, a number of papers on the subject of death by hanging [3,9,15] as well as on the subject of the causative mechanism of haemorrhages in the cervical muscles [1] ignored this well-established finding [12,16]. Studies concerned with cases of delayed death after hanging [11] also did not take these haemorrhages into consideration.…”

Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons

“…The men's prisons included three Young Offenders' Institutes (prisoners aged [18][19][20][21], three Category 'A' (maximum security) prisons, 12 Category B prisons (establishments for those who do not require maximum security but for whom escape must be made difficult) and one Category C prison (for prisoners who cannot be housed in open conditions but who are unlikely to try to escape). The male prisons were all located within a hundred miles of the study centre.…”

“…Hanging (including ligature use and self-strangulation) is by far the most common method of completed suicide in prison [8,16], and, because of its high chance of fatality [16][17][18][19][20], any act in which the prisoner was seen using a ligature, or there was physical evidence of having used it, was considered nearlethal. 2.…”

Fracture of the neck structures in suicidal hangings: A Retrospective study on contributing variables

“…It has been repetitively demonstrated that the incidence of fractures increases with age [7][8][9][10][11][12][13][14][15][16][17]. The role of gender is less clear: some authors found a male predominance of fractures [9,15,18] whereas other observed a female predominance [7,13] or no significant difference between genders [11,19].…”

“…complete hanging with feet off the ground or incomplete hanging with body parts partially supporting the weight of the body) [7,9,13,14,20], the type of ligature [7,9,16], the location of the knot or the highest suspension point [9,10,12,13,19] and the suspension time [13,15]. However, most of these studies evaluated these factors independently of the age of the victims.…”