Characteristics of violent deaths in the autopsy material of the Pathology and Forensic Medicine Institute of the Military Medical Academy in Belgrade
Abstract
Background/Aim. Violent death is caused by external factors. The aim of this study was to determine certain characteristics of violent deaths in the autopsy material of the Pathology and Forensic Medicine Institute of the Military Medical Academy in Belgrade, Serbia. Methods. A retrospective study of autopsy reports from forensic autopsies performed from 2010 until 2019 at the Pathology and Forensic Medicine Institute identified certain characteristics of violent death. Results. Out of 2,763 forensic autopsies performed during that period, violent death was established in 43.68% of the deceased. The majority of those who died violently were men (73.73%). Violent death was most common in people aged 21–40 years (34.96%). The most dominant cause of violent death was mechanical injuries, followed by chemical and asphyxiation injuries, while physical injuries were the rarest. In 59.32% of violent death cases, toxicological analysis of blood and urine samples showed individual or combined presence of alcohol, drugs, and illegal substances. Conclusion. The presented results may be significant for taking measures that will prevent and reduce the number of violent deaths.
References
Marinković N. Forensic medicine. Belgrade: Medija Centar Od-brana; 2018.
Tasić M. Forensic medicine. Novi Sad: Zmaj; 2006. p. 531.
Statistical Office of the Republic of Serbia. Statistical Yearbook of the Republic of Serbia 2020 [Internet]. Belgrade: Statistical Office of the Republic of Serbia; 2020 [cited 2025 Sept 1]. Available from: https://publikacije.stat.gov.rs/G2020/pdf/G
Zhang S, Wang W, Wei M, Luo Y, Long W, Li L, et al. Foren-sic characteristics of 4866 violent injury cases in Sichuan Province China. Sci Rep 2023; 13(1): 5959.
Gonçalves REM, de Carvalho Ponce J, Leyton V. Alcohol Con-sumption and Violent Deaths in the City of Sao Paulo in 2015. Subst Use Misuse 2020; 55(11): 1875–80.
Ossei PPS, Ayibor WG, Agagli BM, Aninkora OK, Fuseini G, Oduro-Manu G, et al. Profile of unnatural mortalities in North-ern part of Ghana; a forensic-based autopsy study. J Forensic Leg Med 2019; 65: 137–42.
Junno JA, Pakanen L, Oura P. Unnatural-cause mortality pat-terns of Northern Finnish men and women diverge in adoles-cence - A 53-year follow-up. Prev Med Rep 2021; 22: 101337.
Khan M, Khurram M, Raza S. Gender based differences in pa-tients of poisoning managed at a Medical Unit. J Pak Med As-soc 2019; 69(7): 1025–8.
Edvardson HME, Clausen T. Opioid related deaths in Norway in 2000-2019. Drug Alcohol Depend 2022; 232: 109281.
Paigham AM, Ataye AW. Study of the mechanical causes of death in fatalities referred to the Department of Forensic Medicine. Int J Sci Res 2020; 9(9): 617–22.
Timsinha S, Parajuli SR. Mechanical Injury among Medicolegal Cases in the Department of Emergency in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60(256): 1000–3.
Bujaroska Perkovikj M, Anastasova L, Stankov A, Zhivikj Z, Poposka V, Petrusevska-Tozi L. The role of alcohol and patterns of alcohol - related death in Republic of North Macedonia within the period 2007-2020. Forensic Sci Med Pathol 2023; 20(3): 933–40.
Road Traffic Safety Agency. Statistical report on the state of road traffic safety in the Republic of Serbia in 2019 [Internet]. Bel-grade: Road Traffic Safety Agency; 2020 [cited 2025 Sept 1]. Available from: https://www.abs.gov.rs/static/uploads/1446
_izvestaj-o-stanju-bezbednosti-saobracaja-u-republici-srbiji-u-2019.-godini.pdf (Serbian)
Šidlo ŠJ, Kováč KV, Očko OP, Mikuláš ML, Šikuta ŠJ. Unusual mechanism of injury in a case of suicide jump from height. Soud Lek 2019; 64(1): 2–4.
Chelly S, Mtira A, Gharesellaoui S, Hassine M, Jedidi M, Mahjoub M, et al. Fatal falls from great height in Sousse (Tunisia): Study of 141 medicolegal autopsy cases. Tunis Med 2023; 101(11): 800–4.
Zdarílek M, Očko P, Šikuta J, Nižnanský Ľ, Šidlo J. Addictive substance in fatal cases of fall/jump from height. Soud Lek 2017; 62(2): 14–7. (Czech)
Grinshteyn E, Hemenway D. Violent death rates in the US com-pared to those of the other high income countries, 2015. Prev Med 2019; 123: 20–6.
Sullivan C, Presnell SE. Non-firearm - related homicides at the Medical University of South Carolina, 2013-2018. Am J Fo-rensic Pathol 2011; 43(2): 110–6.
Negin J, Bell J, Ivancic L, Alpers P, Nassar N. Gun violence in Australia, 2002-2016: a cohort study. Med J Aust 2021; 215(9): 414–20.
Belghith M, Ben Khelil M, Marchand E, Banasr A, Hamdoun M. Homicidal sharp force cases: An 11-year autopsy based study. J Forensic Leg Med 2022; 88: 102347.
Roxburgh A, Hall WD, Dobbins T, Gisev N, Burns L, Pearson S, et al. Trends in heroin and pharmaceutical opioid overdose deaths in Australia. Drug Alcohol Depend 2017; 179: 291–8.
Aktas N, Gulacti U, Lok U, Aydin I, Borta T, Celik M. Charac-teristics of the traumatic forensic cases admitted to emergency department and errors in the forensic report writing. Bull Emerg Trauma 2018; 6(1): 64–70.
Brådvik L, Berglund M, Frank A, Lindgren A, Löwenhielm P. Number of addictive substances used related to increased risk of unnatural death: A combined medico-legal and case-record study. BMC Psychiatry 2009; 9: 48.
Johnson J, Pizzicato L, Johnson C, Viner K. Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Penn-sylvania, 2010-2019. Inj Prev 2021; 27(4): 395–8.
Albano GD, Malta G, La Spina C, Rifiorito A, Provenzano V, Triolo V, et al. Toxicological findings of self-poisoning suicid-al deaths: a systematic review by countries. Toxics 2022; 10(11): 654.
Samaria S, Pandit V, Akhade S, Biswal S, Kannauje PK. Clinical and epidemiological study of poisoning cases presenting to the Emergency Department of a Tertiary Care Center in Central India. Cureus 2024; 16(1): e52368.
Khan AS, Pandey A, Pandey A. Poisoning among autopsies con-ducted in the department of Forensic Medicine and Toxicolo-gy in a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61(264): 639–42.
Azmak D. Asphyxial deaths: a retrospective study and review of the literature. Am J Forensic Med Pathol 2006; 27(2): 13–44.
Trnka J, Gesicki M, Suslo R, Siuta J, Drobnik J, Pirogowicz I. Deaths as results of violent asphyxia in autopsy reports. Adv Exp Med Biol 2013; 788: 413–6.
Lazarević KK, Dolićanin ZĆ, Stojanović MM, Bogdanović DČ, Milićević SR. Violent deaths among adolescents in Serbia: past, present and future. Centr Eur J Public Health 2021; 29(4): 279–83.
Seil K, Takemoto E, Farfel MR, Huynh M, Li J. Exploratory case study of suicide among a sample of 9/11 survivors. Int J Envi-ron Res Public Health 2021; 19(1): 57.
Kleinman R, Morris N. Suicide, homicide, and other violent deaths among people experiencing homelessness in the United States: A cross-sectional study. Pub Health Rep 2023; 138(2): 309–14.
Nikitopulu T, Moraitis K, Tsellou M, Stefanidou-Loutsidou M, Spili-opoulou C, Papadodima S. Violent deaths among elderly in Atti-ca, Greece: A 5-year survey (2011-2015). J Forensic Leg Med 2019; 65: 75–80.
Roza TH, Marchionatti LE, Gosmann NP, de Canto GC, Machado PV, Massuda R, et al. Characteristics of death by suicide in postmortem studies in Brazil: A systematic review and meta-analysis. Suicide Life Threat Behav 2023; 53(6): 1086–107.
Karnecki K, Gos T, Steiner J, Mańkowski D, Kaliszan M. Epide-miology of suicide in the Tri-City metropolitan area in Poland in 2010-2019. Eur Arch Psychiatry Clin Neurosci 2023; 273(4): 911–20.
Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, et al. Prevalence of alcohol and other drug use in patients present-ing to hospital for violence related injuries: a systematic re-view. Trauma Violence Abuse 2024; 25(1): 306–26.
Ghosh T, Bol K, Butler M, Gabella B, Kingcade A, Kaplan G, et al. Epidemiologic assessment of benzodiazepine exposure among suicide deaths in Colorado, 2015-2017. BMC Public Health 2020; 20(1): 1149.
Auckloo MBKM, Davies BB. Post-mortem toxicology in violent fatalities in Cape Town, South Africa: A preliminary investiga-tion. J Forensic Leg Med 2019; 63: 18–25.
Mansoor K, De Souza Concalves B, Lakhani HV, Tashani M, Jones SE, Sodhi K, et al. Prevalence of substance abuse among trau-ma patients in rural West Virginia. Cureus 2023; 15(3): e36468.
Mathling M, Krumbiegel F, Hartwig S, Parr MK, Tsokos M. Toxi-cological findings in suicides–frequency of antidepressant and antipsychotic substances. Forensic Sci Med Pathol 2019; 15(1): 23–30.
Almeida-González M, Luzardo OP, Boada LD, Zaragoza E, Meilán MJ, Zumbado M, et al. Ethanol levels in legally autop-sied subjects (2016-2017): Update of data and epidemiologi-cal implications in relation to violent deaths n Canary Islands (Spain). J Forensic Leg Med 2019; 68: 101868.
Collados-Ros A, Torres-Sánchez C, Pérez-Cárceles MD, Luna A, Legaz I. Suicidal Behavior and its relationship with postmor-tem forensic toxicological findings. Toxics 2022; 10(6): 319.
Cuchara B, Diaz FJ. An 8-year retrospective study on suicides in Washington. Am J Forensic Med Pathol 2020; 41(1): 18–26.
Lasota D, Pawlowski W, Krajewski P, Staniszewska A, Goniewicz K, Czerski R, et al. Alcohol intoxication and suicide by hang-ing in Poland. Alcohol Alcohol 2020; 55(3): 278–83.
Wilson T, Wisborg T, Vindenes V, Jamt RG, Furuhaugen N, Bogstrand ST. Psychoactive substances have major impact on injuries in rural arctic Norway - A prospective observation study. Acta Anaesthesiol Scand 2021; 65(6): 824–33.
Miščikienė L, Štelemėkas M, Petkevičienė J, Rehm J, Lange S, Trišauskė J. The prevalence of alcohol-related deaths in autop-sies performed in Lithuania between 2017 and 2020: a cross-sectional study. Eur J Public Health 2024; 34(5): 979–85.
Greene N, Tomedi LE, Cox ME, Mello E, Esser MB. Alcohol testing and alcohol involvement among violent deaths by state, 2014-2016. Prev Med 2021; 148: 106527.
Branas CC, Han S, Wiebe DJ. Alcohol Use and Firearm Vio-lence. Epidemiol Rev 2016; 38(1): 32–45.
