A critical review of autopsy findings in cases of suicidal hanging and the effect of a layered neck dissection.

Abstract

Suicidal hanging is a common case type referred to death investigation services throughout the world. It is associated with a large number of autopsy findings, but the presentation can vary significantly between cases, based on a multitude of factors related to the decedent, ligature and degree of suspension. There is also considerable variation in the reported incidence of autopsy findings within the published literature, some of which may be explained by different anthropometric characteristics of the included cases. However, study design and the thoroughness of the autopsy examination undertaken also undoubtedly influence results. This study therefore aimed to retrospectively review a series of autopsy reports from cases of suicidal hanging to assess not only the incidence of common findings identified during Coronial autopsies recently undertaken within a single region of the United Kingdom (UK), but also how the quality or thoroughness of the examination influenced their rate of detection. The results demonstrated considerable variation in the detection rates of common autopsy findings between individual consultant forensic pathologists and that the detection of neck muscle bruising (p = < 0.001), hyoid bone fractures (p = < 0.001) and thyroid cartilage fractures (p = 0.009) was greater when a layered neck dissection was undertaken. As a secondary objective, the range, incidence and impact of any natural disease and trauma additional to the ligature mark identified during the autopsy were assessed. Despite the array of natural disease and trauma recorded, none was considered critical to providing the underlying primary medical cause of death to the Coroner.