Sharp force injury-related deaths: A 20-year forensic autopsy study from Thailand

Abstract

Background: Sharp-force fatalities represent a recurrent medico-legal challenge, particularly in differentiating homicide from suicide based on injury patterns and contextual findings. Region-specific autopsy series remain limited, especially from Southeast Asia, and may contribute valuable data for comparative analyses and future meta-analyses. Methods: We conducted a retrospective autopsy-based study of sharp-force deaths examined over a 20-year period at two large university-affiliated medico-legal centers in Thailand. Demographic variables, manner of death, and detailed external and internal injury characteristics were extracted from finalized autopsy reports. Comparative analyses between homicidal and suicidal cases were performed descriptively where appropriate. Results: We conducted a retrospective autopsy-based study of 160 sharp-force deaths examined over 20 years at two university-affiliated medico-legal centers in Thailand. Of these, 153 (95.6%) were certified as homicides and 7 (4.4%) as suicides; 147 decedents (91.6%) were male. Homicidal deaths were more frequently associated with multiple wounds, variable anatomical distribution, and the presence of concomitant non-sharp injuries, whereas suicidal cases more often demonstrated localized, anatomically targeted wounds. Single-stab cases were identified in both manners of death and remain diagnostically challenging. The small number of suicides and female decedents limited subgroup analyses. Conclusions: This long-term, dual-center autopsy series provides structured characterization of sharp-force fatalities in a Thai cohort and highlights injury pattern differences of medico-legal relevance when differentiating homicide from suicide. The findings underscore the need for standardized injury severity metrics, structured modelling approaches integrating autopsy and contextual data, and multicenter international datasets to enable culturally informed comparative analyses and future meta-analyses.