Retrospective analysis of 319 hanging and strangulation cases between 2001 and 2014 in Shanghai.
Level 4 - case-series / case-control
Retrospective case series of forensic autopsy records
PubMed 27219113 · doi:10.1016/j.jflm.2016.05.001
What was done
Retrospective analysis of 319 asphyxial death cases (141 hanging and 178 ligature strangulation) documented by the Shanghai Municipal Public Security Bureau between January 2001 and December 2014. The study evaluated demographic characteristics, manner of death, ligature mark morphology, vital reactions, and internal injury patterns to identify features that differentiate hanging from ligature strangulation.
What was found
Hanging cases were predominantly suicides with some accidents and showed a male-to-female ratio of 5:2. Ligature strangulation cases were predominantly homicides (with rare suicides or sexual asphyxia) and showed a female-to-male ratio of 13:5. Hanging ligature marks were almost exclusively U-shaped and positioned above the hyoid bone, whereas strangulation marks were nearly always a closed circle with variable positioning. Vital reactions included subcutaneous hemorrhage, exfoliation, and blisters. Hemorrhagic spots on the scalp, temporalis, chest, and back were common in strangulation but rare in hanging. Muscle hemorrhage most commonly involved the sternocleidomastoid in hanging, but the sternohyoid and sternothyroid muscles in strangulation. Neck skeletal fractures were present in ~17% of victims overall.
Why it matters
These findings delineate morphological and anatomical markers—specifically ligature mark geometry and specific neck muscle hemorrhage sites—to assist forensic pathologists in differentiating suicidal or accidental hanging from homicidal ligature strangulation.
Limits
The study is a retrospective review from a single geographic jurisdiction (Shanghai) and relies on public security bureau records. The abstract lacks specific contingency table counts, exact percentages for muscle hemorrhage subtypes, and formal inferential test statistics.
Cited by
- supports According to some forensic pathologists, the way and force with which a hyoid bone is broken is more consistent with homicide than suicide.