Journal of Forensic and Legal Medicine 37 (2016) 71e77

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Journal of Forensic and Legal Medicine

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m

Original communication

The hazard of sharp force injuries: Factors influencing outcome

Stine Kristoffersen a, b, *, Stig-Andre

Normann c, Inge Morild a, b, Peer Kåre Lilleng a, b, f,
d, e, f
Jon-Kenneth Heltne
a
Department of Pathology, The Gade Institute, Haukeland University Hospital, 5021 Bergen, Norway
b
Department of Clinical Medicine, Gade Laboratory of Pathology, University of Bergen and Haukeland University Hospital, 5021 Bergen, Norway
c
Cand.Med.-Degree Programme, Faculty of Medicine and Dentistry, University of Bergen, Norway
d
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, 5021 Bergen, Norway
e
Department of Clinical Medicine, University of Bergen, Bergen, Norway

a r t i c l e i n f o a b s t r a c t

Article history: The risk of dying from sharp force injury is difficult to ascertain. To the best of our knowledge, no study
Received 25 May 2015 has been performed in Norway regarding mortality due to sharp force injury or factors that impact
Received in revised form survival. Thus, the objective of the present study was to investigate and assess mortality in subjects with
4 September 2015
sharp force injury. This retrospective study comprises data on 136 subjects (34 female, 102 male) with
Accepted 24 October 2015
Available online 5 November 2015
suspected severe sharp force injury (self-inflicted or inflicted by others) admitted to Haukeland University
Hospital between 2001 and 2010. The majority of subjects were intoxicated, and the injury was most
often inflicted by a knife. The incidence of sharp force injury in Western Norway is similar to the incidence
Keywords:
Sharp force injury
in other European countries. Almost half of the subjects with self-inflicted injury died. In cases with injury
Knife inflicted by another individual, one in five died. Mortality rates were higher in those with penetrating
Attack chest injuries than those with penetrating abdominal injuries and higher in cases with cardiac injury
Self-infliction compared to pleural or lung injury. Sharp force injury can be fatal, but the overall mortality rate in this
Mortality rate study was 29%. Factors influencing mortality rate were the number of injuries, the topographic regions of
Injury Severity Score the body injured, the anatomical organs/structures inflicted, and emergency measures performed.
© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

1. Introduction The incidence of sharp force injury in Western Norway is diffi-

In court, forensic pathologists are often asked, “How
dangerous is a knife injury?” The underlying question is, “What
is the risk of dying from sharp force injury?” Therefore, the
primary purpose of the present study was to assess mortality in
victims of sharp force injuries. We investigated this issue in
surviving and deceased victims of sharp force injury admitted
to Haukeland University Hospital. We studied subjects with
sharp force injury inflicted by others or by the subjects them-
selves according to The World Health Organisation's definition
of violence1: “The intentional use of physical force or power,
threatened or actual, against oneself, another person, or against
a group or community, that either results in or has a high like-
lihood of resulting in injury, death, psychological harm, malde-
velopment or deprivation.”
* Corresponding author. Department of Pathology, Haukeland University Hospi-
tal, 5021 Bergen, Norway. Tel.: þ47 55972567; fax: þ47 55973158.
E-mail address: stine.kristoffersen@helse-bergen.no (S. Kristoffersen).
f
Joint last authorship.
cult to ascertain, as such patients are treated in different health
facilities (e.g., general practitioners, local accident and emergency
departments, and hospitals) and there is no coordinated recording
of all sharp force injuries. In addition, an unknown proportion of
subjects with sharp force injury never seek any treatment. Also,
criminal statistics do not provide the full picture, as many victims
do not press legal charges, supposedly because of low confidence in
the police and justice system.2 Between 2001 and 2007, all types of
violence were between 2.5 and 3.3% of all crimes reported to the
police in Western Norway.3 At the accident and emergency
department of Bergen, 10% of assaulted patients are treated for
minor sharp force injury.2 The real incidence of self-inflicted sharp
force injury is also difficult to estimate, as it frequently occurs in
secret and the injuries are often superficial, not requiring medical
attention.4,5 The Child and Adolescent Self-harm in Europe (CASE)
study has estimated a lifetime prevalence of all acts of self-harm in
Norway to be 16% for women and 5% for men.6 According to the
homicide statistics of the National Criminal Investigation Service
(NCIS), 50% of all homicides in Norway in 2011 were caused by
sharp force injury.7 According to Statistics Norway, sharp force

http://dx.doi.org/10.1016/j.jflm.2015.10.005
1752-928X/© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
72 S. Kristoffersen et al. / Journal of Forensic and Legal Medicine 37 (2016) 71e77
injury caused between 2.1 and 3.6% of all suicides in Norway be-
tween 2001 and 2010.8
Inclusion criteria and registration procedures vary in different
studies of victims of sharp force injury, making a comparison of the
success ratios difficult. This study includes subjects with severe
injuries or injuries suspected of being severe enough to be admitted
to hospital, as well as those who died at the scene. Only one study
from Oslo has assessed survival time after sharp force injury in
Norway, but all of the cases had fatal outcomes.9 To the best of our
knowledge, no study has been performed in Norway regarding the
mortality rate of sharp force injury and factors that impact survival.
2. Material and methods
Haukeland University Hospital serves as the local hospital of
Bergen, the central hospital of Hordaland County, and the regional
hospital of Hordaland, Rogaland, and Sogn and Fjordane Counties,10
covering a population of 996,712 inhabitants in 2009.11e13 Data
included deceased and surviving subjects with sharp force injury
considered severe or potentially severe who were brought to the
hospital between 1 January 2001 and 31 December 2010.
We included subjects with self-inflicted injury and those with
injury inflicted by others. Subjects with sharp force injuries due to
accidents were excluded. The study subjects resided mainly in
Bergen, the second largest city of Norway, and its surrounding
municipalities.
Data were obtained from the database of the emergency
department, the database of the Norwegian Air Ambulance Service,
and from the archive of forensic reports in The Gade Laboratory of
Pathology. The Trauma Coordinator of Haukeland University Hos-
pital provided additional data for the years 2009 and 2010 from a
new database established in 2009 with new registration procedures.
Medical records from surviving patients comprised as little as one
short page with limited information to several pages. Post-mortem
examinations included an assessment of injuries, and in most cases
a toxicology report based on analyses of fluid or tissue samples (e.g.,
blood, urine, psoas major muscle, or vitreous humour).
In deceased subjects, the levels of ethanol and drugs were
determined, but in surviving subjects the levels of substances were
not often given in the medical records. Therefore, substances were
simply recorded as being present or absent in the blood, urine, psoas
major muscle, or vitreous fluid. In deceased subjects, postmortal
fermentation of ethanol was verified by the presence of metabolic
products of ethanol, ethyl glucuronide and ethyl sulphate.
Significance was determined by chi-square tests using SPSS
PAWS Statistics, versions 20 and 21. Diagrams were created in Excel
(version 2007 and Mac 2011).
The following parameters were recorded: age, perpe-
tratorevictim relationship, scene of event, nationality, weapon/tool
used, date of event, number of injuries, anatomical regions injured,
organ injury, toxicology results, and treatment. The subjects were
grouped according to whether the injuries were self-inflicted or
inflicted by others, and by outcome (non-fatal or fatal) and gender.
Subjects were scored according to the Injury Severity Score (ISS)
in order to compare our results to those of other studies (Appendix
1). A high ISS is associated with poor performance status/poten-
tially fatal injury. When an ISS was not in the medical records, we
calculated it based on the information available.
3. Results
3.1. Characteristics of the study population
The study population included 34 women and 102 men divided
into four groups (Table 1). Surviving victims with sharp force
injury inflicted by others were assigned to group 1 (n ¼ 72). Vic-
tims of homicide by sharp force injury were group 2 (n ¼ 17).
Surviving victims with self-inflicted sharp force injury were group
3 (n ¼ 25). Victims of suicide by sharp force injury were group 4
(n ¼ 22).
Grouping subject ages in intervals of 10 years revealed that the
age distribution was different in the groups (l2 ¼ 63.7, df ¼ 18,
p ¼ 0.001), with the lowest median age in group 1 and highest in
group 4. Subjects who survived an attack (group 1) were younger
than subjects who were killed in an attack (group 2), and subjects
who survived self-inflicted injury (group 3) were younger than
those who committed suicide (group 4). Comparing the first and
last 5 years of the study period, we found a 47% increase in sharp
force injury due to an increase in males in groups 1 and 4. However,
the increase was not significant.
Gender proportions were different in the four subject groups
(l2 ¼ 17.6, df ¼ 3, p ¼ 0.001). Among attacked individuals (groups 1
and 2), there were gender differences in perpetrator/victim re-
lationships. A considerable proportion of female victims (39%) had
sharp force injury inflicted by a past or present intimate male
partner (spouse, co-habitant, or boyfriend), and 56% of these sub-
jects died. In contrast, 9% of male victims were attacked by female
intimate partners, and all survived.
The scene was unknown in 40% of the cases in group 1, most
related to male victims, reflecting that these subjects claimed to
have been attacked by a stranger. In all other groups, a private home
was the predominant scene of events (68e82%) (l2 ¼ 44, df ¼ 21,
p < 0.002).
In our study population, 81% of the subjects were of Norwegian
nationality. The distribution of subjects of non-Norwegian nation-
ality was unevenly distributed between the groups. The proportion
of subjects of non-Norwegian nationality was highest in group 1
(28%) (l2 ¼ 8.6, df ¼ 3, p ¼ 0.034).
3.2. Weapon
In 83% of the incidents, a knife was the weapon used to inflict
the injury. In 8% of the cases, broken glass was utilised (predomi-
nantly in group 1), and in the remaining cases various tools and
sharp objects (e.g., scissors, screwdriver, and bayonet). We found no
significant differences in regards to the weapon used in relation to
subject group, gender, or mortality outcome.
3.3. Time of incident
In groups 1 and 2, a higher occurrence of events occurred on the
weekend than in the earlier days of the week. In groups 3 and 4,
events were evenly distributed throughout the week. This differ-
ence was not significant. In the total study population, most sharp
force incidents occurred in the summer.
3.4. Ethanol and drugs
Levels of ethanol and drugs were determined in deceased sub-
jects (groups 2 and 4) and in surviving subjects (groups 1 and 3) if
given in the medical records. In surviving subjects, the levels of
substances most often were not given in the medical records, just
the presence. This made it impossible to compare surviving and
deceased subjects in regard to levels of substances.
Ethanol, drugs, or both were detected in 79% of the subjects. The
highest proportion of subjects under the influence of ethanol only
or both ethanol and drugs was in group 1. The highest proportion of
subjects under the influence of drugs only was in group 3 (l2 ¼ 71.5,
df ¼ 12, p < 0.001; Fig. 1). Ethanol, drugs, or both were detected in a
higher proportion of males than females (83% and 65%,
 S. Kristoffersen et al. / Journal of Forensic and Legal Medicine 37 (2016) 71e77 73

Table 1
Gender, median age, and nationality.

Group 1: Surviving subjects, Group 2: Killed subjects Group 3: Surviving Group 4: Subjects
attacked by others subjects, self-mutilated committing suicide

Number of subjects 72 17 25 22
Males/females 60/12 6/11 18/7 18/4
Median age (years)
Total 27.5 36 38 54
Males 27 34 44 49
Females 28 37 26 72
Norwegian nationality 52 14 24 20
Non-Norwegian nationality 20 3 1 2

Fig. 1. Ethanol and/or drugs in subjects with sharp force injury (l2 ¼ 71.5, df ¼ 12, p < 0.001).

respectively; l2 ¼ 18.8, df ¼ 4, p < 0.001) and in a higher proportion
of survivors (groups 1 and 3) than deceased subjects (groups 2 and
4) (85% and 64%, respectively; l2 ¼ 26.0, df ¼ 4, p < 0.001).
3.5. Number of injuries
deceased subjects (2.5%) compared to surviving subjects (26%)
(l2 ¼ 16, df ¼ 6, p ¼ 0.01; Fig. 3).
3.7. Mortality rate related to penetrating injuries and topographic
region

The median number of sharp force injuries was 2, and the mean
was 4.4 (range 1e147, SD 13.2). Nearly half of the subjects had only
one sharp force injury. Twenty-six percent had two to three sharp
force injuries and 27% had four or more. Most survivors had only
one injury (62%) and most deceased subjects (87%) had more than
one injury (l2 ¼ 30.7, df ¼ 2, p < 0.001; Fig. 2). We found no sig-
nificant difference between the genders in regards to the number of
injuries.
3.6. Injuries in regards to topographic regions
The injuries were classified according to anatomical region
(head, neck, chest, abdomen, upper limbs, lower limbs, or mul-
tiple regions). We found no significant difference between the
genders in regards to injury distribution (l2 ¼ 1.9, df ¼ 6, p ¼ 0.92)
or between attacked subjects (groups 1 and 2) and subjects with
self-inflicted injury (groups 3 and 4) (l2 ¼ 7.1, df ¼ 6, p ¼ 0.31). No
subjects with self-inflicted injury had injuries to the head. Over
half (56%) of the deceased subjects (groups 2 and 4) had injuries
to multiple regions, whereas multiple region injuries were found
in a minority (27%) of surviving subjects (groups 1 and 3). The
most striking difference was a lower proportion of injuries to the
abdomen (both penetrating and non-penetrating injury) in
Forty-three percent of all subjects had penetrating injuries
through the thoracic or abdominal wall. Injuries to both the thorax
and abdomen were classified according to the most severe injury,
the injury that contributed most to death. Notably, even when a
weapon penetrates the abdominal wall, the most severe injury is
sometimes localised in the thoracic cavity and vice versa, particu-
larly when the sharp force injury is inflicted at an angle with the
weapon pointing either upwards or downwards.
Penetrating sharp force injury to the chest resulted in a fatal
outcome in 47% of the subjects, whereas 15% of subjects with
penetrating injury through the abdominal wall died (l2 ¼ 5.9,
df ¼ 1, p ¼ 0.015; Fig. 4). Penetrating injury through the abdominal
wall can lead to death from bleeding in cases of organ or vessel
injury, as well as peritonitis, though with a more prolonged course.
Penetrating sharp force injury through the thoracic wall often leads
to pneumothorax, and many subjects suffer from injury to the
heart, lung(s), and various vessels. Pneumothorax and/or lung
injury had lethal outcomes in 26% of cases. Isolated heart injury had
lethal outcomes in 80% of cases. Combined injuries (pneumo-
thorax/lung and heart injury) led to death in 82% of the cases
(l2 ¼ 11.5, df ¼ 2, p ¼ 0.003).
Of the three subjects with penetrating abdominal injury who
died, one had injuries to both the intestines and the aorta. The
74 S. Kristoffersen et al. / Journal of Forensic and Legal Medicine 37 (2016) 71e77

Fig. 2. Number of sharp force injuries, related to outcome (l2 ¼ 30.7, df ¼ 2, p < 0.001).

Fig. 3. Distribution of sharp force injury in surviving and deceased subjects, related to anatomical regions (both penetrating and non-penetrating injuries) (l2 ¼ 16.0, df ¼ 6,
p ¼ 0.01).

Fig. 4. Number of surviving and deceased subjects with penetrating sharp force injury (l2 ¼ 5.9, df ¼ 1, p ¼ 0.015).
 S. Kristoffersen et al. / Journal of Forensic and Legal Medicine 37 (2016) 71e77
other two subjects had injuries to multiple small mesenterial
vessels, as well as numerous injuries to multiple anatomical re-
gions, and died from the overall exsanguination. Seventeen sub-
jects with penetrating abdominal injuries of various types and
severities survived. The difference in abdominal structures
injured in deceased subjects and survivors was not significant. In
all subjects with penetrating abdominal injury, various types of
knives caused the injury, and our number of subjects is too small
to assess the outcome of penetrating abdominal injuries related to
weapon.
3.8. Treatment
The median length of hospital stay was 1 day, the mean 2.7 days.
Thirty-nine percent of all subjects in our study had injuries
considered to be of low severity (ISS 1e14), 31% had injuries of
moderate severity (ISS 15e74), and 30% had injuries of high
severity (ISS 75). All subjects with an ISS of 75 had fatal outcomes,
except one. This subject had injuries to multiple regions, trans-
portation time of more than 10 min, and injuries that required
laparotomy, but survived. Most subjects who died were declared
dead at the scene (91%). Four subjects were alive long enough to be
admitted to the hospital before they died; three had been attacked
and one had self-inflicted injuries. Two of these subjects had in-
juries to the thoracic region and two to multiple regions. Two of the
four subjects had a transportation time of more than 10 min in an
ambulance, and two had a transportation time of less than 10 min
(Table 2).
Most invasive emergency procedures were performed after the
subjects were admitted to the hospital. Fifty percent of subjects
undergoing thoracotomy survived, whereas two-thirds of the
subjects who were intubated survived. All subjects who underwent
laparotomy or received a thoracic drainage tube survived.
4. Discussion
In this material from Western Norway, 50% of male and 91% of
female homicide victims were killed in a private home. These
results correspond well with a study from Oslo/Copenhagen in
which the proportions were 49% and 78%, respectively.14 We think
this reflects that men are involved in street fights, gang crimi-
nality, or arguing with strangers in public places, often under the
influence of drugs and/or ethanol, more often than women,
whereas women are more often killed by their intimate partners
in private homes.
A knife was used in 83% and broken glass in 9% of the sharp force
incidents. Broken glass was most often recorded as having been
used in cases of attacked, surviving subjects, reflecting the use of
broken bottles in fights in public places. A Swedish study reported
that various types of knives are most often the weapons of choice in
homicides, whereas kitchen knives and razor blades are most often
used in suicides.15
Multiple injuries or injuries involving the abdomen, chest, and
upper limbs were most common in our study. Sharp force injury to
Table 2
Number of subjects related to transportation time, ISS, and outcome.
Transportation time ISS 1e14 ISS 15e74 ISS 75
<10 min 19 18 17
0 dead 0 dead 17 dead
>10 min 29 23 23
0 dead 0 dead 22 dead
Unknown 5 1 1 7
0 dead 0 dead 0 dead
75
multiple regions was associated with the highest mortality, fol-
lowed by the chest and upper limbs alone. We did not find any
gender differences in regards to the topographic regions affected. In
a study from Oslo/Copenhagen, the majority of female homicide
victims had injuries to three or four anatomical regions, compared
to one region in most males.14
Nearly half of the subjects with penetrating chest injury in our
study died. Quick physical collapse is correlated with sharp force
cardiac injury >1.5 cm in length or multiple cardiac stab injuries. A
special case of interest in our study was a female attack victim
who survived as many as 29 injuries, probably because the
weapon was a screwdriver, which is narrower than most knife
blades.
A case has been reported of nearly 2 days survival before a 1.5-
cm penetrating cardiac sharp force injury to the right ventricle was
successfully sutured.16 In another exceptional case, a schizophrenic
man who had inflicted a sharp force injury to his chest refused a
medical examination and treatment from the ambulance personnel
called by his neighbours. He then succeeded in committing suicide
by jumping from a high building 13 days later, with the forensic
post-mortem examination revealing a penetrating cardiac sharp
force injury.17 A prolonged course is sometimes conditioned by
heart muscle tissue contracting near the injured area18 or the for-
mation of blood clots.19 Potential contraction and blood clot for-
mation are associated with a ventricular rather than an atrial heart
injury due to the thickness and configuration of the walls.20,21
Although cardiac tamponade has been claimed to increase the
risk of a deadly outcome,18 some authors have claimed the opposite
because the pressure effect of pericardial blood slows exsangui-
nation to some extent.20,22 Pneumothorax or lung injury is not
necessarily lethal, but if the injury is lethal it is tolerated longer
before the subject dies compared to cardiac or major thoracic vessel
injury.23
Most subjects with penetrating injuries through the abdominal
wall survive. Therefore, it is tempting to suggest that injuries to this
region are most often not fatal if treated within a short time.
However, it is important to emphasise that injury to blood-filled
organs, such as the liver and spleen, in addition to major blood
vessels, or multiple injuries to small mesenterial vessels, may be
fatal. There is also a risk of developing peritonitis over a longer time
span. Nevertheless, the outcome of abdominal penetrating injury
relative to specific abdominal injuries is often random and
unpredictable.
Sharp force injury to the upper limbs occurred in 15% of the
attacked subjects, most often as defence injuries, and 19% of the
self-harmed subjects. In suicidal individuals, deaths caused by
multiple and deep lesions to the upper limbs suggest a strong death
wish. Typically, several injuries are found in close proximity on the
flexor side of the wrist, often including more superficial tentative
wounds and hesitation marks.24,25
High survival rate in some countries can be explained by the
fact that all subjects with sharp force injury (from mild to severe)
are admitted to the same health facility. In addition, the preva-
lence of sharp force events is high in some countries, allowing
emergency staff to gain expertise. Studies from England have re-
ported that 99.5% of subjects admitted to a hospital with sharp
force injuries survive. These studies are not comparable to our
study because the subjects who died before being admitted to a
Total hospital were not included.26,27 A study from Scotland between
1992 and 1996 that covered all penetrating and possible pene-
54
17 dead trating knife injuries in victims of attack reported a mortality rate
75 of 17%. This study excluded subjects with self-inflicted injuries
22 dead and is not entirely comparable to our study.28 In a study from
Honduras, 19% of subjects with severe stab injuries died. This
0 dead
study included sharp force injury as a result of attack, self-
76 S. Kristoffersen et al. / Journal of Forensic and Legal Medicine 37 (2016) 71e77
infliction, and accident, and excluded subjects under the age of 15
years.29 Therefore, the population in this study is somewhat
different from ours.
In Norway, patients with less severe sharp force injuries are
offered health care services at local health centres. Surviving sub-
jects in our study only includes subjects admitted to the hospital;
thus, our subject group has more severe injuries or injuries
appearing to be more severe than a population comprising all
victims of sharp force injuries.
In the study from Scotland, the majority of survivors had an ISS
<15, and 95% of fatal cases had scores >15. Of the subjects who died
after being stabbed, 60% had no signs of life when reached by
medical staff, 15% died at the scene of the crime or in transit to the
hospital, and 25% lived long enough to be admitted to the hospi-
tal.28 In contrast, 35 of the deceased subjects (90%) in our study
were declared dead at the scene. Four subjects (10%) who later died
lived long enough to be admitted to the hospital. One subject sur-
vived with an ISS of 75 and injuries that required laparotomy.
However, the number of subjects is too small to make any general
assumptions.
Quite similar to this study, a study of sharp force injury in a
California prison identified 11 prisoners with thoracic injuries,
five of which were taken to the hospital with varying vital signs.
Four of these five subjects had repairable injuries, but two died
from complications. The two survivors had minor injuries to the
right heart ventricle and tamponade and were transported
quickly.30
Few subjects in our study developed signs of respiratory or
circulatory failure while being transported to the hospital if they
had not shown any signs before transportation. Yet, fast trans-
portation is crucial, as shown in a study from France in which
survival time 2 h was strongly associated with a high ISS.31 A
review based on 46 articles concluded that load-and-go contributes
to a higher survival rate.32
Due to short transportation distances, most invasive emer-
gency procedures were done after the subjects in this study were
admitted to the hospital. An exception to this was thoracotomy, a
procedure performed to evacuate bleeding causing cardiac tam-
ponade, control intrathoracic bleeding, facilitate open cardiac
massage, or temporarily occlude the descending part of the aorta.
The highest survival rate is seen in cases of cardiac tamponade
when thoracotomy is performed at the scene.33 The indications
for laparotomy are haemodynamic instability and peritonitis.
Laparotomy is normally performed in patients with a lower ISS
than indicated for thoracotomy.34,35 In our study, none of the
patients treated with laparotomy died.
5. Limitations of the study
The number of subjects in our study was small, reflecting that
subjects with sharp force injury are most often treated by general
practitioners and in local accident and emergency departments.
Also, some subjects never seek medical treatment and are never
recorded in any medical database. The subjects included in our
study often had severe injuries or injuries appearing to be severe,
resulting in immediate transportation to the hospital or referral
from primary treatment facilities to the hospital. This implies that
our study population is skewed. In addition, comparing subjects
with sharp force injury inflicted by others and subjects with self-
inflicted injury is problematic due to different underlying injury
mechanisms and levels of intent to cause injury. Similarly, surviving
subjects with self-inflicted injury are not necessarily comparable to
subjects who committed suicide. This is reflected by less severe
injuries in group 3 in our study, indicating that the purpose is often
to inflict pain rather than to induce a fatal outcome. In the group
committing suicide, the death wish is probably stronger, as re-
flected in their more severe injuries.
6. Conclusion
The risk of dying from sharp force injury is hard to ascertain. The
overall mortality rate in this study was 29% and knives were the
weapon of choice. Factors that influenced mortality were the
number of injuries, the topographic regions of the body injured, the
anatomical organs/structures of infliction, and the emergency
measures performed. However, the outcome of sharp force injury is
often random and unpredictable.
Conflict of interest
The authors declare that they have no conflicts of interest.
Funding
None declared.
Ethical approval
This study complies with the current laws of Norway and was
given approval from the Director of Public Prosecutions (Riksad-
vokaten) and Regional Committee for Medical and Health Research
Ethics (Regionale komite
er for medisinsk og helsefaglig
forskningsetikk).
Acknowledgements
We thank the Trauma Coordinator of Haukeland University
Hospital, Kurt Børslid Andersen, for identifying additional patients
with sharp force injuries who were admitted between 2009 and
2010 from the Trauma Database.
Appendix 1. Injury Severity Score regions.
Each injury is assigned an Abbreviated Injury Scale (AIS) score
corresponding to one of the six body regions in the table.
Regions
Head, neck, and cervical spine
Face, including nose, mouth, eyes, and ears
Thorax, thoracic spine, and diaphragm
Abdomen and lumbar spine
Extremities, including pelvis
External soft tissue
Appendix 2. Abbreviated Injury Scale (AIS) score meanings.
Only the highest AIS in each body region is used. Adding the
square AIS of the three most severely injured body regions
results in the ISS (0e75). If any region is assigned an AIS of 6
(unsurvivable injury), the ISS is automatically assigned to
75.36,37
AIS score Meaning
1 Minor
2 Moderate
3 Serious
4 Severe
5 Critical
6 Maximal
 S. Kristoffersen et al. / Journal of Forensic and Legal Medicine 37 (2016) 71e77 77

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