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Forensic life-threat assessments using trauma scoring in single stabs to the trunk

Berg von Linde, Maria LU ; Acosta, Stefan LU orcid ; Khoshnood, Ardavan M LU orcid and Wingren, Carl Johan LU (2026) In International Journal of Legal Medicine
Abstract
Introduction
Forensic assessments of whether an injury would have been life-threatening often rely on empirical knowledge rather than evidence-based criteria. To address this gap, we applied the validated trauma scoring system New Injury Severity Score (NISS) to estimate mortality risk along the natural course of single stab injuries to the trunk.

Methods and materials
We included 408 survivors and 139 fatalities with single stab injuries to the trunk, using data from registries maintained by the Swedish National Board of Forensic Medicine. Organ and vessel damage in survivors, stratified by intervention complexity; and fatalities, stratified by time until death, were presented. The predictive performance of NISS was... (More)
Introduction
Forensic assessments of whether an injury would have been life-threatening often rely on empirical knowledge rather than evidence-based criteria. To address this gap, we applied the validated trauma scoring system New Injury Severity Score (NISS) to estimate mortality risk along the natural course of single stab injuries to the trunk.

Methods and materials
We included 408 survivors and 139 fatalities with single stab injuries to the trunk, using data from registries maintained by the Swedish National Board of Forensic Medicine. Organ and vessel damage in survivors, stratified by intervention complexity; and fatalities, stratified by time until death, were presented. The predictive performance of NISS was estimated using logistic regression and Receiver Operating Characteristic (ROC) analysis.

Results
NISS was strongly associated with intervention complexity among survivors and demonstrated excellent performance in predicting fatal outcomes without lifesaving treatment (area under the curve (AUC) = 0.94, 95% CI 0.92–0.96), with optimal discrimination at NISS ≥ 20 (Youden’s Index = 0.72).

Discussion and conclusion
To increase the evidence base in forensic life-threat assessment, we suggest applying NISS as a complement to the expert opinion, as it offers potential for establishing a transparent and systematic tool that increases the rule of law. However, the tool needs to be validated in other settings and for multiple injuries. (Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
forensic autopsy, Forensic Medicine, Knife, Assault, homicide
in
International Journal of Legal Medicine
publisher
Springer
external identifiers
  • scopus:105035297583
  • pmid:41957322
ISSN
0937-9827
DOI
10.1007/s00414-026-03781-6
project
An evidence-based approach to forensic assessments of single stab injuries to the trunk
language
English
LU publication?
yes
id
80e269ec-4de7-4f81-8c07-7eefbf848cca
date added to LUP
2026-04-17 02:33:12
date last changed
2026-05-15 07:37:42
@article{80e269ec-4de7-4f81-8c07-7eefbf848cca,
  abstract     = {{Introduction<br/>Forensic assessments of whether an injury would have been life-threatening often rely on empirical knowledge rather than evidence-based criteria. To address this gap, we applied the validated trauma scoring system New Injury Severity Score (NISS) to estimate mortality risk along the natural course of single stab injuries to the trunk.<br/><br/>Methods and materials<br/>We included 408 survivors and 139 fatalities with single stab injuries to the trunk, using data from registries maintained by the Swedish National Board of Forensic Medicine. Organ and vessel damage in survivors, stratified by intervention complexity; and fatalities, stratified by time until death, were presented. The predictive performance of NISS was estimated using logistic regression and Receiver Operating Characteristic (ROC) analysis.<br/><br/>Results<br/>NISS was strongly associated with intervention complexity among survivors and demonstrated excellent performance in predicting fatal outcomes without lifesaving treatment (area under the curve (AUC) = 0.94, 95% CI 0.92–0.96), with optimal discrimination at NISS ≥ 20 (Youden’s Index = 0.72).<br/><br/>Discussion and conclusion<br/>To increase the evidence base in forensic life-threat assessment, we suggest applying NISS as a complement to the expert opinion, as it offers potential for establishing a transparent and systematic tool that increases the rule of law. However, the tool needs to be validated in other settings and for multiple injuries.}},
  author       = {{Berg von Linde, Maria and Acosta, Stefan and Khoshnood, Ardavan M and Wingren, Carl Johan}},
  issn         = {{0937-9827}},
  keywords     = {{forensic autopsy; Forensic Medicine; Knife; Assault; homicide}},
  language     = {{eng}},
  month        = {{04}},
  publisher    = {{Springer}},
  series       = {{International Journal of Legal Medicine}},
  title        = {{Forensic life-threat assessments using trauma scoring in single stabs to the trunk}},
  url          = {{http://dx.doi.org/10.1007/s00414-026-03781-6}},
  doi          = {{10.1007/s00414-026-03781-6}},
  year         = {{2026}},
}