The Forensic Tabula Rasa – Agreement on Manner of Death from Injury Patterns to the Extremities Only
Year: 2026
Type: article
Abstract: PURPOSE: In Sweden, the forensic pathologist must determine the manner of death. Contextual information is often used in these assessments. This study investigates the inter-rater reliability and accuracy of forensic pathologists when determining the manner of death based solely on autopsy findings of sharp force injuries to extremities, excluding contextual data. METHODS: 23 forensic pathologists and forensic pathologists in training assessed injury data from 59 cases, visualized using body maps. Inter-rater agreement was analyzed using Fleiss' kappa. Sensitivity, specificity and the influence of experience and number of injuries were evaluated. RESULTS: Agreement among raters was moderate at best. No experience level outperformed others significantly, though senior specialists had a higher specificity. Sensitivity was higher for suicides (0.656) than homicides (0.535), while specificity was high for both (>0.85). The number of injuries positively influenced agreement and sensitivity. CONCLUSION: Forensic pathologists showed only moderate agreement, with better consistency in suicide cases. Experience level had a significant impact of specificity but limited impact on sensitivity, where the number of injuries was a more significant factor. These findings suggest that while extremity injury patterns can be used to assess the manner of death, their interpretative value is conditional and influenced by contextual information.
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,790
Funder: Rättsmedicinalverket
OpenAlex ID: W7160861469