Key Factors

Table 1 identifies key factors that may be relevant in the examination of anyone with injuries and that, if relevant, should be determined when the history is taken from the injured person.

It is important to document the time at which the injury was said to have occurred. Injuries heal, and thus the appearance of an injury after assault is time dependent. Assaults may not be reported for days or weeks after the incident. There may be several injuries from different incidents. Specific times should be sought for each. If more than one type of assault has occurred, clear records must be made of which injury was accounted for by which implement. Document the handedness (left, right, or both) of both the victim and

Table 1

Potential Relevant Factors to Determine From History

• How was the injury sustained?

• Weapon or weapons used (is it [are they] still available?)

• What time was the injury sustained?

• Has the injury been treated?

• Regular physical activity (e.g., contact sports).

• Regular medication (e.g., anticoagulants, steroids).

• Handedness of victim and suspect.

Table 2

Potential Relevant Information Required When Assessing Injury

Table 2

Potential Relevant Information Required When Assessing Injury

• Location

• Type (e.g., bruise, cut, or abrasion)

(anatomical—measure distance

• Size (use metric values)

from landmarks)

• Shape

• Pain

• Color

• Tenderness

• Orientation

• Stiffness

• Age

• Causation

• Time

• Handedness

• Transientness (of injury)

the assailant, if known, because this may affect the interpretation of injury causation. Witnesses may give different accounts of the incident; it is the forensic physician's role to assist the court in determining the true account. These accounts may also be influenced by the effect of drugs and/or alcohol, and it is appropriate to assess the influence that these may have in each case. Knowledge of the type of weapon used can be important when assessing injury because particular implements can give identifiable injuries. The type of clothing worn (e.g., long-sleeved shirts or armless vests) should be noted. When examining any individual for injury, all these features should at least be considered to see whether they may have relevance to the case; others may become relevant as the examination progresses or as other accounts of any assault are given.

Documentation of injuries can be in several formats, including hand-drawn notes, annotated pro forma diagrams, and photographic. Figure 1 illustrates one form of body chart and note system (3). Table 2 lists the characteristics of each injury that may be needed for appropriate documentation.

Fig. 1. Body chart and note system.

Table 3 Classification of Injuries

Wheals and erythema

(reddening)

Hematoma

Abrasions

(grazes)

Scuff/brush abrasions

Lacerations

Slash

Stab wounds

Bruises

(contusion or ecchymosis)

Petechiae

Scratches

Point abrasion

Incisions

Chop

Firearms

Bites

Digital images have now become an appropriate way of documenting injury, and the digital image evidence should be supported by contemporaneous written and hand-drawn notes. Ensure at the time of examination that each injury is accounted for by the account given. If an injury is not consistent with the account given, question it at the time. In many cases, individuals who have been involved in fights or violent incidents are simply unaware of the causation of many sites of injury. It may be appropriate (particularly with blunt injury) to reexamine injuries 24-48 hours later to see how injuries evolve and whether bruises have appeared or other sites of injury noted. Pretreatment and posttreatment examination and photography may be useful.

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