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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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 (&gt;0.85). The number of injuries positively influenced agreement and sensitivity.</p> Conclusion <p>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.</p>

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The Forensic Tabula Rasa – Agreement on Manner of Death from Injury Patterns to the Extremities Only

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月11日

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  • Anton Mittendorf,
  • Josephine Gydell,
  • Yohan Robinson,
  • Carl Johan Wingren,
  • Ali-Reza Rezaie,
  • Brita Zilg

摘要

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.