Critical Analysis of Firearm Wound Characteristics in Victims Brought for Autopsy at LHMC, New Delhi: A 20-Year Retrospective Study



Abstract Views
199

Downloads
225

Citations

Share

##plugins.themes.bootstrap3.article.sidebar##

Submitted Jul 3, 2023
Published Aug 31, 2023
10.24018/ejmed.2023.5.4.1871

Abstract viewed = 199 times

Table of Contents

##plugins.themes.bootstrap3.article.main##

Firearmwound characteristics vary a lot depending upon type of firearmand firearm ammunition used, site of entry or exit, range and direction of firing, presence or absence of interposing wearing apparels etc. Depending upon the availability and accessibility of firearm, the pattern of firearm injuries and deaths vary from country to country, region to region and locality to locality. Lady Hardinge Medical College & Associated Hospitals, New Delhi primarily deals with medico-legal works pertaining to New Delhi District which is the most sensitive and VVIP zone of India. Hence, the crime rate is controlled in comparison to other parts of Delhi and NCR of Delhi. However, suicidal firearm fatalities by police personnel engaged insecurity, homicidal firearm fatalities and, firearm fatalities due to terrorist activities and counter-terrorism operations do happen occasionally. A 20-year retrospective study from the year 2007 to 2016 revealed that rifled firearms were commonly used. Pre-autopsy X-Ray examination was done only in few cases. Detailed description about wound characteristics, wearing apparels, recovered firearm projectiles were found missing on many autopsy reports.

Keywords: Autopsy Critical analysis Firearm deaths Wound characteristics

Downloads

Download data is not yet available.

Introduction

Task of forensic pathologist increases by many fold in case of death due to firearm injuries. While examining such a case, it is important to examine wearing apparels, to differentiate wound caused by fire arm and by any other kind of weapon, to differentiate rifled firearm from shotgun, to differentiate firearm entry wound from firearm exit wound, to differentiate exit wound caused by firearm projectile and secondary projectile, to estimate probable range of firing, to determine direction of firing and to preserve all the medico-legal evidences including recovered firearm projectiles. Thus critical analysis of the wound characteristics along with exploration of the wound track is vital for proper interpretation and conclusion in firearm death. Pre-autopsy radiological examination may be helpful to identify firearm death, to identify type of firearm used before autopsy and reduce duration and unnecessary dissection to recover firearm projectiles lodged inside the dead body during autopsy. Department of Forensic Medicine at Lady Hardinge Medical College & Associated Hospitals, New Delhi primarily deals with medico-legal works pertaining to New Delhi District which is the most sensitive and VVIP zone of India. Hence, the crime rate is very low in comparison to other parts of Delhi and NCR of Delhi. Considering fewer firearm deaths in this area, a 20-year retrospective study was conducted to analyse the qualitative data that were available in the autopsy reports archived in the Department.

Materials and Methods

After getting clearance from Institutional Ethical Committee, a 20-year retrospective study was conducted by analysing all the 95 firearm deaths autopsied in the last 20 years from 1997 to 2016 from the post-mortem records available in Department of Forensic Medicine, Lady Hardinge Medical College, New Delhi during October 2017 to March 2019. All the necessary data were captured from the post-mortem records using a pre-designed structured proforma. From the 95 firearm deaths, 5 cases were excluded due to non-availability of sufficient data.

Results and Discussion

Type of Firearm Used

Type of firearm used for causing firearm injury or death basically depends upon their availability or accessibility. In the present study, out of 90 firearm deaths, rifled firearm was used in 79 (87.77%) cases and shotgun was used in 9 (10%) cases whereas both rifled and shotgun were used in 1 case (Table I). The present study is in agreement with the studies conducted by references [1]–[5] but not with the studies conducted by references [6]–[30].

Type of firearm used Number of cases Percentage
Rifled 79 87.77
Shotgun 9 10
Rifled and shotgun 1 1.11
Undetermined 1 1.11
Total 90 100
Table I. Type of Firearm Used

X-Ray Prior to the Autopsy

Radiological examination of the deceased prior to autopsy in suspected firearm death, decomposed or charred dead body can give wide range of information like cause of death, manner of death, direction and range of the firing beside saving time for completing autopsy and avoiding unnecessary extensive dissection of the dead body for recovery of the firearm projectile. However, necessity of pre-autopsy X-ray examination in suspected firearm death may not felt by some well competent forensic pathologists. In the present study, radiological examination (X-Ray) prior to autopsy was done on only in 8 (8.88%) firearm deaths. However, details were not available in 40 firearm deaths (Table II). No research study was found to compare the present study.

X-Ray examination Number of cases Percentage
Done 8 8.88
Not done 42 46.66
Details not available 40 44.44
Total 90 100
Table II. Radiological Examination Before Conducting the Autopsy

Details of Wearing Apparels

The wearing apparels were found in-situ in 44 (48.88%) victims of firearm deaths. The wearing apparels were found well preserved in 46 (51.11%) cases. Tears during tussle with the assailant were found in 2 (2.22%) cases. Damage caused by firearm entry wound was found in 14 (15.55%) cases. Damage caused by firearm exit wound was found in 12 (13.33%) cases. Staining or soiling of clothes by blood was evident in 38 (42.22%) cases. Details about wearing apparels were not available in 44 (48.88%) cases (Table III). No research study was found to compare the present study.

No. of victims Percentage
Availability of clothes
   Clothes-in-situ 44 48.88
   Supplied separately by police 2 2.22
   Details not available 44 48.88
Nature of clothes
   Thick 20 22.22
   Thin 26 28.88
   Details not available 44 48.88
Evidence of firearm deaths in clothes
   Tears from tussle 2 2.22
   Damage due to firearm entry wound 14 15.55
   Damage due to firearm exit wound 12 13.33
   Presence of burning effect 4 4.44
   Presence of gun powder residue 4 4.44
   Presence of tattooing 0 0
   Staining or soiling by blood 38 42.22
Table III. Details of Wearing Apparels of Victims of Firearm Deaths

Single/Multiple Shots

Knowing well the importance of different vital organs, firearm user targets the site. Suicide neither intends more than one shot nor gets chance for it whereas assailant may use more than one shot to ensure death of the victim. In the present study, 58 (64.44%) of the victims had received only single shot whereas 29 (32.22%) victims had received multiple shots ranging from 2 to 30 (Table IV). The present study is in agreement with studies conducted by references [1], [12]–[14], [26], [31]–[34].

Number of shots Number of victims Percentage
Single 58 64.44
Multiple 29 32.22
Undetermined 3 3.33
Total 90 100
Table IV. Number of Shots Received by the Victims of Firearm Deaths

Site of Firearm Entrance Wounds

Site of fire arm entrance wound depends upon election of site by suicide for rapid and relatively pain less death or by assailant based upon range and accuracy to hit the target site. In the present study, most of the firearm entrance wounds were found exclusively in head and neck region i.e., in 46 (51.11%) victims followed by chest in 16 (17.77%) victims. Eight (8.88%) victims had firearm entrance wounds only in abdominal region (Table V). The present study is in agreement with the studies conducted by references [1], [3], [8], [11], [12], [14], [23], [27], [32], [33]–[42] but not with the studies conducted references [2], [5], [9], [13], [19], [21], [25], [26], [43]–[45].

Site of entry wounds Number of cases–shotgun Number of cases–rifled firearm Number of case–rifled & shotgun Number of cases–undetermined firearm Total number of cases Percentage
Head & neck region 2 44 0 0 46 51.11
Chest 4 12 0 0 16 17.77
Abdomen 1 6 0 1 8 8.88
Multiple sites including head & neck region 1 6 0 0 7 7.77
Multiple sites excluding head & neck region 0 11 1 0 12 13.33
Lower limb 1 0 0 0 1 1.11
Total 90 100
Table V. Site of Rifled/Smooth Bored Firearm Entrance Wounds

Details of Firearm Entrance Wounds and Wound Characteristics

Out of 80 deaths caused by rifled firearm, entrance wounds were found over bone in 30 (37.5%) victims. Rifled firearm entrance wounds were found over soft tissue in 42 (52.5%) victims. Shape of rifled firearm entrance wounds were found oval in 26 (32.5%) victims, circular in 12 (15%) victims and circular along with oval in 13 (16.25%) victims. Single rifled firearm entrance wounds were found in 53 (66.25%) victims, whereas multiple rifled firearm entrance wounds were found in 27 (33.75%) victims, with maximum of 30 shots (Table VI). Muzzle impression around rifled firearm entrance wounds were found in 9 (11.25%) victims. Abrasion collar around rifled firearm entrance wounds were found in 41 (51.25%) victims. Burning effect around rifled firearm entrance wounds were found in 26 (32.5%) victims. Gun powder residue in and around rifled firearm entrance wounds was found in 10 (12.5%) victims. Deposition of soot particles around rifled firearm entrance wounds was noticed in 3 (3.75%) victims. Tattooing effect around rifled firearm entrance wounds was found in 3 (3.75%) victims. Pinkish discoloration in rifled firearm entry wounds due to carboxy-hemoglobin was noticed in 3 (3.75%) victims. Bullets of rifled firearm were recovered in 30 (37.5%) cases (Table VII). No research study was found to compare the present study.

Rifled firearm Shotgun
No. of victims Percentage No. of victims Percentage
Site of entrance
   Over bone 30 37.5 3 30
   Over soft tissue 42 52.5 5 50
   Over bone and soft    tissue both 8 10 2 30
Shape of entry wounds
   Circular 12 15 2 20
   Oval 26 32.5 4 40
   Cruciate 2 2.5 0 0
   Stellate 6 7.5 0 0
   Y-Shaped 1 1.25 0 0
   Crescent 1 1.25 0 0
   Elliptical 1 1.25 0 0
   Irregular 6 7.5 2 20
   Linear 1 1.25 0 0
   Laceration 1 1.25 0 0
   Circular + Oval 13 16.25 0 0
   Circular + Cruciate 2 2.5 0 0
   Circular + Oval   + Irregular 2 2.5 1 10
   Irregular + Cruciate 1 1.25 0 0
   Details not available 5 6.25 1 10
Number of entry wounds
   1 53 66.25 6 60
   2 11 13.75 2 20
   More than 2 16 20 2 20
Table VI. Details of Rifled Firearm Entrance Wounds
Rifled firearm
No. of victims Percentage No. of victims Percentage
Muzzle impression
   Present 9 11.25 0 0
   Absent 59 73.75 10 100
   Details not available 12 15 0 0
Abrasion collar
   Present 41 51.25 0 0
   Absent/Not mentioned 21 26.25 10 100
   Details not available 18 22.5 0 0
Burning effect
   Present 26 32.5 3 30
   Absent 36 45 0 0
   Details not available 18 22.5 7 70
Presence of gun powder residue
   Present 10 12.5 2 20
   Absent 7 8.75 8 80
   Details not available 63 78.75 0 00
Deposition of soot particles
   Present 3 3.75 1 10
   Absent 24 30 9 90
   Details not available 53 66.25 0 0
Presence of tattooing
   Present 3 3.75 2 20
   Absent 24 30 8 80
   Details not available 53 66.25 0 0
Effects of CoHb
   Present 3 3.75 1 10
   Absent 24 30 9 90
   Details not available 53 66.25 0 0
Bullet/Pellets recovered
   Yes 30 37.5 9 90
   No 25 31.25 1 10
   Details not available 25 31.25 0 0
Table VII. Details of Firearm Entrance Wounds Characteristics

Out of 10 deaths caused by shotgun, firearm entrance wounds were found over bone in 3 (30%) victims, over soft tissue in 5 (50%) victims and over both bone and soft tissue in 2 (20%) victims. Shape of shotgun entrance wounds were found oval in 4 (40%) victims, circular in 2 (20%) victims and irregular in 2 (20%) victims. Single shotgun entrance wounds were found in 6 (60%) victims, double entrance wounds in 2 (20%) victims and multiple shotgun entrance wounds with dispersion of pellets were found in 2 (20%) victims (Table VI). Muzzle impression around shotgun entrance wounds was not found in any victim. Abrasion collar around shotgun entrance wounds was not mentioned in any case. Burning effect around shotgun entrance wounds were found in 3 (30%) victims. Gun powder residue in and around shotgun entrance wounds was found in 2 (20%) victims. Deposition of Soot particles around shotgun entrance wounds was noticed in 1 (10%) victims. Tattooing effect around shotgun entrance wounds was found in 2 (20%) victims. Pinkish discoloration in shotgun entry wounds due to carboxy-hemoglobin was noticed in 1 (10%) victims. Pellets of shotgun firearm were recovered in 9 (90%) cases and in one case a total 42 pellets could be recovered (Table VII). No research study was found to compare the present study.

Details of Firearm Exit Wounds

In the present study, firearm exit wounds were present in 66 (73.33%) victims of 90 firearm deaths. Exit wounds through bone were found in 37 (41.11%) victims whereas exit wounds through soft tissue were found in 25 (27.77%) victims. Blast head was found in 6 (6.66%) victims. Single exit wound was noticed in 45 (50%) victims, double exit wounds in 12 (13.33%) victims and 15 number of exit wounds were found in 1 victim. Shape of the exit wounds were found oval in 22 (24.44%) cases and irregular in 13 (14.44) cases. Exit wound caused by secondary projectile was not found in any victim of the firearm deaths (Table VIII). Reference [22] in their study on suicidal firearm injuries to chest reported that out of 67 cases, firearm exit wounds were present in 55 cases. Reference [28] in their study on firearm deaths reported that firearm exit wounds were present in 58.9% victims. Reference [18] in his study on abdominal gunshot injuries reported thtable-9t firearm exit wounds were present in 53% victims.

No. of cases Percentage
Presence of exit wound
   Present 66 73.33
   Absent 22 24.44
   Details not available 2 2.22
Site of exit wound
   Through bone 37 41.11
   Through soft tissue 25 27.77
   Through soft tissue and bone both 4 4.44
   Not applicable 22 24.44
   Details not available 2 2.22
Presence of blast head
   Present 6 6.66
   Absent 82 91.11
   Details not available 2 2.22
No. of exit wounds
   1 45 50
   2 12 13.33
   3 1 1.11
   4 2 2.22
   5 4 4.44
   12 1 1.11
   15 1 1.11
   Not applicable 22 24.44
   Details not available 2 2.22
Shape of exit wound
   Circular 8 8.88
   Oval 22 24.44
   Cruciate 5 5.55
   Stellate 3 3.33
   Irregular 13 14.44
   Tri-radiate 1 1.11
   Rhomboid 1 1.11
   Multiple 6 6.66
   Not applicable 22 24.44
   Details not available 9 10
Exit wound caused by secondary projectile
   Present 0 0
   Absent 66 73.33
   Not applicable 22 24.44
   Details not available 2 2.22
Table VIII. Details of Firearm Exit Wounds

Direction of the Firearm Wound Tracks

In case of homicide, direction of the firearm wound track depends upon the relative position of the assailant and victim and behaviour of firearm projectile inside the body based on muzzle velocity and range of firing. In case of suicide, it depends upon site of election, dominant hand of the victim, method used and relative positioning of the firearm to the body. In the present study, direction of the firearm wound tracks were found upward-backward to the left in 18 (20%) cases whereas multiple directions were found in 13 (14.44%) cases (Table IX). Reference [29] in their study on thoraco-abdominal firearm injuries reported that the most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back.

Direction of the wound track Suicide Homicide Accidental No. of cases Percentage
Backward 0 4 0 4 4.44
Backward to left 2 2 0 4 4.44
Backward to right 0 1 0 1 1.11
Forward 0 2 0 2 2.22
Right to left 1 1 0 2 2.22
Upward and backward 5 1 2 8 8.88
Upward to left 1 0 0 1 1.11
Upward-forward to left 2 0 0 2 2.22
Upward-forward to right 0 1 0 1 1.11
Upward-backward to left 14 4 0 18 20
Upward-backward to right 4 3 1 8 8.88
Downward-forward to left 2 1 0 3 3.33
Downward-forward to right 0 3 0 3 3.33
Downward-backward to left 6 1 0 7 7.77
Downward-backward to right 1 7 1 9 10
Multiple directions 1 12 0 13 14.44
Details not available 0 4 0 4 4.44
Total 39 47 4 90 100
Table IX. Direction of the Firearm Wound Track

Vital Organs Involved

Vital organs injured by firearm depend upon the site of entrance wound and the direction of the firearm wound track. In the present study, brain was found injured all total in 51 (56.66%) firearm deaths. Only brain was found injured in 46 (51.11%) firearm deaths. Thoracic organs or structures were injured in 37 (41.11%) firearm deaths. Abdominal Organs were injured in 19 (21.11%) firearm deaths (Table X). Reference [29] in their study on thoraco-abdominal injuries due to gunshot homicide reported that the most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs are struck by most bullets that entered the thorax. Reference [46] in their study on pattern of injury to internal organs in firearm homicide cases reported that lungs were the most injured internal organ (46.4%) followed by Brain (40.9%), Heart (28.8%), Intestines (15.0%), Liver (12.3%) and major blood vessels of the thoracic and abdominal cavities (8.7%). Reference [47] in his study reported that in maximum (46.59%) cases, brain and meninges were injured, followed by pleura and lungs (20.45%), pericardium and heart (18.18%). These were followed by injury to ribs (15.90%), liver (13.63%), aorta (9.9%), stomach (6.80%), small intestine (5.68%) and large intestine (4.54%).

Injury to vital organs No. of cases Percentage
Brain 46 51.11
Brain + Right lung 2 2.22
Brain + Left lung 1 1.11
Brain + Multiple thoracic organs 2 2.22
Right lung 3 3.33
Left lung 3 3.33
Both lungs 3 3.33
Lungs + Mesentery 1 1.11
Lungs + Liver 1 1.11
Right lung + Spinal cord 1 1.11
Left lung + Intestine 2 2.22
Left lung + Spleen 1 1.11
Right lung + Liver 1 1.11
Heart and left lung 3 3.33
Heart and right lung 1 1.11
Heart + Stomach 1 1.11
Multiple thoracic organs 3 2.22
Multiple abdominal organs 1 1.11
Multiple thoraco-abdominal organs 6 6.66
Thoracic aorta 1 1.11
Liver 1 1.11
Intestines 1 2.22
Intestine + Mesentery 3 3.33
Femoral blood vessels 1 1.11
Details not available 1 1.11
Total 90 100
Table X. Injury to Vital Organs in Firearm Deaths

Cause of Death

Cause of death in firearm cases depends upon the targeted vital organs and their extent of damage. In the present study, the most common cause of death in firearm deaths was cranio-cerebral damage i.e., found in 48 (53.33%) victims followed by hemorrhagic shock in 29 (32.22%) victims (Table XI). Reference [25] in their study on firearm deaths reported that cause of death was haemorrhagic shock in 77.27% victims. Reference [26] in their study on firearm injuries reported that cause of death was hemorrhagic shock in 68.9% victims. Reference [39] in his study on firearm deaths reported that cause of death was haemorrhage and shock in 68.5% victims. Reference [45] in their study on firearm deaths found that cause of death was hemorrhagic shock in 96.3% victims (Fracture of skull bone and laceration of brain tissue-50.7%, Fracture of other bones with laceration of blood vessels-25% and Laceration of viscera, blood vessels and soft tissues-20.6%). Reference [48] in their study on firearm deaths reported that cause of death was hypovolemia in 52.9% victims.

Cause of death Suicidal Homicidal Accidental No. of cases Percentage
Cranio-cerebral damage 32 14 2 48 53.33
Cerebral edema 0 1 0 1 1.11
Hemorrhagic shock 5 22 2 29 32.22
Shock 1 2 0 3 3.33
Peritonitis 0 1 0 1 1.11
Septicemia 0 7 0 7 7.77
Asphyxia 1 0 0 1 1.11
Total 90 100
Table XI. Cause of Death in Firearm Deaths

Manner of Death

In the present study, the most common manner of firearm deaths was homicide i.e., found in 47 (52.22%) cases followed by suicide in 39 (43.33%) case. The highest number of suicide (32) was found among Police/Army personnel (Table XII). The present study was in agreement with studies conducted by references [5], [9], [10], [12]–[14], [16], [21], [25], [36], [38], [42], [45], [49]–[52].

Manner of death Police officials/Army personnel Civilian MP/VIP Criminal/Terrorist Others/Details not available Total number of cases Percentage
Suicide 32 7 0 0 0 39 43.33
Homicide 10 22 1 5 9 47 52.22
Accidental 3 0 0 1 0 4 4.44
Total 45 29 1 6 9 90 100
Table XII. Manner of Firearm Deaths

Range of Firing

In the present study, range of firing was found contact in 25 (27.77%) firearm deaths, distant in 24 (26.66%) firearm deaths and close in 18 (20%) firearm deaths (Table XIII). Reference [1] in their study on firearm deaths reported that ranges of firing were contact or semi-contact in 89% suicide victims and 7% homicide victims. Reference [5] in their study on firearm deaths reported that range of firing was close in most of the victims. Reference [14] in their study found that distant range of firing was common in homicide (73.4%) victims. Reference [23] in their study on firearm deaths found that range of firing remained undetermined in most of the cases. Reference [24] in their study on firearm deaths reported that contact range firing was common in suicide victims whereas distant range firing was common in homicide victims. Reference [25] in their study on firearm deaths found that range of firing was close in 60.60% victims. Reference [27] in their study on firearm deaths found that range of firing was distant in 89.10% victims and close in 6.25% victims. Reference [29] in their study on firearm deaths reported that range of firing was 1 meter or above in most of the victims. Reference [31] in his study on firearm deaths reported that range of firing was close range in 1/3 homicide victims. Reference [33] in their study on firearm deaths reported that close range was respectively found in 53.5% of the homicide cases and in all suicide cases. Reference [34] in their study on suicidal firearm deaths reported that range of firing was contact or near contact in 81.12% victims.

Range of firing Number of cases Manner
Contact 25 Suicidal—23 Homicidal—1 Accidental—1
Semi-contact 1 Suicidal—1
Near contact 5 Suicidal—4 Homicidal—1
Close 18 Suicidal—7 Homicidal—9 Accidental—2
Distant 24 Homicidal—23 Accidental—1
Mixed 7 Homicidal—5 Suicidal—2
Range—details not available 10 Suicidal—2 Homicidal—8
Total 90 90
Table XIII. Range of Firing in Firearm Deaths

Recovery of Firearm Projectile

Firearm projectiles (bullet/pellets) could be recovered from 38 (42.22%) victims of firearm deaths (Table XIV). No research study was found to compare the present study.

Projectiles recovery Number of cases Percentage
Projectile recovered 38 42.22
Projectile not recovered 51 56.66
Details not available 1 1.11
Total 90 100
Table XIV. Recovery of Firearm Projectile in Firearm Deaths

Site of Lodging of Firearm Projectile

Firearm projectiles (bullet/pellets) were found lodged in soft tissue in most of the victims i.e., in 17 (18.88%) cases followed by inside the bone in 5 (5.55%) cases (Table XV). No research study was found to compare the present study.

Site of lodging of the projectile Number of cases Percentage
In soft tissue 17 18.88
Inside bone 5 5.55
Under skin 4 4.44
Muscles and cranial cavity 1 1.11
In soft tissue and bone 1 1.11
Joint and bone 1 1.11
Multiple areas 3 3.33
In clothes 1 1.11
Details not available 4 4.44
Not applicable 53 58.88
Total 90 100
Table XV. Site of Lodging of Firearm Projectile in Firearm Deaths

Conclusion

‘Details not available’ as reflected inside many tables under results indicated that many autopsy reports lack qualitative descriptions. Inadequate information supplied by the investigating agency may be one of the reasons. More studies regarding firearm wound characteristics in detail should be conducted to enrich the literature on gunshot wounds.

References

  1. A study of fatal gunshot injuries over two years in Mumbai, India. (2017). Indian J Forensic Community Med, 4(3). https://doi.org/10.18231/2394-6776.2017.0033
     Google Scholar
  2. An analysis of firearms-related deaths between 1993–2010: a retrospective study. (2013). Ulus Travma Acil Cerrahi Derg, 19(6). https://doi.org/10.5505/tjtes.2013.70120
    DOI  |   Google Scholar
  3. An analysis of the characteristics of thoracic and abdominal injuries due to gunshot homicides in Israel. (2016). J Forensic Sci, 61(1), 87-92. https://doi.org/10.1111/1556-4029.12901
    DOI  |   Google Scholar
  4. An epidemiology of homicidal deaths due to rifled firearms in Peshawar Pakistan. (2010). J Coll Physicians Surg Pak, 20(2).
     Google Scholar
  5. Autopsy features relevant for discrimination between suicidal and homicidal gunshot injuries. (2002). Int J Legal Med, 116(5).
    DOI  |   Google Scholar
  6. Autopsy findings of suicidal deaths committed by firearms in Ankara. (2009). Turkey Med Sci Law, 49(3).
    DOI  |   Google Scholar
  7. Characteristics of firearms and gunshot wounds as markers of suicide. (1992). Am J Forensic Med Pathol, 13(4).
    DOI  |   Google Scholar
  8. Characterization of the gunshot suicides. (2007). J Forensic Leg Med, 14(4).
    DOI  |   Google Scholar
  9. Civillian abdominal gunshot wounds in Durban, South Africa: a prospective study of 78 cases. (2008). TRAUMA: Ann R Coll Surg Engl, 90. https://doi.org/10.1308/003588408X301118
    DOI  |   Google Scholar
  10. Emerg Med J. (2012). https://doi.org/10.1136/emj.2009.085837
    DOI  |   Google Scholar
  11. Fatal fire arm injuries in autopsy cases at central Bangkok, Thailand: a 10-year retrospective study. (2014). J Forensic Leg Med, 28, 5-10. https://doi.org/10.1016/j.jflm.2014.09.002
    DOI  |   Google Scholar
  12. Fatal firearm injuries in tennessee: a comparison study of tennessee’s two most populous counties 2009-2012. (2016). J Forensic Sci, 61(3). https://doi.org/10.1111/1556-4029.12834
    DOI  |   Google Scholar
  13. Fatal firearm wounds: a retrospective study in Bari (Italy) between 1988 and 2003. (2007). Forensic Sci Int, 168(2–3), 95-101.
    DOI  |   Google Scholar
  14. Fatal gunshot injuries in Benin City, Nigeria. (2013). Med Sci Law, 53(4), 199-202. https://doi.org/10.1177/0025802413483718
    DOI  |   Google Scholar
  15. Firearm deaths in Yorkshire and Humberside. (1992). Forensic Sci Int, 57(2).
    DOI  |   Google Scholar
  16. Firearm fatalities. (1992). Forensic Sci Int, 56(1), 59-64.
    DOI  |   Google Scholar
  17. Firearm fatalities in Delhi, India. (2006). India Leg Med (Tokyo), 8(5).
    DOI  |   Google Scholar
  18. Firearm fatalities in Eastern Saudi Arabia: impact of culture and legislation. (1997). Am J Forensic Med Pathol, 18(4).
    DOI  |   Google Scholar
  19. Firearm fatalities in Edirne, 1984–1997. (1998). Forensic Sci Int, 95(3).
    DOI  |   Google Scholar
  20. Firearm fatalities in Western Sydney 1994–2003. (2007). Forensic Sci Med Pathol, 3(4). https://doi.org/10.1007/s12024-007-0035-0
    DOI  |   Google Scholar
  21. Firearm-related deaths in Brescia (Northern Italy) between 1994 and 2006: a retrospective study. (2009). J Forensic Leg Med, 16(6). https://doi.org/10.1016/j.jflm.2009.01.006
    DOI  |   Google Scholar
  22. Firearm-related deaths in two industrial cities of Turkey and their province. (2007). Leg Med (Tokyo), 9(1), 14-21.
    DOI  |   Google Scholar
  23. Firearm-related fatalities: an epidemiologic assessment of violent death. (1985). Am J Public Health, 75(2).
    DOI  |   Google Scholar
  24. Firearm-related mortality: a review of four hundred-forty-four deaths in Diyarbakir, Turkey between 1996 and 2001. (2003). Tohoku J Exp Med, 201(3).
    DOI  |   Google Scholar
  25. Firearms accidents in Northern India (1980–2000). (2006). Med Sci Law, 46(1), 69-75.
    DOI  |   Google Scholar
  26. Firearms fatalities in Denmark 1970–1979. (1983). Forensic Sci Int, 23(2–3).
    DOI  |   Google Scholar
  27. Forensic issues in suicidal single gunshot injuries to the chest: an autopsy study. (2012). Am J Forensic Med Pathol, 33(4). https://doi.org/10.1097/PAF.0b013e31824a4797
    DOI  |   Google Scholar
  28. Frequency of firearm injuries, deaths and related factors in Kanpur, India; an original study with review of literature. (2013). Int J Med Toxicol Forensic Med, 3(3), 88-95.
     Google Scholar
  29. From gun store to smoking gun: tracking guns that kill children in North Carolina. (2004). J Pediatr Surg, 39(12).
    DOI  |   Google Scholar
  30. Gunshot deaths in Geneva, Switzerland: 2001 to 2010. (2013). Am J Forensic Med Pathol, 34(3). https://doi.org/10.1097/PAF.0b013e318288b221
    DOI  |   Google Scholar
  31. Gunshot fatalities in Stockholm, Sweden with special reference to the use of illegal weapons. (1993). J Forensic Sci, 38(6).
    DOI  |   Google Scholar
  32. Gunshot wounds: a review of firearm type, range, and location as pertaining to manner of death. (2013). Am J Forensic Med Pathol, 34(4). https://doi.org/10.1097/PAF.0000000000000065
    DOI  |   Google Scholar
  33. Homicidal deaths by firearms in Peshawar: an autopsy study. (2006). J Ayub Med Coll Abbottabad, 18(1).
     Google Scholar
  34. Homicidal deaths in Dammam, Kingdom of Saudi Arabia. (2011). Egypt J Forensic Sci, 1.
    DOI  |   Google Scholar
  35. Homicidal firearm injuries: a study from Sri Lanka. (2010). Forensic Sci Med Pathol, 6(2).
    DOI  |   Google Scholar
  36. Homicide by firearms in two Scandinavian capitals. (2000). Am J Forensic Med Pathol, 21(3).
    DOI  |   Google Scholar
  37. Incidence, case-fatality rate and clinical pattern of firearm injuries in two cities where arm owning is forbidden. (2005). Injury, 36(6).
    DOI  |   Google Scholar
  38. Influence of ballistic and autopsyparameters on the manner of death in case of long firearms fatalities. (2008). Forensic Sci Int, 177(2–3). https://doi.org/10.1016/j.forsciint.2008.01.002
    DOI  |   Google Scholar
  39. Medico-legal aspects of firearm injury cases in Agra region. (2014). J Indian Acad Forensic Med, 36(4).
     Google Scholar
  40. Medico-legal evaluation of firearm injuries during the period from 2005 to 2010 in the Suez Canal Area, Egypt: a retrospective study. (2012). Egypt J Forensic Sci, 2, 1-10.
    DOI  |   Google Scholar
  41. Medico-legal evaluation of firearm injuries—an original study from India with review of literature. (2015). J Forensic Sci, 60(Suppl 1). https://doi.org/10.1111/1556-4029.12593
    DOI  |   Google Scholar
  42. Pathology of firearm mortalities in the Niger Delta region of Nigeria: a study of 136 consecutive autopsies. (2009). Med Sci Law, 49(1).
    DOI  |   Google Scholar
  43. Pattern of civilian gunshot injuries in Irrua, Nigeria. (2005). S Afr J Surg, 43(4).
     Google Scholar
  44. Pattern of firearm injuries in head and neck regions at a tertiary care hospital. (2016). J Pak Med Assoc, 66(7).
     Google Scholar
  45. Pattern of injury to internal organs in firearm homicidal cases—on autopsy. (2014). J Med Sci (Peshawar), 22(4).
     Google Scholar
  46. Shotgun shooting in northern India—a review (1980–1999). (2005). Forensic Sci Int, 150(1).
    DOI  |   Google Scholar
  47. Shotgun wounds: a review of range and location as pertaining to manner of death. (2007). Am J Forensic Med Pathol, 28(2), 99-102.
    DOI  |   Google Scholar
  48. Site of entrance wound and direction of bullet path in firearm fatalities as indicators of homicide versus suicide. (1997). Forensic Sci Int, 88(2).
    DOI  |   Google Scholar
  49. Study of pattern of injuries in homicidal firearm injury cases. (2005). JIAFM, 27(2).
     Google Scholar
  50. Study of wounds in victims of homicide by firearms and explosives. (2013). J Evol Med Dent Sci, 2(44).
    DOI  |   Google Scholar
  51. Suicide by firearms on the Island of Crete: a 9-year record. (2010). Crisis, 31(1), 43-52. https://doi.org/10.1027/0227-5910/a000006
    DOI  |   Google Scholar
  52. Trends in firearm usage in homicides and suicides in Bexar County Texas from 1982 to 2004. (2008). Am J Forensic Med Pathol, 29(4). https://doi.org/10.1097/PAF.0b013e31818480a4
    DOI  |   Google Scholar