Adji Suwandono1, Yahya �Ammar Yaritsul
Firdaus2
Faculty of Medicine, Sebelas Maret University1,2
E-mail : [email protected]
|
Keywords |
�Abstract |
|
asphyxia; death;
forensic; visum et repertum |
Asphyxia is the third most common case in
forensics. Death from asphyxia can occur due to murder, accident, or
suicide.� This study aims to determine
the description of death cases with asphyxia. This research is a descriptive research with observational study. The data
collection technique used was total sampling with a sample of all cases of
death with asphyxia examined at Dr. Moewardi
Hospital in the period 2017-2022. From 2017 to 2022, there were 105
cases of death with asphyxia. The most cases were in 2020 (23%). The majority
of victims were male (85%) and aged more than 50 years (39%).� A total of 21 cases (20%) were
strangulation asphyxia, 18 (17%) cases of suffocation asphyxia, 3 cases (3%)
chemical asphyxia, 10 cases (10%) asphyxia due to disease, and 53 (50%) cases
were other asphyxia. Signs of cyanosis were found in 91% of cases, petechiae
in 56% of cases, edema in 2% of cases, and fine foam in 13% of cases. The
most victims were found indoors with 48 cases (46%), followed by outdoors
with 46 cases (44%), and in transportation with 1 case (1%). The three
regions that sent the most victims were Surakarta city (63%), Sukoharjo
district (10%), and Karanganyar district (10%). Most cases occurred in 2020. Males
are most common in asphyxia cases. Other asphyxia is the most common type of
asphyxia. In the majority of cases, signs of cyanosis were found. The place
where the victims were found was relatively the same between indoors and
outdoors |
*Correspondence Author: Adji Suwandono
Email: [email protected] ��
INTRODUCTION
Asphyxia is a condition when the body
experiences a lack of oxygen due to disruption of supply and transportation
between the environment and organs (Dettmeyer et al.,
2014). Lack of oxygen in the organs can cause
death. Death from asphyxia itself can occur due to murder, accident, or
suicide. Asphyxia is categorized into 3 types, namely suffocation,
strangulation, and chemical asphyxia. Signs of death due to asphyxia include
cyanosis, extensive and fast-onset body bruising, darker color of body bruises,
foam from the mouth or nose, and blunt trauma marks around the nose or mouth if
caused by smothering (Sihaloho &
Parinduri, 2022).
In the US, suicide is the 10th leading cause
of death with 42,773 cases in 2014. A total of 11,407 (26.7%) of them were
related to asphyxia, namely hanging, strangulation, and smothering. The
incidence of asphyxia due to suicide increased by 45.7% from 2005 to 2014 to
3.57 per 100,000 deaths. Some of the methods of suicide recorded in the study
include 90.7% by hanging, 6.8% by smothering, 3.8% by gas, 0.6% by
strangulation, and <0.1% by ingestion of foreign objects (Yau & Paschall, 2018). Based on a report on the epidemiology of
asphyxia in the Forensic Department in Peshawar, Pakistan, 130 cases of death
due to asphyxia were obtained from a total of 3,265 autopsy cases with a
mortality rate of 3.98%. The causes of asphyxia in the study were murder
(93.85%), suicide (3.85%), and accidental (2.3%), respectively (Khalil et al., 2014).
Research conducted in the Forensic Medicine
and Medikolegal Section of Prof. Dr. D. Kandou
Hospital in 2013-2017 obtained the results of 26 cases of death due to
asphyxia. The subjects were dominated by male gender with 17 cases (65%) and
the age group 17-25 years with 7 cases (27%). The prevalence of mechanical
asphyxia was the highest at 25 cases (96.2%) with the most common cause being
drowning (Rey et al., 2017). The number of deaths due to mechanical
asphyxia in the Forensic Medicine Section of Prof. Dr. R D Kandou Hospital from
2010-2015 was 22 cases with the most cases occurring in 2011 as many as 32%.
The biggest cause that is often found is self-hanging as much as 68.2% and the
most common gender in cases of mechanical asphyxia death is male (54.5%) (Robi et al., 2016).
Based on the large number of cases and the
lack of research on asphyxia, the researcher intends to conduct further
research in the Forensic Medicine and Medikolegal
Section of Dr. Moewardi Surakarta Hospital regarding
the description of death cases with asphyxia. It is hoped that this study can
provide an overview of asphyxia cases at Dr. Moewardi
Hospital from 2017-2022.
METHODS
The research conducted
was a descriptive observational study with a cross sectional approach. The
research subjects included all cases of death with asphyxia examined at the
Forensic Medicine and Medikolegal Installation of Dr.
Moewardi Hospital in the 2017-2022 timeframe recorded
in the visum et repertum
and contained all research variables. Sampling was done using total sampling
technique.
The
variables in this study were measured through Visum et Reperum files and visum
request files. The variables studied in this study were the number of cases per
year, age, gender, type of asphyxia, signs of asphyxia, and crime scene. The
data obtained were then analyzed descriptively and presented in the form of
tables and graphs. This study has had an ethical feasibility permit issued by
Dr. Moewardi Hospital with number 2.274/XII/HREC/2023.
RESULTS AND DISCUSSION
RESULTS
Data collection was
carried out in December 2023 - January 2024 by identifying Visum
et Repertum recorded in the Forensic Medicine and Medikolegal Section of Dr. Moewardi
Hospital in 2017-2022.
|
Table 1. Number of death cases with asphyxia
|
Based on Table 1, it is found that during the 2017-2022 period, the most
cases occurred in 2020, namely 24 cases and decreased in 2021 to 18 cases.
Table 2. Overview of Death Cases with Asphyxia by Age
|
Age |
Number of Cases |
% |
|
0-5 years |
9 |
9 |
|
6-17 years |
4 |
4 |
|
18-30 years |
16 |
15 |
|
31-50 years |
35 |
33 |
|
>50 years |
141 |
39 |
|
Total |
105 |
100 |
Based on Table 2, it was found that during the period 2017-2022, the
highest incidence of asphyxia occurred at the age of more than 50 years, namely
41 cases (39%). The least number of cases was occupied by the age range of 6-17
years, namely as many as 4 cases (4%).
Table 3. Overview of Death Cases with Asphyxia by
Gender
|
Gender |
Number of Cases |
% |
|
Male |
89 |
85 |
|
Female |
16 |
15 |
|
Total |
105 |
100 |
Based on Table 3, it was found that during the period 2017-2022, deaths
with asphyxia occurred more in males with a percentage of 85%
Table 4. Overview of Death Cases with Asphyxia Based
on Type of Asphyxia
|
Type of Asphyxia |
Number of Cases |
% |
|
Strangulation |
21 |
20 |
|
Sufocation |
18 |
17 |
|
Chemical |
3 |
3 |
|
Disease |
10 |
10 |
|
Other |
53 |
50 |
|
Total |
105 |
100 |
Based on Table 4, it was found that during the period 2017-2022 the most
common type of asphyxia found in this study was other asphyxia with a total of
53 cases (50%) and the least was chemical asphyxia which was 3 cases (3%).
Table 5. Overview of Death Cases with Asphyxia Based
on Signs of Asphyxia
|
Signs of Asphyxia |
Number of Cases |
% |
|
Petechiae |
59 |
56 |
|
Cyanosis |
96 |
91 |
|
Edema |
2 |
2 |
|
Fine foam |
14 |
13 |
Based on Table 5, it was found that during the period 2017-2022 91% of
cases of death with asphyxia had cyanosis. The least sign that appeared was
edema which was only found in 2 cases or about 2%.
Table 6. Overview of Death Cases with Asphyxia by
Crime Scene Category
|
Crime Scene Category |
Number of Cases |
% |
|
Indoor |
48 |
46 |
|
Outdoor |
46 |
44 |
|
In Transportation
Tools |
1 |
1 |
|
Unknown |
10 |
10 |
|
Total |
105 |
100 |
Based on Table 6, it was found that during the 2017-2022 period, the most
common location was the indoor category with 48 cases (46%) and followed by
outdoors with 46 cases (44%). Only 1 case (1%) was found with a crime scene in
a means of transportation.
Table 7. Overview of Death Cases with Asphyxia by
Crime Scene Region
|
Crime Scene Region |
Number of Cases |
% |
|
Surakarta |
66 |
63 |
|
Sragen |
3 |
3 |
|
Karanganyar |
11 |
10 |
|
Boyolali |
7 |
7 |
|
Pacitan |
2 |
2 |
|
Sukoharjo |
11 |
10 |
|
Wonogiri |
1 |
1 |
|
Unknown |
4 |
4 |
|
Total |
105 |
100 |
Based on Table 7, it was found that during the period 2017-2022, most
cases were located in Surakarta City with a total of 66 cases (63%). This can
happen considering that Dr. Moewardi Hospital was
established in the city.
Although the forensic service of RSUD Dr. Moewardi
operates in Surakarta, based on the results of the study, the crime scene was
also found outside Central Java. There were 2 cases (2%) of deaths due to
asphyxia examined at Dr. Moewardi Hospital with a
crime scene in East Java. These cases were found in Pacitan
District, East Java.
DISCUSSION
Based on the results of
Visum et Repertum research
in the Forensic Medicine and Medikolegal Section of
Dr. Moewardi Hospital in 2017-2022, 105 cases of
death with asphyxia were obtained. 2020 is the year when the most cases of
death with asphyxia occurred, namely 24 cases (23%), up 85% from the previous
year, namely 13 cases (12%). This can be influenced by the COVID-19 pandemic
which causes mass layoffs and economic pressure, increasing the risk of suicide
(Riani et al., 2021). The average case of death with asphyxia
examined at Dr. Moewardi Hospital in 2017-2022 per
year was 17.5 cases.
The age of victims of
death cases with asphyxia examined at Dr. Moewardi
Hospital in 2017-2022 varied with the most cases in the age category of more
than 50 years with 41 cases (39%). While the fewest cases were in the age range
of 6-17 years with a total of 4 cases (4%). Research in Pakistan showed similar
results, namely 38.8% (85) cases of death with asphyxia aged over 49 years. Of
these 85 cases, 49 cases (22.4%) of them were aged 49-58 years and 36 cases
(16.4%) were over 59 years old (Memon et al., 2021).
Death victims with
asphyxia examined at Dr. Moewardi Hospital in
2017-2022 were mostly male as many as 89 cases (85%). Meanwhile, cases of death
with asphyxia that were female amounted to 16 cases (15%). This is in line with
research in Maharashtra, India where 457 cases (69.9%) were male and 197 cases
(30.1%) were female. However, the number of strangulation asphyxia cases was
dominated by the female gender with a total of 8 out of 9 cases (88.9%) (Ghadge et al., 2016). Male gender was also the most common
finding in the 2010-2016 study in Mexico compared to female gender (Miguel et al., 2019).
In this study,
suffocation asphyxia was found in 18 cases (17%), strangulation asphyxia in 21
cases (20%), and asphyxia due to disease in 10 cases (10%). Other types of
asphyxia were the most common with 53 cases (50%) and chemical asphyxia was the
least with 3 cases (3%). According to research in Maharashtra, India in
2006-2015, the most common type of asphyxia was strangulation asphyxia with a
total of 418 cases (63.9%), of which 409 were cases due to hanging. The second
highest asphyxia frequency was suffocation asphyxia due to drowning (31.2%).
According to the study, access to water, residential areas close to rivers,
floods, lack of security, are factors that can increase the risk of drowning (Ghadge et al., 2016). In this study, there were 8 cases of
asphyxia suspected to be due to drowning. This is in line with the geographical
conditions of Surakarta City and its surroundings which are passed by the Bengawan Solo River which is the longest river on the
island of Java.
Hanging is the most
common cause because it is the most common way of suicide. However, in this
study, there were 12 cases of hanging which was not the most common case that
caused asphyxia. This may occur due to differences in regions/countries which
is in line with research conducted at Dr. Soetomo
Hospital Surabaya. Of the 108 cases of asphyxia found in the study, 45 of them
were cases of self-hanging while the other 63 cases were not cases of asphyxia
due to self-hanging (Ermawati et al., 2018).
Ten out of 105 cases
were asphyxia that occurred presumably because the victim was sick and 53 cases
could not be identified as the cause or type of asphyxia. This can occur
because the majority of asphyxia cases that occurred were not subjected to
internal examination or autopsy, so the exact cause of death of the victim is
unknown.
It was found that 91%
of asphyxia cases studied had signs of cyanosis. While the sign of petechiae
was found in 56% of cases, fine foam in 14% of cases, and the least edema in 2%
of cases. The four signs can be found simultaneously in one case or not. However,
the possibility of death due to asphyxia can appear if there is one of the four
signs. According to the results of research at Dr. Mohammad Hosein Hospital
Palembang, the most common sign of asphyxia is cyanosis with a percentage of
100% or found in all cases. Petechiae was also found in 3 Visum
et Repertum files (27.3%) where the sign was mostly
found on the sclera (Nasution et al., 2014).
The
scene of the crime (TKP) or the place where the victim was found dead with
asphyxia was mostly indoors with 48 cases (46%) and followed by outdoors with
46 cases (44%). Meanwhile, only 1 case (1%) was found in a means of
transportation and 10 cases (10%) had no crime scene listed. The most cases of
death with asphyxia examined at Dr. Moewardi Hospital in 2017-2022 came from
Surakarta City, namely 66 cases (63%). While the least cases came from Wonogiri
Regency with 1 case (1%).
�
CONCLUSIONS
Most cases occurred in
2020. Males are most common in asphyxia cases. Other asphyxia is the most
common type of asphyxia. In the majority of cases, signs of cyanosis were
found. The place where the victims were found was relatively the same between
indoors and outdoors. Surakarta City is the largest contributor to death cases
with asphyxia at Dr. Moewardi Hospital.
REFERENCES
Dettmeyer, R., Verhoff, M., & Sch�tz, H. (2014). Forensic
Medicine. In Springer Science & Business Media (Vol. 39, Issue 3).
https://doi.org/10.1080/00325481.1966.11695735
Ermawati, S., Moediarso, B., & Soedarsono, S. (2018).
Hubungan Jenis Kelamin, Usia Dan Pekerjaan Dengan Kejadian Asfiksia Gantung
Diri Di Rsud Dr Soetomo Tahun 2013-2016. Indonesian Journal of Legal and
Forensic Sciences (IJLFS), 8(1), 12.
https://doi.org/10.24843/ijlfs.2018.v08.i01.p04
Ghadge, M., Samel, D., Kulkarni, D., & Pate, R. (2016).
Socio-demographic factors in mechanical asphyxial deaths in Thane region,
Maharashtra, India. International Journal of Research in Medical Sciences,
4(9), 4078�4083. https://doi.org/10.18203/2320-6012.ijrms20162937
Khalil, Z. H., Naeem, M., Adil, M., Khan, M. Z. ul I., Abbas,
S. H., & Alam, N. (2014). Asphyxial deaths: A four year retrospective study
in Peshawar. Journal of Postgraduate Medical Institute, 28(1),
24�26.
Memon, A. M., Mal, S., Magsi, I., Khalid, A., Qayyum, S. A.,
Anwar, H. N., Samad, A., & Awan, E. A. (2021). A Post-Mortem Medicolegal
Study of Asphyxial Deaths: An Autopsy Based Study. Pakistan Journal of
Medical and Health Sciences, 15(8), 2148�2150.
https://doi.org/10.53350/pjmhs211582148
Miguel, B.-H. A., Guadalupe, M.-S., & Beatriz, D.-R.
(2019). Epidemiological behavior of mechanical asphyxias in the forensic
medical service of the Veracruz-Boca del rio zone. Rev Mex Med Forense, 4(1),
36�42.
Nasution, I. S., Tanzila, R. ., & Irfanuddin, I. (2014).
Gambaran Tanda Kardinal Asfiksia Pada Kasus Kematian Gantung Diri di Departemen
Forensik RSU Dr. Muhammad Hoesin Palembang Periode Tahun 2011-2012. Syifa�
MEDIKA: Jurnal Kedokteran Dan Kesehatan, 5(1), 63.
https://doi.org/10.32502/sm.v5i1.1425
Rey, N. E. K., Mallo, J. F., & Kristanto, E. G. (2017). Gambaran
Kasus Kematian dengan Asfiksia di Bagian Kedokteran Forensik dan Medikolegal
RSUP Prof. Dr. R. D Kandou Manado Periode 2013-2017.
Riani, N., Safari, U., Nurmala, A., & Saripudin, D.
(2021). Dampak Pendemi Covid-19 Terhadap Kesehatan Mental Masyarakat. Jurnal
Medika Hutama, 2(04), 1245�1254.
Robi, M., Siwu, J. F., & Kristanto, E. G. (2016).
Gambaran Kasus Asfiksia Mekanik di Bagian Forensik RSUP Prof. Dr. R.D. Kandou
periode tahun 2010 -2015. E-CliniC, 4(2).
https://doi.org/10.35790/ecl.4.2.2016.14348
Sihaloho, K., & Parinduri, A. G. (2022). Kematian
Seorang Wanita Akibat Pembekapan. 12, 117�124.
Yau, R. K., & Paschall, M. J. (2018). Epidemiology of
Asphyxiation Suicides in the United States, 2005�2014. Injury Epidemiology,
5(1), 1�9. https://doi.org/10.1186/s40621-017-0131-x
Dettmeyer, R., Verhoff, M., & Sch�tz, H. (2014). Forensic
Medicine. In Springer Science & Business Media (Vol. 39, Issue 3).
https://doi.org/10.1080/00325481.1966.11695735
Ermawati, S., Moediarso, B., & Soedarsono, S. (2018).
Hubungan Jenis Kelamin, Usia Dan Pekerjaan Dengan Kejadian Asfiksia Gantung
Diri Di Rsud Dr Soetomo Tahun 2013-2016. Indonesian Journal of Legal and
Forensic Sciences (IJLFS), 8(1), 12.
https://doi.org/10.24843/ijlfs.2018.v08.i01.p04
Ghadge, M., Samel, D., Kulkarni, D., & Pate, R. (2016).
Socio-demographic factors in mechanical asphyxial deaths in Thane region,
Maharashtra, India. International Journal of Research in Medical Sciences,
4(9), 4078�4083. https://doi.org/10.18203/2320-6012.ijrms20162937
Khalil, Z. H., Naeem, M., Adil, M., Khan, M. Z. ul I., Abbas,
S. H., & Alam, N. (2014). Asphyxial deaths: A four year retrospective study
in Peshawar. Journal of Postgraduate Medical Institute, 28(1),
24�26.
Memon, A. M., Mal, S., Magsi, I., Khalid, A., Qayyum, S. A.,
Anwar, H. N., Samad, A., & Awan, E. A. (2021). A Post-Mortem Medicolegal
Study of Asphyxial Deaths: An Autopsy Based Study. Pakistan Journal of
Medical and Health Sciences, 15(8), 2148�2150.
https://doi.org/10.53350/pjmhs211582148
Miguel, B.-H. A., Guadalupe, M.-S., & Beatriz, D.-R.
(2019). Epidemiological behavior of mechanical asphyxias in the forensic
medical service of the Veracruz-Boca del rio zone. Rev Mex Med Forense, 4(1),
36�42.
Nasution, I. S., Tanzila, R. ., & Irfanuddin, I. (2014).
Gambaran Tanda Kardinal Asfiksia Pada Kasus Kematian Gantung Diri di Departemen
Forensik RSU Dr. Muhammad Hoesin Palembang Periode Tahun 2011-2012. Syifa�
MEDIKA: Jurnal Kedokteran Dan Kesehatan, 5(1), 63.
https://doi.org/10.32502/sm.v5i1.1425
Rey, N. E. K., Mallo, J. F., & Kristanto, E. G. (2017). Gambaran
Kasus Kematian dengan Asfiksia di Bagian Kedokteran Forensik dan Medikolegal
RSUP Prof. Dr. R. D Kandou Manado Periode 2013-2017.
Riani, N., Safari, U., Nurmala, A., & Saripudin, D.
(2021). Dampak Pendemi Covid-19 Terhadap Kesehatan Mental Masyarakat. Jurnal
Medika Hutama, 2(04), 1245�1254.
Robi, M., Siwu, J. F., & Kristanto, E. G. (2016).
Gambaran Kasus Asfiksia Mekanik di Bagian Forensik RSUP Prof. Dr. R.D. Kandou
periode tahun 2010 -2015. E-CliniC, 4(2).
https://doi.org/10.35790/ecl.4.2.2016.14348
Sihaloho, K., & Parinduri, A. G. (2022). Kematian
Seorang Wanita Akibat Pembekapan. 12, 117�124.
Yau, R. K., & Paschall, M. J. (2018). Epidemiology of
Asphyxiation Suicides in the United States, 2005�2014. Injury Epidemiology,
5(1), 1�9. https://doi.org/10.1186/s40621-017-0131-x
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