kjlm The Korean Journal of Laboratory Medicine Korean J Leg Med 2383-5702 2383-5710 The Korean Society for Legal Medicine 10.7580/kjlm.2014.38.1.8 kjlm-38-8 원 저 A Classification of Asphyxia Autopsy Cases of the Korea in 2012 according to New Classification of Asphyxia NaJoo Young 1 ParkJong Pil 2 YangKyung-Moo 2 ChungNak-Eun 3 LeeHan Young 2 Forensic Medicine Division, Gwangju Institute of Scientific Investigation, Jangseong-gun, Jeollanam, Korea Forensic Medical Center, National Forensic Service, Wonju-si, Gangwon, Korea Department of Forensic Medicine Investigation, Seoul Institute of Scientific Investigation, Seoul, Korea Presentation history: 본 논문은 2013. 11. 7-8. 개최된 제1회 한국포렌식연합회 공 동학술대회에서 연제로 발표되었음을 밝 힘. 책임저자 : 나주영 (515-822) 전라남도 장성군 서삼면 축령 로 687, 광주과학수사연구소 법의학과 전화 : +82-61-393-8442 FAX : +82-61-393-8440 E-mail : pdrdream@gmail.com 12014 1712014 381 812 21012014 14022014 19022014 Copyright © 2014 The Korean Society for Legal Medicine 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

No accepted standard currently exists to classify asphyxia and define its subtypes. Sauvageau and Boghossian proposed an asphyxia classification system in 2010 that divided asphyxia into suffocation, strangulation, mechanical asphyxia, and drowning. Here, we present a modification of this classification system. We propose to classify asphyxia into four main categories: suffocation, strangulation, mechanical asphyxia, and complicated asphyxia. Suffocation includes smothering and choking as well as confined spaces, entrapment, and vitiated atmosphere. Strangulation is subdivided into hanging, ligature strangulation, manual strangulation, and other unspecified strangulation. Mechanical asphyxia includes positional and traumatic asphyxia. Finally, complicated asphyxia is defined as cases with two or more identifiable mechanisms of asphyxia. In this study, we review autopsy cases from 2012 diagnosed as asphyxia and classify them according to our proposed asphyxia classification system. In 24.7% of cases, the age range was 40-49 years, and 51.9% were men. The most common method of asphyxia was hanging (245 cases, 55.1%), followed by ligature or manual strangulation (53 cases, 11.9%). Most hangings were suicides; smothering, ligature, and manual strangulation were usually homicides. Eighteen cases were complicated asphyxia. This classification provides a simplified, unified, and useful tool to classify and understand deaths due to asphyxia.

 Key Words Asphyxia Autopsy Classification Korea REFERENCES Yun JJ Forensic medicine Seoul Korea Medical Publisher 1993 12663 Kang HW Lee SD Asphyxia Kang DY Kang HW Kwak JS ed. A textbook of legal medicine Seoul Jungmunkag 2007 21542 Sauvageau A Boghossian E Classification of asphyxia: the need for standardization J Forensic Sci 201055 125967 Na JY Park JP Park HJ The statistical analysis on legal autopsy performed in Korea during 2012 year Korean J Leg Med 201337 198207 Byard RW Commentary on: Sauvageau A, Boghossian E. Classification of asphyxia: the need for standardization J Foresnic Sci 2012555): 1259-67. J Forensic Sci 2011;56: 264 Azmak D Asphyxial deaths: a retrospective study and review of the literature Am J Forensic Med Pathol 200627 13444 Wyatt JP Wyatt PW Squires TJ Hanging deaths in children Am J Forensic Med Pathol 199819 34346 Rodge S Hougen HP Poulsen K Asphyxial homicide in two Scandinavian capitals Am J Forensic Med Pathol 200122 12833 Lupascu C Lupascu C Beldiman D Mechanical asphyxia by three different mechanisms Leg Med (Tokyo) 20035 1101 Abder-Rahman HA Abu-Alrageb SY Killing tools in mechanical asphyxia Legal Med 19991 25 Figures and Tables

The classification of asphyxia used in this study is shown.

Age, Sex, and Subtypes of Asphyxia Autopsies Performed in Korea during the Year 2012

Asphyxia Age Sex <9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80< NI∗ Subtotal Total l (%)
M F M F M F M F M F M F M F M F M F M F NI∗ M F
Suffocation 9 13 1 1 6 2 4 0 8 2 10 1 2 1 1 2 0 1 0 0 0 41 23 64 14.4
 Smothering 8 8 0 0 2 1 1 0 2 1 4 1 0 0 0 0 0 1 0 0 0 17 12 29 45.3
 Chocking 1 5 1 1 2 1 2 0 4 1 4 0 2 1 1 2 0 0 0 0 0 17 11 28 43.8
 Deficient 0 0 0 0 2 0 1 0 2 0 2 0 0 0 0 0 0 0 0 0 0 7 0 7 10.9
Strangulation 4 4 6 3 15 27 25 49 51 38 42 22 21 9 4 13 3 6 9 1 4 180 172 356 80.0
 Hanging 1 1 1 0 13 18 22 38 40 21 35 14 15 4 1 2 3 2 9 1 4 140 101 245 68.8
 Ligture stangulation 2 0 3 1 1 2 0 4 6 7 5 2 5 2 3 7 0 3 0 0 0 25 28 53 14.9
 Manual strangulation 1 3 2 2 1 7 2 7 2 10 1 6 1 3 0 4 0 1 0 0 0 10 43 53 14.9
 Straungulation, NOS 0 0 0 0 0 0 1 0 3 0 1 0 0 0 0 0 0 0 0 0 0 5 0 5 1.4
Mechanial asphyxia 0 0 0 0 1 0 0 0 2 2 1 0 1 0 0 0 0 0 0 0 0 5 2 7 1.6
 Positional asphyxia 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 2 28.6
 Compressive asphyxia 0 0 0 0 1 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 4 1 5 71.4
Complicated asphyxia 0 3 0 0 1 0 1 2 2 5 0 2 1 0 0 1 0 0 0 0 0 5 13 18 4.0
Subtotal 13 20 7 4 23 29 30 51 63 47 53 25 25 10 5 16 3 7 9 1 4 231 210 445 100.0
Total 33 11 52 81 110 78 35 21 10   14 445    
(%) 7.4 2.5 11.7 18.2 24.7 17.5 7.9 4.7 2.2   3.1 100.0    

NI: Not identified;

NOS: Not otherwise specified

Cause and Manner of Death in Asphyxia of Legal Autopsies Performed in Korea during the Year 2012

  Sex Sucide Homicide Accident Undetermined Subtotal Total (%)
M F NI∗ M F NI∗ M F NI∗ M F NI∗ M F NI∗    
Suffocation 6 5 0 11 6 0 24 12 0 0 0 0 41 23 0 64 14.4
 Smothering 3 5 0 11 6 0 3 1 0 0 0 0 17 12 0 29 45.3
 Chocking 0 0 0 0 0 0 17 11 0 0 0 0 17 11 0 28 43.8
 Deficient 3 0 0 0 0 0 4 0 0 0 0 0 7 0 0 7 10.9
Strangulation 149 115 4 20 55 0 8 1 0 3 1 0 180 172 4 356 80.0
 Hanging 138 100 4 0 0 0 1 1 0 1 0 0 140 101 4 245 68.8
 Ligture stangulation 11 15 0 12 12 0 1 0 0 1 1 0 25 28 0 53 14.9
 Manual strangulation 0 0 0 8 43 0 1 0 0 1 0 0 10 43 0 53 14.9
 Straungulation, NOS† 0 0 0 0 0 0 5 0 0 0 0 0 5 0 0 5 1.4
Mechanial asphyxia 1 0 0 0 0 0 4 2 0 0 0 0 5 2 0 7 1.6
 Positional asphyxia 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 2 28.6
 Compressive asphyxia 1 0 0 0 0 0 3 1 0 0 0 0 4 1 0 5 71.4
Complicated asphyxia 1 1 0 2 11 0 2 1 0 0 0 0 5 13 0 18 4.0
 Subtotal 157 121 4 33 72 0 38 16 0 3 1 0 231 210 4 445 100.0
 (%) 35.3 27.2 0.9 7.4 16.2 0.0 8.5 3.6 0.0 0.7 0.2 0.0 51.9 47.2 0.9 100.0 0
 Total   282     105     54     4     445      
 (%)   63.4     23.6     12.1     0.9     100.0      

NI: Not identified;

NOS: Not otherwise specified

Cause and Manner of Death in Complicated Asphyxia Cases Performed in Korea during the Year 2012

Asphyxia Sucide Homicide Accident Undetermined Sum of case number
Suffocation
 Smothering #10∗, #12, #1, #6, #7, #13 #4, #8, #9, #14, #15   10
 Chocking     #8, #14   2
 Deficient         0
Strangulation
 Hanging   #5   #2 2
 Ligture stangulation #10, #12 #3, #11, #13, #16, #17, #18   #2 9
 Manual strangulation   #3, #5, #6, #7, #11, #16, #17, #18     8
 Straungulation, NOS†         0
Mechanial asphyxia
 Positional asphyxia   #1 #14   2
 Compressive asphyxia   #1 #4, #9, #15   4
Sum of case 2 10 5 1  

: Case number;

NOS: Not otherwise specified