Anatomical distribution and autopsy features of gunshot injuries to determine the manner of death. A 5-year retrospective study from the cook county medical examiner’s office

Gunshot wounds are associated with significant morbidity and mortality worldwide. In such cases, determining the manner of death is mandatory. The analysis of the pattern and location of the gunshot wounds can help in understanding the circumstances of death. This study will provide data to support an association between gunshot wound features and the manner of death. The files of the Cook County Medical Examiner’s Office were searched for deaths due to gunshot wounds between August 2014 and April 2019. Complications due to remote gunshot wounds were not included in the study. The investigative, autopsy and toxicological reports were reviewed in each case. The following parameters were recorded: manner of death, gender, race and age, firearms, and bullets type (if available), number and sites of entrance and exit wounds, shooting distance, internal bullet pathway, blood drugs and/or alcohol concentration, and investigative narratives. The obtained data were then subcategorized as to the manner of death (suicide, homicide, accident, or undetermined). The information detected on the autopsy report were used to create a graphic reconstruction of the anatomical distribution of the gunshot wounds on the body surface. A total of 3492 deaths due to gunshot wounds were identified, that have been subcategorized based on the manner of death, showing: 2842 homicides (81%), 627 suicides (18%), 4 accidents (<1%), and 19 undetermined (<1%). The ages of the subjects ranged from 0 to 96 years, with an average of 32. Males accounted for 92% while females for 8%, and in 1 case the gender was undetermined (unknown bones). Regarding race, there were 2437 African Americans, 1006 Caucasians, 14 Asians, 1 Native American, 2 undetermined, and 32 "Others”. The presented research is one of the most extensive case studies about gunshot wound fatalities and presents distinct differences that should be considered while investigating gunshot-wounds related deaths. A thorough discussion of the results, including graphical models showing the most common location of the injuries will be presented.