Comparison of Injury Severity and Weapon Type in Assault Cases Presenting for Medico-Legal Examination

Assault refers to the intentional infliction of physical harm by one individual upon another through the use of bodily force or weapons. Victims of assault frequently present to emergency departments and medico-legal centers for assessment, treatment, and legal documentation.^1,2 Medico-legal examination serves a crucial role in objectively recording injury characteristics, determining the severity of trauma, and correlating wounds with the alleged mechanism of injury.³ Among the various factors influencing injury patterns, the type of weapon used during an assault is particularly important because it directly affects the extent of tissue damage and the resulting clinical outcomes.⁴

 

The etiology of assault is multifactorial and involves a complex interaction of individual, social, economic, and environmental factors. Young adult males are disproportionately affected due to increased exposure to high-risk social environments and aggressive behaviors. Poverty, unemployment, low educational attainment, substance abuse, domestic conflicts, gang-related activities, and inadequate conflict resolution mechanisms have all been identified as important contributors to violent encounters.⁵ Alcohol and illicit drug use are particularly significant risk factors, as they impair judgment and increase impulsive and aggressive behavior. Access to weapons further influences both the occurrence and severity of assault-related injuries. Firearms, knives, sharp-edged instruments, sticks, iron rods, and other blunt objects are commonly used in assaults, with each weapon type producing distinct injury patterns.⁶

 

The pathophysiological effects of assault injuries depend largely on the mechanism of force transfer and the nature of the weapon involved. Blunt force trauma results from impact with hard objects or bodily force and may produce abrasions, contusions, hematomas, fractures, and internal organ damage through compression and crushing mechanisms.⁷ Sharp-force trauma, caused by knives, blades, or pointed instruments, produces incised wounds, stab wounds, and penetrating injuries that can disrupt blood vessels, nerves, and internal organs. Firearm injuries are associated with high-energy transfer, causing extensive tissue destruction, cavitation, hemorrhage, and multi-organ damage.⁸

 

Clinical manifestations of assault-related injuries vary considerably, ranging from minor superficial wounds to severe life-threatening trauma. Victims commonly present with pain, swelling, bruising, lacerations, bleeding, fractures, and neurological deficits. Injuries involving the head, neck, chest, and abdomen are of particular concern because of the potential involvement of vital structures.⁹ Severe assaults may result in hemorrhagic shock, traumatic brain injury, respiratory compromise, visceral organ damage, and permanent disability. In addition to physical consequences, assault victims often experience significant psychological distress, including anxiety, depression, fear, and post-traumatic stress disorder. These psychological effects may persist long after physical wounds have healed and can adversely affect social functioning and quality of life. The overall burden of assault therefore extends beyond immediate injury and encompasses long-term medical, psychological, social, and economic consequences.¹⁰

 

Previous studies have demonstrated a clear association between weapon type and the pattern as well as severity of injuries sustained during assaults. Firearm-related injuries are generally associated with higher rates of severe trauma and mortality, whereas sharp weapons commonly produce penetrating injuries with potentially serious consequences depending on the anatomical site involved.^11,12 Blunt weapons may appear less lethal but can nevertheless cause substantial morbidity and fatal outcomes when significant force is applied or vital organs are affected. Despite these observations, variations in weapon availability, sociocultural factors, healthcare infrastructure, and injury classification systems have resulted in differing findings across regions and populations. Consequently, continued evaluation of injury severity in relation to weapon type remains important for enhancing medico-legal assessments, improving trauma care planning, and strengthening evidence-based approaches to violence prevention and forensic practice.

This cross-sectional analytical study was conducted at Medicolegal Section (MLS), Liaquat University Hospital (LUH), Hyderabad from January 2025 to July 2025. The sample size was calculated using the WHO sample size calculator by taking an anticipated proportion of severe injuries among assault victims of 11%, a confidence level of 95%, and an absolute precision of 5%. The calculated sample size was 151 patients, which was increased to 166 patients to account for incomplete records and improve study power.

 

A total of 166 assault victims presenting for medico-legal examination during the study period were enrolled through consecutive non-probability sampling. Patients of either gender aged 18 years and above who presented with a history of physical assault and underwent complete medico-legal examination were included in the study. Patients with self-inflicted injuries, accidental trauma, animal-related injuries, burn injuries, cases with incomplete medico-legal records, and patients who refused participation were excluded.

 

After obtaining informed consent, demographic information including age and gender was recorded on a structured proforma. Detailed information regarding the assault incident, including the alleged weapon type, was obtained from the patient and medico-legal records. Weapon types were categorized as blunt weapons, sharp weapons, firearms, and others. A comprehensive medico-legal examination was performed by the designated medico-legal officer, and all injuries were documented according to standard medico-legal protocols.

 

Injury severity was assessed based on medico-legal classification. Injuries were categorized as minor, grievous, or life-threatening according to the extent of tissue damage, involvement of vital organs, presence of fractures, permanent disability, or risk to life. The anatomical location and number of injuries were also recorded. Where required, radiological investigations and specialist consultations were reviewed to confirm the extent and severity of injuries.

 

All collected data were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Quantitative variables such as age were presented as mean ± standard deviation, whereas qualitative variables including gender, weapon type, injury location, and injury severity were presented as frequencies and percentages. The association between weapon type and injury severity was assessed using the Chi-square test. A p-value of ≤0.05 was considered statistically significant.

A total of 166 assault victims were included in the study. The mean age of the participants was 33.7 ± 11.2 years. The most common age group was 18–30 years comprising 78 (47.0%) patients, followed by 31–40 years with 42 (25.3%) patients. Males constituted the majority of the study population with 131 (78.9%) cases, while females accounted for 35 (21.1%) cases. Blunt weapons were the most frequently used weapons in assault incidents, reported in 82 (49.4%) cases, followed by sharp weapons in 48 (28.9%) cases, firearms in 21 (12.7%) cases, and other weapons in 15 (9.0%) cases. Regarding injury severity, minor injuries were observed in 87 (52.4%) patients, grievous injuries in 59 (35.5%) patients, and life-threatening injuries in 20 (12.1%) patients, as given in Table 1.

Head and neck injuries were the most commonly affected anatomical site, observed in 57 (34.3%) patients, followed by upper limb injuries in 39 (23.5%) patients and lower limb injuries in 28 (16.9%) patients. Chest and abdominal injuries were reported in 17 (10.2%) and 12 (7.2%) patients, respectively, while multiple-site injuries were present in 13 (7.9%) patients. Regarding the number of injuries sustained, single injuries were the most frequent, occurring in 61 (36.7%) patients, followed by two injuries in 52 (31.3%) patients, three injuries in 31 (18.7%) patients, and four or more injuries in 22 (13.3%) patients, as given in Table 2.

 

Table 2: Anatomical Distribution and Number of Injuries Among Assault Victims (n = 166)

Among male victims, minor injuries were reported in 65 (49.6%) cases, grievous injuries in 48 (36.6%) cases, and life-threatening injuries in 18 (13.7%) cases. Among female victims, minor injuries were observed in 22 (62.9%) cases, grievous injuries in 11 (31.4%) cases, and life-threatening injuries in 2 (5.7%) cases. The association between gender and injury severity was not statistically significant (p=0.321). Regarding weapon type, blunt weapons were predominantly associated with minor injuries, accounting for 53 (64.6%) cases. Sharp weapons resulted in minor, grievous, and life-threatening injuries in 22 (45.8%), 20 (41.7%), and 6 (12.5%) cases, respectively. Firearms showed the highest proportion of life-threatening injuries, observed in 10 (47.6%) cases. A statistically significant association was found between weapon type and injury severity (p<0.001), as given in Table 3.

 

Table 3: Association of Injury Severity with Gender and Weapon Type Among Assault Victims (n = 166) presented as n (%)

The distribution of injury severity varied according to the anatomical site of injury. Among patients with head and neck injuries, 22 (38.6%) had minor injuries, 25 (43.9%) had grievous injuries, and 10 (17.5%) had life-threatening injuries. Upper limb injuries were predominantly minor, accounting for 29 (74.4%) cases. Life-threatening injuries were most frequently observed in patients with abdominal injuries, where 4 (33.3%) cases fell into this category. A statistically significant association was observed between anatomical site of injury and injury severity (p=0.002), as given in Table 4.

 

 

 

 

 

 

Table 4: Association of Anatomical Site of Injury with Injury Severity Among Assault Victims (n = 166) presented as n (%)

 

Assault-related injuries are a major cause of morbidity and mortality worldwide and represent a substantial burden on healthcare and medico-legal systems. The severity and pattern of injuries sustained during assaults are influenced by multiple factors, including the type of weapon used. Different weapons produce distinct injury mechanisms, ranging from superficial wounds to life-threatening trauma. Accurate assessment of injury severity is essential for clinical management, forensic evaluation, and legal proceedings. Understanding the relationship between weapon type and injury severity can improve medico-legal documentation and trauma care. Therefore, evaluation of assault cases remains important for both public health and forensic practice.

 

In the present study, males constituted 78.9% of assault victims. Similar findings were reported by Aggarwal et al. (2008), who observed that 92% of victims with sharp weapon injuries were male and that the highest frequency occurred in the 21–40-year age group.18 Likewise, Brennan et al. (2007) found that 74.5% of assault victims were male, while Iqbal et al. (2024) reported male predominance in 83.63% (189/226) of fabricated injury cases. These findings collectively support the observation that younger males represent the group most commonly involved in assault-related incidents.20

 

With respect to weapon type, blunt weapons accounted for 49.4% of assault cases in the present study. Comparable findings were reported by Bhatti et al. (2013), who found that blunt weapons were responsible for 43.19% of medico-legal trauma cases, compared with 26.76% for firearms and 10.80% for sharp-edged weapons.16 Similarly, Ahmad et al. (2011) reported that blunt weapons constituted 67.3% of assault-related injuries, whereas sharp weapons and firearms accounted for 9.1% and 5.5% of cases, respectively. These studies, along with our findings, indicate that blunt force trauma remains the predominant mechanism of assault-related injury.17

 

In our study, minor injuries were observed in 52.4% of patients, while blunt weapons were associated with minor injuries in 64.6% of cases. Comparable observations were made by Aggarwal et al. (2008), who reported that 80% of sharp weapon injuries were simple in nature. Although the study specifically evaluated sharp weapon injuries, both studies demonstrated a predominance of less severe injury patterns among assault victims.18

 

Head and neck injuries represented the most common anatomical site in our study, accounting for 34.3% of cases. A similar pattern was reported by Iqbal et al. (2024), who found that the scalp was involved in 51.3% of fabricated injuries.20 The predominance of injuries involving exposed regions of the head and neck in both studies may reflect common assault mechanisms and victim-defense behaviors.

 

Regarding the number of injuries sustained, single injuries were observed in 36.7% of cases in the present study. Similar findings were reported by Brennan et al. (2007), who found that 81% of assault victims sustained a single injury. Although the proportion was higher in their study, both investigations identified isolated injuries as the most frequent presentation among assault victims.

 

The present study demonstrated a statistically significant association between weapon type and injury severity (p<0.001), whereas no significant association was observed between gender and injury severity (p=0.321). In contrast, Bangash et al. (2024) reported a significant association between gender and medico-legal case type (p<0.001).21 Furthermore, Bangash et al. observed that physical assault accounted for 20.8% of medico-legal cases, sharp injuries for 19.0%, and firearm incidents for 4.0%. The differences between the two studies may be explained by variations in study design, study population, and outcome measures evaluated.21

 

Study Limitations

This study was conducted at a single tertiary care center, which may limit the generalizability of the findings. The cross-sectional design precluded assessment of long-term outcomes and causal relationships. Additionally, information regarding weapon type was partially dependent on victim-reported history, which may have introduced reporting bias.

Weapon type demonstrated a significant association with injury severity among assault victims presenting for medico-legal examination. Firearm-related assaults were associated with a higher proportion of life-threatening injuries, whereas blunt weapons were more commonly associated with minor injuries. Recognition of these patterns may assist clinicians and forensic experts in the assessment and management of assault-related trauma.

Acknowledgement: We sincerely acknowledge the support and guidance of our mentors, colleagues, and the staff of the participating hospital for their valuable assistance throughout this study.

Conflict of Interest: No

Funding Disclosure: None

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