Characteristics of hemorrhages located at the origin of the sternocleidomastoid muscle in suicidal hangings: A retrospective autopsy study

Abstract

The study aimed to determine the incidence, distribution, and relation to the knot in a noose position of the sternocleidomastoid (SCM) muscle origin hemorrhages in hangings and to assess their occurrence regarding the subjects' major anthropometric characteristics. A retrospective study on 126 cases of suicidal hangings was conducted. Data on the subject's age, body weight and height, thyrohyoid and cervical spine fractures, and presence and distribution of SCM muscle origin hemorrhages were collected. The SCM muscle origin hemorrhage distribution regarding the knot position was analyzed by descriptive statistics and comparing characteristics between typical and atypical hangings, anterior and lateral hangings, and left and right lateral hangings. Median age was 55 years (17–94), body weight was 70.0 kg (40–125), body height was 176.0 cm (145–205). The hemorrhages were present in 108 (85.7%) cases. Bilateral hemorrhages were most common in the anterior knot position (5 of 7 cases, 71.4%), followed by the posterior knot position (N = 33, 53.2%). Unilateral SCM muscle origin hemorrhage was most common in lateral knot positions (N = 20, 35.1%). In lateral hangings, left SCM muscle origin hemorrhage (aOR = 5.76, 95% CI 1.64–20.19) and absence of right SCM muscle origin hemorrhage (aOR = 6.06 95% CI 1.48–24.78) were significantly associated with the left side of the knot. Body weight (≥67.5 kg) was a significant predictor of these hemorrhages (AUC = 0.639, p < 0.05, sensitivity 62.0%, specificity 66.7%). Hemorrhages at the origin of SCM muscles are a common autopsy finding in suicidal hangings, and knot position impacts their occurrence and distribution. © 2025 American Academy of Forensic Sciences.