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Diagnostic Criteria for Commotio Cordis Caused by Violent Attack

Review of the Literature

Lupariello, Francesco, MD; Curti, Serena Maria, MD; Di Vella, Giancarlo, MD, PhD

The American Journal of Forensic Medicine and Pathology: December 2018 - Volume 39 - Issue 4 - p 330–336
doi: 10.1097/PAF.0000000000000433
Review Article

The diagnosis of lethal commotio cordis (CC) is really complex. The forensic pathologist's task is even more relevant when he/she has to explain a CC diagnosis caused by an assault in a trial. The purpose of this study was to analyze the literature on lethal CC as a result of violent attacks and identify relevant parameters that may help in the diagnosis. A review of the relevant articles was performed. Fifty-two cases of CC caused by violent attacks were identified. The collected data allowed to confirm the following literature's criteria for CC diagnosis in case of assaults: witnessed occurrence of a blunt, nonpenetrating blow to the chest preceding cardiovascular collapse; absence of structural damage to the sternum, ribs, or heart itself; and absence of any underlying cardiovascular abnormalities (such as other causes of sudden death). Regarding the assessment of the third criterion, the authors suggest that the pathologist should always specify the scientific autopsy guidelines that he/she used to differentiate CC from the other causes of sudden death. In addition, the authors highlight the importance of a multidisciplinary approach for a correct interpretation of clinical, autopsy, and laboratory findings.

From the Sezione di Medicina Legale, Dipartimento di Scienze della Sanità Pubblica e Pediatriche, “Università degli Studi di Torino,” Torino, Italy.

Manuscript received June 8, 2018; accepted August 4, 2018.

The authors report no conflict of interest.

Reprints: Francesco Lupariello, MD, corso Galileo Galilei 22, 10126 Turin, Italy. E-mail:

© 2018 by Lippincott Williams & Wilkins.