Fatal Cardiovascular Injuries in Homicidal Chest Trauma: A Prospective Autopsy Study of Pattern, Mechanism, and Demographic Distribution in Nairobi, Kenya

Abstract

The purpose of this article was to determine the distribution, mechanisms, and demographic characteristics of cardiovascular injuries in homicidal chest trauma in Nairobi, Kenya. Cardiovascular injuries are the most lethal component of thoracic trauma, yet detailed structure-specific forensic data from sub-Saharan Africa remain limited. A prospective descriptive autopsy study was conducted at Nairobi City Mortuary between July 2009 and June 2010. A total of 915 violent chest trauma cases were examined within 72 hours post-mortem using a census of all eligible cases. Data were analysed using descriptive statistics and chi-square tests. Of the 915 cases, 544 (59.5%) were classified as homicide, with cardiovascular structures involved in 290 (53.3%) cases. Relative to all homicidal chest trauma cases, injuries to the heart accounted for 21.1 per cent, followed by the aortic arch (12.7%) and thoracic aorta (9.6%). Within the subgroup of cardiovascular injuries, these corresponded to (39.7%, 23.8%, and 17.9%), respectively. Males constituted 87.7 per cent of cases, while young adults aged 15–44 years accounted for 79.6 per cent, with the highest incidence occurring among those aged 25–34 years (35.2%). Penetrating trauma accounted for 59.0 per cent of homicidal cardiovascular injuries, compared with 41.0 per cent caused by blunt trauma. Cardiovascular injuries were significantly more frequent in homicide than in accidental deaths (χ² = 18.4, p < 0.001). The findings demonstrate that injuries to the heart and aorta are the leading cause of mortality in homicidal chest trauma in Nairobi, disproportionately affecting young adult males and arising mainly from penetrating trauma. These findings support targeted violence prevention strategies and strengthened trauma care systems.