Cause of death interrelation in homicide and persecution criminal act with dead victims which autopsied in forensics installation sanglah central hospital in 2010-2015

Background: Legal case, determining cause of death is a requirement either to prove the victim death by natural cause or unnatural cause. In determining the cause of death is usually started by seeking information about the scene, the state of the corpse when it was found, information from witnesses, and other information. Recognizing the risk factors characteristic of cases of death due to criminal acts can assist stakeholders in making decisions and policies associated with crime. Objective: This study aimed to examine Cause of death interrelation in homicide and persecution criminal act with dead victims. Methods: The research was conducted with a descriptive cross-sectional design using data based on letter of request by police and visum et repertum archive in Forensic Installation Sanglah Central Hospital from 2010 to 2015. Results: Among 70 samples obtained there are 49 male cases (70%) and 21 female cases (30%) with the largest age group is early adulthood as many as 23 cases (32.9%). Injury patterns obtained 33 cases (47.1%) sharp violent death, 33 cases (47.1%) blunt violence, violent firearms 2 cases (2.9%), 1 burns case (1.4%) and 1 case of other cause (1.4%). The most injured region that caused death is head region with 28 cases (40%) and the leading mechanism of death according to the autopsy report is bleeding by 55 cases (78.6%). Other death by cardiovascular system is by 31 cases (44,3%), then death by blunt force by 23 cases (32,9%), death by gunfire is 1 case (1,4%) and by stroke is 1 case (1,4%). Cause of death because of respiratory system failure and because of central nervous system failure respectively by 7 cases (10%). Conclusion: The most frequent demographic characteristic of murder and persecution cases that autopsied in Sanglah Central Hospital in 2010-2015 are male and age characteristic of adult (17-25 years). Whereas the most frequent type of violence is blunt violence. As for the most frequent mechanism of death is cardiovascular failure.


INTRODUCTION
Determining cause of death is one of forensics doctor competence.In legal case, determining cause of death is a requirement either to prove the victim death by natural cause or unnatural cause.In determining the cause of death is usually started by seeking information about the scene, the state of the corpse when it was found, information from witnesses, and other information.Besides collecting information about the deceased such as medical records, interview of the family or significant others also conducted.This can give general idea of how the death of the victim occurs.But an autopsy is the main way to determine the cause of death considering autopsy produce definitive evidence of how the mechanism of death of the deceased and provide details that might help identify the suspect if the death is suspected of murder 1 .
Research on the characteristics and patterns of causes of death is required to assess the risk factors of criminal acts of murder and persecution.Recognizing the risk factors characteristic of cases of death due to criminal acts can assist stakeholders in making decisions and policies associated with crime.According to Global Homicide Book 2014 the youngest spectrum of murder and persecution victim was 15 years old (8%), this shows that age participation is relatively young compared to majority of murder and persecution case involve age 29 (43%) 2 .In some countries that do not have firearms regulation such as the United States and some countries that are in conflict such as some middle east country, killings due to firearms is very high in contrast with Australia that have implemented the regulation of firearms is strictly since 1996 significantly reduce the violence associated with the use of firearms 3 .This shows that good policy making in accordance to the risk factor of crime can significantly decrease the crime rate.In this case there is not much data and research showing many factor that contribute in crime of murder and persecution in Bali, Indonesia.

MATERIALS AND METHODS
This study performs cross-sectional analysis of cause of death pattern in murder and persecution criminal cases in Forensics

RESULTS
This research of cause of death interrelation in homicide and persecution criminal act with dead victims which autopsied in Forensics Installation Sanglah Central Hospital in 2010-2015 was performed in September -December 2016 with total of 70 samples.
Average wound per cases is 12,32 wounds, 9,27 average wound per cases for sharp violence, and average blunt violence wound per cases 14,97 wounds.This is done by excluding one extreme case with total 117 wounds (Table 1

.).
The mechanism of death caused by cardiovascular system failure are 56 cases (80%), whereas the lowest death mechanism is due to multiple organ failure is 1 cases (1.4%), the rest are caused by 7 cases (10%) of respiratory system failure and 6 cases (8,7%) because of central nervous system failure.In addition to that, 8.7% of death cases due to brain tissue damage occur due to swelling of the brain, suppressing vital center leading to death (Table 2.).

DISCUSSION
In crime case of murder and persecution with dead victim dominated by male victim (70%), according to criminal statistics by Central Statistics Agency male crime (60%) significantly higher in Indonesia as for dominant age characteristics of crime participation are age of 15-29 years and 30-44 years.This statistic shows that higher criminal participation among productive demographic spectrum-juvenile-adult spectrum.This dominance of demographic spectrum may be influenced by risk-taking behaviors.Risk-taking behavior is described as behavior to took risky decision in other words the subject cannot see clearly how the result of the decision will affect, this behavior is widely observed in adolescent age group, this behavior decreases with increasing of age 2,4 .
According to table 1, the most common type of violence is sharp and blunt violence (47,1% respectively) contrary to report in Global Study on Homicide 2014 as the most common type of violence globally is firearm.As Indonesia enforce law that prohibit the use of firearm by civilian and limit the use of sharp weapon such as Peraturan Kapolri Nomor 82 Tahun 2004, this explain lowest type of violence is firearm (2,9%).Blunt and sharp violence still the highest despite of law and policy that prohibit them as the weapon used still accessible to civilian such as kitchen knife, cleaver, broken glass, screwdriver, and razor blade 2 .In table 1, most frequent anatomical region of the cause of death wound are head (40%) and neck region (25%), in other study of six states in the United States reveal that regions with the most injuries (72.2%) is the head, face and neck.The number of cases of death due to criminal acts that attack the head region fatality can reach to 80.2% and increase if there is accompanied fracture of cranial bones 5,6 .
One case of cardiovascular system failure was because non hemorrhagic stroke of 75 years' male victim.As stroke is organic and natural manner of death, contrary to the Visum et Repertum and Police's Letter of Request the case was alleged of persecution with unnatural manner of death.The examination reveal that the victim was persecuted to death as there is 21 wounds found because of blunt violence.Autopsy finding was found that the left brain tissue softened as the result of tissue liquefactive necrosis. 7,8
for: a) name, b) age, c) sex, d) nationality, we also obtain characteristics of death by looking for: a) alleged manner of death, b) wound location, c) type of violence, d) mechanism of death, e) cause of death.
Installation Sanglah Central Hospital performed by collecting data from Visum et Repertum and Police's Letter of Request.Data of Visum et Repertum and Police's Letter of Request for this research provided by Forensics Installation of Sanglah Central Hospital, Denpasar, Bali.The population for this study are all of the criminal case of murder and persecution that autopsied in Forensic Installation of Sanglah Central Hospital in 2010-2015 with drop out criteria: a) murder and persecution case that did not autopsy, b) victim that cannot have identified, c) perinatal cases, d) incomplete Visum et Repertum data.Sample characteristics is obtained by looking at Visum et Repertum and Police's Letter of Request

Table 1 .
Characteristic of autopsied murder and persecution crime victim