Increasing Injury Intensity Among 6500 Violent Deaths in the State of Maryland.

BACKGROUND: Anecdotal evidence strongly suggests there has been a rise in violent crimes. This study sought to examine trends in injury characteristics of homicide victims in Maryland. We hypothesized that there would be an increase in the severity of wound characteristics.

STUDY DESIGN: The Office of the Chief Medical Examiner is a statewide agency designated by law to investigate all homicides, suicides, or unusual/suspicious circumstances. Using individual autopsy reports, we collected data among all homicides from 2005-2017, categorizing them into three time-periods: 2005-2008 (early), 2009-2013, and 2014-2017 (late). Primary outcomes included the number of gunshots, stabs, and fractures from assaults. High-violence intensity outcomes include victims having 10+ gunshots, 5+ stabs, or 5+ fractures from assaults.

RESULTS: Of 6500 homicides (annual range 403-589), the majority were from firearms (75%), followed by stabbings (14%) and blunt assaults (10%). Most homicides died in the hospital (60%). The average number of gunshots per victim was 3.9 (range 1-54), stabs per victim was 9.4 (range 1-563), and fractures from assaults per victim was 3.7 (range 0-31). The proportion of firearm victims with at least 10 gunshots nearly doubled from 5.7% in the early period to 10% (P<.01) in the late period. Similarly, the proportion with 5+ stabbings increased from 39% to 50% (P=.02) and assault homicides with 5+ fractures increased from 24% to 38% (P<.01).

CONCLUSIONS: In Maryland, the intensity of violence increased across all major mechanisms of homicide. Further follow-up studies are needed to elucidate the root causes underlying this escalating trend.