Diagnostic Criteria for Commotio Cordis Caused by Violent Attack: Review of the Literature

The diagnosis of lethal commotio cordis is really complex. The forensic pathologist’s task is even more relevant when he/she has to explain a commotio cordis diagnosis caused by an assault in a trial. The purpose of this study is to analyze the literature on lethal commotio cordis as a result of violent attacks and identify relevant parameters that may help in the diagnosis. A review of the relevant articles was performed. 52 cases of commotio cordis caused by violent attacks were identified. The collected data allowed to confirm the following literature’s criteria for commotio cordis diagnosis in case of assaults: witnessed occurrence of a blunt, non-penetrating 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 commotio cordis 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.