Discriminating Antemortem From Post-Mortem Low-Voltage Electrocution Burns: A Prospective Two-Year Study Applying a Three-Point Histopathologic Checklist and Sem/Eds Correlation

Abstract

Background: Correctly determining whether an electric-current skin lesion was produced during life (antemortem, AM) or after death (post-mortem, PM) remains pivotal in forensic reconstruction yet notoriously difficult when only gross inspection is available. Gross morphology overlaps, while several “vital” histological changes can be reproduced experimentally in cadavers. Methods: In a two-year prospective series (July 2018 – June 2020) we examined 25 consecutive AM electrocution fatalities and 30 fresh cadavers in which standardised PM electrical burns were experimentally created (220 V AC, 400–1000 mA, 3–4 s). For every lesion we recorded macro morphology, fourteen predefined light-microscopic variables on haematoxylin–eosin (H&E) sections and surface/elemental characteristics on scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM/EDS). Pearson’s χ² with Yates’ correction tested inter-group differences; diagnostic performance indices were calculated for individual and composite markers. Results: AM lesions were significantly larger (≥ 1 cm in 52 % vs 17 %, p = 0.01) and more often oval/elongated. Epidermal nuclear streaming (72 % vs 53 %, p = 0.04), coagulative epidermal necrosis (72 % vs 43 %, p = 0.02), dermal collagen homogenisation > ⅓ thickness (36 % vs 10 %, p = 0.01) and sweat-gland nuclear elongation (56 % vs 16 %, p < 0.001) discriminated AM from PM injuries. Combining any two of the three strongest criteria—deep dermal homogenisation, sweat-gland nuclear streaming, marked epidermal necrosis—achieved 84 % sensitivity and 90 % specificity for vitality. Metallisation was absent in both cohorts except sparse environmental particles, limiting the value of SEM/EDS in low-voltage deaths. Conclusion: The grade and depth of dermal and adnexal damage, rather than their mere presence, provide reliable positive criteria of vitality in electrocution burns. A simple three-point H&E checklist offers high diagnostic accuracy and can be readily adopted in routine forensic practice.