Medico-legal profiles, lethal pathways, and death timing in 162 autopsied fatal assaults in Casablanca, 2018–2025

Abstract

Background Autopsy data regarding fatal interpersonal violence in Morocco and North Africa remain limited. This study describes the demographic, injury, thanatological, and procedural profiles of autopsied fatal assaults in Casablanca and explores factors associated with death within 24 hours. Methods Between 2018 and 2025, 4,816 medico-legal autopsies were performed at the institute; 162 deaths met the operational definition of a fatal assault involving the action or omission of a third party, all of which underwent a complete medico-legal autopsy. The principal assault category, dominant lethal injury region, multiregional injury, dominant terminal mechanism, survival, hospitalization, and autopsy interval were analyzed. Rare cells and complete separation phenomena justified the use of exact methods and Firth penalized logistic regression for adjusted analysis. Results The 162 fatal assaults represented 3.4% of the 4,816 autopsies performed. Victims were predominantly male (136/162; 84.0%), and 45.1% were aged 20–39 years. Principal categories were blunt-force trauma (40.1%), sharp-force/penetrating trauma (28.4%), burns (10.5%), mixed mechanisms (8.6%), exposure/neglect (6.8%), mechanical asphyxia (4.9%), and firearm (0.6%). Among 134 cases with a focal traumatic injury, the head was the dominant lethal region in 48.5%, and 35/134 (26.1%) were multiregional. Fatal hemorrhage (40.7%) and fatal cranioencephalic injuries (32.1%) predominated. Fifty-five victims (34.0%) died within 24 hours. Multiregional injury was associated with early death in unadjusted analysis among focal cases (19/35 vs. 30/99; OR 2.73; 95% CI 1.24–6.03; p=0.015). Firth penalized regression applied to the 134 focal cases and adjusted for age and sex yielded an aOR=3.23 (95% CI 1.42–7.56; p=0.005) for multiregionality. Regarding modalities, mechanical asphyxia, characterized by 8 early deaths out of 8 cases, produced complete separation; Firth yielded a finite but highly imprecise estimate compared with blunt-force trauma (OR=40.54; 95% CI 4.66–5,337.49; p<0.001). Conclusion This institutional autopsy series is characterized by a young male predominance, blunt-force and sharp-force/penetrating mechanisms, and deaths dominated by hemorrhage and cranioencephalic injuries. The frequency of early deaths and the diversity of delayed complications underscore the need to integrate injury extent, clinical trajectory, and the entire causal chain into medico-legal interpretation.