Burns in forensic medicine: patterns and antemortem signs
- Finding
The forensic doctor describes the cause, extent and pattern of burns and looks for signs that they happened in life.
What it is
Burns are caused by flame, hot liquids (scalds), contact with hot objects, chemicals, electricity or radiation. Forensic medicine asks three questions: what caused them, whether they happened in life and whether the pattern fits the history. Some patterns suggest inflicted injury, above all in children: immersion scalds with sharp, symmetrical edges, contact burns shaped like the object, and small round burns of equal size. Burns sustained in life show a vital reaction: a red margin, blisters with protein-rich fluid and a red base.
How to tell it apart
- Accidental versus inflicted scald: an accidental spill leaves splashes and irregularity; forced immersion, sharp margins and symmetry.
- Conditions that mimic burns: impetigo, contact dermatitis, congenital dermal melanocytosis, lesions from cultural practices.
- Electrical burns: small, pale, with a raised edge; see the electricity page.
- Antemortem versus postmortem burn: vital reaction, blister contents and histology.
How to recognise it
- Flame: irregular burns, with soot, singed hair and an upward pattern.
- Spill or splash scald: arrowhead or drip pattern, uneven depth.
- Immersion scald: sharp margins, even depth, flexural creases spared.
- Contact: the exact shape of the hot object, with sharp edges.
- Chemical: diffuse edges, colour depending on the substance, no blisters in some cases.
How it forms
- Heat denatures proteins and damages the skin in depth according to temperature and contact time.
- In life, inflammation of the margin and plasma leakage form the red halo and protein-rich blisters.
- After death there is no circulation: blisters contain little fluid and there is no inflammatory halo.
Next step: what to do and document
- Describe the cause, site, extent, depth, pattern and edges of each burn, with scaled photographs.
- Ask and record in the patient's or companion's own words how it happened, and whether the account fits the pattern.
- In children, older or dependent people with a suspicious pattern, examine the whole body, report and activate the protection pathway.
- Keep related clothing and objects (garments, containers) with a chain of custody if a crime is suspected.
- In the expert report, state the incapacity and possible sequelae, such as disfigurement or loss of function.
Common mistakes
- Accepting an accident history without checking that the burn pattern fits it.
- Not examining the whole body of a burned child for other signs of maltreatment.
- Confusing postmortem blisters or skin slippage from decomposition with burns in life.
- Describing extent without a reproducible method.
Test yourself
Think of the answer, then tap the question to see it.
Which scald pattern suggests child maltreatment?
An immersion scald with sharp, symmetrical glove or stocking margins, no splashes and the flexural creases spared.
Which signs show that a burn happened in life?
A red inflammatory halo and blisters with protein-rich fluid and a red base; postmortem blisters have a pale base and little fluid.
What do several small round burns of the same size suggest?
Inflicted contact burns, for example with a cigarette; they call for a full-body examination and a report.
Elsewhere in DurgiPedia
- Thermal injury: burns, hyperthermia and hypothermia
- Mandatory reporting: public health, violence and abuse
Connections
Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.
Sources: Cause of Death in Charred Bodies: Reflections and Operational Insights Based on a Large Cases Study (Diagnostics, PubMed Central, 2022); Inhalation Injury (StatPearls, NCBI Bookshelf, 2023).
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Representative model, for educational purposes only.