Fatal bleeding following scalp laceration: an uncommon cause of death in adults

Any wound of the scalp involving the subcutaneous layer may cause profuse bleeding. In such cases, haemorrhage may continue for a while because the natural tension of the scalp inhibits effective haemostasis. In addition, if special conditions coexist, this bleeding may lead to death. We described three cases of haemorrhagic shock by scalp lacerations. An 83-year-old man was found dead in his home lying on a large amount of blood on the floor. He had plenty of comorbidities and a multi-drug therapy, as anticoagulant. A 53- year-old heavy drinker man was found dead in his home with the bathroom and bedroom extensively smeared with blood. A 55-year- old woman with multiple sclerosis was hit in the face by a large stone while she was sitting on her car seat. A toxicological exam on blood revealed benzodiazepines at therapeutic levels. The most relevant conditions that must be present for a scalp laceration to become fatal are unwitnessed head trauma, delayed activation of emergency services, old age, comorbidities, anticoagulant medica- tion, alcohol abuse and significant blood loss from the scalp wound. Other possible causes of death should be excluded. Furthermore, in such cases, the differentiation between homicide and accident can be challenging