Diagnostic Value and Forensic Applicability of Tissue-Based Findings in Suspected Fatal Electrocution: A Systematic Review.

Fatal electrocution remains a difficult diagnosis in forensic pathology, particularly when external electrical marks are absent or poorly preserved. Histopathology is commonly used as supportive evidence, but the diagnostic value of individual findings is uncertain. We systematically reviewed studies reporting histopathologic and ancillary tissue-based findings in suspected fatal electrocution or electrical injury. Twenty-seven primary studies with extractable tissue-level data were included. Skin electrical marks were the most frequently investigated target. Routine hematoxylin and eosin (H&E) findings included intraepidermal or subepidermal separation, coagulative necrosis, epidermal nuclear elongation or streaming, vacuolization, dermal collagen homogenization, and vascular changes. Comparative studies indicated that combinations of these findings may help distinguish electrical marks from flame burns or abrasions, although no feature was pathognomonic. Scanning electron microscopy with energy-dispersive x-ray spectroscopy or analysis (SEM-EDS/EDX) provided the strongest ancillary support through detection of metallization, particularly when conventional histology or histochemical stains were inconclusive. Cardiac studies described myofiber break-up, contraction bands, cardiomyolysis, microhemorrhages, and conduction-related changes, but these findings were generally nonspecific. Overall, tissue findings should be interpreted using a multimodal, context-dependent approach. Skin histology and metallization analysis offer the greatest diagnostic support, whereas cardiac and other internal-organ findings are mainly supportive or mechanistic.