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Wen S, Unuma K, Hanazawa R, Nagano S, Watanabe R, Hirakawa A, Uemura K. Alcohol and toxicological factors influencing fatal falls from height in the Greater Tokyo Area: a retrospective study. Int J Legal Med 2024; 138:793-800. [PMID: 37968477 DOI: 10.1007/s00414-023-03125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Abstract
Falls from height pose a significant public health concern in urban regions, including the highly urbanized Greater Tokyo Area. The Japanese population is characterized by high rates of suicide and psychoactive drug usage, underscoring the importance of investigating these attributes in falls from height. This study aimed to retrospectively analyze the alcohol and toxicological aspects influencing falls from height in the Greater Tokyo Area between 2014 and 2022 and compare the findings with existing reports on other populations. In total, 75 cases of falls from height and 159 cases of natural deaths were included. Consistent with previous findings, Fisher's exact test revealed a predominance of males (66.67%, 50/75) and young adults (57.33%, 43/75) in falls from height. Multivariate logistic regression analysis identified antidepressant usage as the most significant risk factor within the target population, while younger individuals under alcohol influence constituted another high-risk group. Notably, contradictory to other populations, female individuals involved in fatal falls in the Greater Tokyo Area exhibited a higher frequency of alcohol consumption than males (48.00%, 12/25 vs. 26.00%, 13/50), and most of them were associated with suicide (83.33%, 10/12). These findings elucidate the population characteristics that pose a high risk for fatal falls from height in Japan and can serve as a reference for other Asian populations residing in similar megacities.
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Affiliation(s)
- Shuheng Wen
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
- Department of Forensic Medicine, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shutaro Nagano
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ryo Watanabe
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koichi Uemura
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Terayama T, Toda H, Nagamine M, Tanaka Y, Saitoh D, Yoshino A. Association between length of hospital stay and fractures in the spine, pelvis, and lower extremity among patients after intentional fall from a height: an analysis of the Japan Trauma Databank. Trauma Surg Acute Care Open 2023; 8:e000988. [PMID: 37303981 PMCID: PMC10254599 DOI: 10.1136/tsaco-2022-000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
Objective This study investigated the association between the number of regions with fractures in the spine, pelvis, and lower extremity (NRF) and the proportion of patients with a length of hospital stay (LOS) ≥30 days among those who attempted suicide by falling from a height. Methods Data recorded between January 1, 2004 and May 31, 2019 in the Japan Trauma Databank of patients aged ≥18 years injured by suicidal falls from a height and with ≥72 hours of LOS (period from admission to discharge home or to another hospital) were analyzed. Patients with an Abbreviated Injury Scale score ≥5 in the head region or those who died after admission were excluded. Multivariate analyses including clinically relevant variables as covariates were performed to determine the association, expressed as risk ratio with 95% CI, between NRF and LOS. Results Among 4724 participants, the multivariate analysis revealed significant factors related to LOS ≥30 days, including NRF=1 (1.64, 95% CI 1.41 to 1.91), NRF=2 (2.00, 95% CI 1.72 to 2.33), NRF=3 (2.01, 95% CI 1.70 to 2.38), systolic blood pressure in the emergency department (ED; 0.999, 95% CI 0.998 to 0.9997), heart rate in the ED (1.002, 95% CI 1.00 to 1.004), Injury Severity Score (1.007, 95% CI 1.00 to 1.01), and intubation in the ED (1.21, 95% CI 1.10 to 1.34). However, history of psychiatric diseases was not a significant factor. Conclusion An increase in NRF was associated with an increase in LOS of patients injured by intentional falls from a height. This finding can help both emergency physicians and psychiatrists in acute care hospitals to develop better treatment strategies with attention to time constraints. Further investigation of the association between LOS and both trauma and psychiatric treatment is required to evaluate the effect of NRF on treatment in acute care hospitals. Level of evidence Level III, retrospective study with up to two negative criteria.
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Affiliation(s)
- Takero Terayama
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan
| | - Hiroyuki Toda
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan
| | - Masanobu Nagamine
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Yoshihiro Tanaka
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Daizoh Saitoh
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Aihide Yoshino
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan
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Kort I, Belhaj A, Kebsi D, Gharbaoui M, Bellali M, Allouche M. A 13-Year Study of Fatal Falls From Height in Northern Tunisia. Am J Forensic Med Pathol 2022; 43:340-346. [PMID: 35642789 DOI: 10.1097/paf.0000000000000769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Falls from height are a major cause of unintentional injury death, resulting in high disability and mortality. We investigated the characteristics of fatal falls and their relationship with intentionality, injury patterns, and death on impact. MATERIALS AND METHODS In this retrospective study, we examined 545 cases of fatal falls from height that underwent autopsy in the forensic department of the Charles Nicolle hospital of Tunis (Tunisia) between January 2008 and December 2020. Cases were reviewed in terms of demographics, fall characteristics, and autopsy findings. RESULTS The population was predominately male (86.6%). Four hundred twenty-one (77.3%) originated from accidents, 120 (22%) were found to be suicidal, with 4 homicide cases. A notable decline in cases was noticed following the Jasmine revolution, 2011 (R squared = 0.8). The mean height of falls was 8 m. Higher falls were associated with a set of organ-specific injuries. Organ injury pattern did not differ based on intentionality. Female victims were 2.4 times more likely to sustain pelvic injuries than males. The majority of victims deceased before reaching health care structures. Death on impact was strongly associated with higher falls, cranial impact, and organ-specific injuries, including cardiac, pulmonary, and skull injuries.Falls from height are in many cases preventable. A clearly defined fall safety policy, strict implementation of evidence-based interventions, efficient allocation of resources, and raising safety awareness must to be urgently implemented. CONCLUSION Understanding patterns of injury and the factors that influence death on impact may be of further interest in the prevention and management of survivors in the acute period.
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Affiliation(s)
- Ikram Kort
- From the Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Azza Belhaj
- From the Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Dhouha Kebsi
- From the Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
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Tsellou M, Dona A, Antoniou A, Goutas N, Skliros E, Papadopoulos IN, Spiliopoulou C, Papadodima SA. A comparative autopsy study of the injury distribution and severity between suicidal and accidental high falls. Forensic Sci Med Pathol 2022; 18:407-414. [PMID: 35771377 DOI: 10.1007/s12024-022-00496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
Falls are the second cause of accidental deaths worldwide. Falls from height are also a common method of suicide. The aim of this study is to compare the characteristics of the victims, the circumstances of the fall and the severity and distribution of the injuries reported in an autopsy case series of falls from height. This study is a retrospective analysis of consecutive autopsy cases of suicidal and accidental falls from height which were investigated in the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens during the period 2011-2019. The recorded variables included demographic data of the victim, height of fall, length of hospital stay, toxicological results, the existence and location of injuries and Injury Severity Score (ISS). Victims of suicidal falls were younger (55.53 vs. 62.98, p = 0.001), they fell from higher heights (12.35 vs. 5.18 m, p < 0.001), and they sustained more severe injuries compared with victims of accidental falls (ISS 51.01 vs. 40.88, p < 0.001). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequently observed after a suicidal fall (93.6% vs. 67.3%, 72.1% vs. 21.4%, 72.1% vs. 27.6%, 42.9% vs. 15.3%, 45.7% vs. 13.3%, respectively-p < 0.001), probably due to the higher height of fall. Our study outlines the differences in the profile of the victims and in the severity of injuries caused by falls from height depending on the intention of the victim to fall. However, a distinctive injury pattern in victims of suicidal falls was not demonstrated.
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Affiliation(s)
- Maria Tsellou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemis Dona
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Goutas
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Papadodima
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece.
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Fujii M, Shirakawa T, Nakamura M, Baba M, Hitosugi M. Factors influencing the injury severity score and the probability of survival in patients who fell from height. Sci Rep 2021; 11:15561. [PMID: 34330987 PMCID: PMC8324820 DOI: 10.1038/s41598-021-95226-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
In Japan, falls from height result in the second highest trauma mortality rate after traffic motor vehicle collisions and the highest trauma-related mortality rate amongst young people. We aimed to identify factors that worsen injury severity and lower survival probability of patients who fell from height and to contribute to the improvement of their prehospital and in-hospital care. This retrospective analysis retrieved hospital records of 179 patients aged ≥ 15 years who were transported to our hospital after a fall from height during April 2014–March 2020. On multiple regression analysis, fall height ≥ 5 m more significantly resulted in higher the injury severity score. Logistic regression analysis revealed that fall height ≥ 5 m with the reference of 2–3 m significantly resulted in lower the survival probability with odds ratio (95% confidence interval) of 0.10 (0.02–0.55). Using ‘feet-first’ as the reference body position, the odds ratios (95% confidence interval) of survival for those who impacted the surface on the lateral or dorsal regions were 0.11 (0.02–0.64) and 0.17 (0.03–0.99), respectively. Collecting information on the abovementioned factors at pre-hospitalisation may facilitate prompt diagnosis and treatment. These results may help improve prehospital and in-hospital care, avoiding preventable trauma deaths.
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Affiliation(s)
- Masashi Fujii
- Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae, Nagahama, Otsu, Shiga, 526-8585, Japan. .,Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | - Tsutomu Shirakawa
- Department of Orthopaedic Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mineko Baba
- Centre for Integrated Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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Çakı İE, Karadayı B, Çetin G. Relationship of injuries detected in fatal falls with sex, body mass index, and fall height: An autopsy study. J Forensic Leg Med 2021; 78:102113. [PMID: 33485089 DOI: 10.1016/j.jflm.2020.102113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/24/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
Falls from height are the most common cause of blunt trauma after traffic accidents. The focus of this retrospective study was to analyze the relationship between injuries in fatal falls and fall height, body mass index (BMI), and sex in 206 autopsy reports. Age, sex, weight, height, place of the fall, fall height, period between the incidence and death, external examination findings in the autopsy, intracranial findings, fractures, internal organ injuries, and information about the causes of death were recorded. Accidents and men were the largest groups. Injuries to the upper and lower extremities were frequently detected in accidents. Lower extremity injuries were more common in women. The occurrence of head and neck injuries were rare in overweight individuals. When evaluated by manner of death, there were differences in extremities and posterior body injuries. There was no difference between sex in terms of autopsy findings. It was observed that the injuries increased as the height increased. There was a statistical difference between the BMI groups in terms of liver, rib and sternum injuries. The most common cause of death was head injuries. Many factors have been known to affect injury patterns in cases of falls from height. Fall height, BMI, and gender are just a few of these factors. This study will be beneficial to support the findings of this study with larger-scale studies and statistical modeling that consider more factors affecting injuries in cases of falls.
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Affiliation(s)
| | - Beytullah Karadayı
- Istanbul University-Cerrahpaşa, Cerrahpasa Faculty of Medicine, Forensic Medicine Department, 34303, Istanbul, Turkey.
| | - Gürsel Çetin
- Istanbul University-Cerrahpaşa, Cerrahpasa Faculty of Medicine, Forensic Medicine Department, 34303, Istanbul, Turkey.
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Al-Thani H, Mekkodathil A, Consunji R, Mollazehi M, Ammar AA, Parchani A, Jogol H, Hakim SY, Kanbar A, El-Menyar A. Traumatic injuries associated with suicide attempts: A retrospective study from single national level 1 trauma center. Int J Crit Illn Inj Sci 2020; 10:92-98. [PMID: 32904460 PMCID: PMC7456287 DOI: 10.4103/ijciis.ijciis_64_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Suicide is a complex phenomenon involving several risk factors. We aimed to describe the frequency, pattern, and outcomes of patients with traumatic injuries following suicide attempts admitted to a level 1 trauma center. Methods: We conducted a retrospective analysis of data obtained from Qatar National Trauma Registry and mortuary database. The study included all patients with traumatic injuries following suicide attempts, admitted to the Hamad Trauma Center (HTC) from April 2008 to March 2018. Results: During this 10–year period, 206 patients were admitted to the HTC for injuries associated with suicide attempts. The majority were males (76%), young age (mean age 31 years), and expatriates specifically from South Asia (55%). The most common injury was due to self-inflicted cutting and piercing (51%) followed by jumping from height (30%). Females chose jumping from high place more often as a method of suicide attempt (59% vs. 20%), while males chose self-stabbing or cutting their throat (59% vs. 25%) (P = 0.001). Most of the patients had head injuries (30%) that was severe in terms of abbreviated injury scale score (3.6 ± 0.9). More than half (54%) of the patients required psychiatric consultations. The in-hospital mortality was 8% which was comparable in both genders. Conclusions: The present study revealed that 1.8% of trauma admissions at HTC were related to suicidal attempts. Better understanding of risk factors is important in devising preventive strategies.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Injury Prevention Program, Hamad General Hospital, Doha, Qatar
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, National Trauma Registry, Hamad General Hospital, Doha, Qatar
| | - Adham A Ammar
- Laboratory Department, Clinical Services Unit, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Hisham Jogol
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Suhail Y Hakim
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahad Kanbar
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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Effect of Height of Fall on Mortality in Patients with Fall Accidents: A Retrospective Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114163. [PMID: 32545236 PMCID: PMC7312001 DOI: 10.3390/ijerph17114163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 12/03/2022]
Abstract
Background: Accidental falls are a common cause of injury and deaths. Both ground-level falls (GLF) and non-GLF may lead to significant morbidity or mortality. This study aimed to explore the relationship between height of falls and mortality. Method: This is a retrospective study based on the data from a registered trauma database and included 8699 adult patients who were hospitalized between 1 January 2009 and 31 December 2017 for the treatment of fall-related injuries. Study subjects were divided into three groups of two categories based on the height of fall: GLF (group I: < 1 m) and non-GLF (group II: 1–6 m and group III: > 6 m). The primary outcome was in-hospital mortality. The adjusted odds ratio (AOR) of mortality adjusted for age, sex, and comorbidities with or without an injury severity score (ISS) was calculated using multiple logistic regression. Results: Among the 7001 patients in group I, 1588 in group II, and 110 in group III, patients in the GLF group were older, predominantly female, had less intentional injuries, and had more pre-existing comorbidities than those in the non-GLF group. The patients in the non-GLF group had a significantly lower Glasgow Coma Scale (GCS), a higher injury severity score (ISS), worse physiological responses, and required more procedures performed in the emergency department. The mortality rate for the patients in group I, II, and III were 2.5%, 3.5%, and 5.5%, respectively. After adjustment by age, sex, and comorbidities, group II and group III patients had significantly higher adjusted odds of mortality than group I patients (AOR 2.2, 95% CI 1.64–2.89, p < 0.001 and AOR 2.5, 95% CI 1.84–3.38, p < 0.001, respectively). With additional adjustment by ISS, group II did not have significantly higher adjusted odds of mortality than group I patients (AOR 1.4, 95% CI 0.95–2.22, p = 0.082), but group III patients still had significantly higher adjusted odds of mortality than group I patients (AOR 10.0, 95% CI 2.22–33.33, p = 0.002). Conclusion: This study suggested that patients who sustained GLF and non-GLF were distinct groups of patients, and the height of fall did have an impact on mortality in patients of fall accidents. A significantly higher adjusted odds of mortality was found in the GLF group than in the non-GLF group after adjusting for age, sex, and comorbidities.
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Kaiser S, Yacob M, Abhilash KPP. Profile and outcome of patients with ground-level falls. J Family Med Prim Care 2020; 9:614-618. [PMID: 32318391 PMCID: PMC7113992 DOI: 10.4103/jfmpc.jfmpc_1110_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A ground-level fall is one of the most common modes of injury sustained across all age groups. For older adults, ground level falls can result in multiple injuries and are associated with significant morbidity and mortality. METHODOLOGY This retrospective observational study included all patients presenting with fall from a ground level to our emergency department (ED) from January 2018 to December 2018. Demographics, details of incident, severity of injury, and outcome were analyzed. RESULTS During the study period, 596 patients with a mean age of 40.9 (standard deviation [SD]: 25.9) years were included in the analysis. A quarter (23%) were aged less than 15 years, while the elderly (>60 years) comprised of 29.5%. Half the patients were triaged as priority 2 (53.8%). The lower limbs (36.6%), upper limbs (23.9%), and face (15.3%) were the body areas that were most commonly injured. The new injury severity score (NISS) was more than 8 in 28% of patients. Multivariate logistic regression analysis showed the elderly (>60 years) to have a higher odds (2.51 95% confidence interval [CI]: 1.57-4.02) of sustaining a fracture of a dislocation. One fifth of the patients (120/596; 20.1%) required hospital admission with only one fatality. Fifteen patients (2.5%) left the hospital against medical advice. Two-thirds (66.3%) required only conservative management, while 19.9% required major surgical intervention. CONCLUSION A ground-level fall is a common mode of injury in children (<15 years) and the elderly (>60 years). The extremities and face are the most common areas of the body that are prone to injuries. Age-friendly infrastructure modifications at home, work places, and in public areas for elders and ensuring playground safety for children are the needs of the hour to decrease falls on level ground.
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Affiliation(s)
- Salma Kaiser
- Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Myla Yacob
- Department of General Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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Rowbotham SK, Blau S. The circumstances and characteristics of fatal falls in Victoria, Australia: a descriptive study. AUST J FORENSIC SCI 2016. [DOI: 10.1080/00450618.2016.1194472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Samantha K. Rowbotham
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Soren Blau
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria 3006, Australia
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12
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Rowbotham SK, Blau S. Skeletal fractures resulting from fatal falls: A review of the literature. Forensic Sci Int 2016; 266:582.e1-582.e15. [PMID: 27264682 DOI: 10.1016/j.forsciint.2016.04.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 02/11/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Abstract
To investigate what is currently known about skeletal blunt force trauma (BFT) resulting from falls, and how valuable that research is in contributing to forensic anthropology investigations and interpretations of circumstances of death, a comprehensive review of forensic anthropology, forensic pathology and clinical medicine literature was performed. Forensic anthropology literature identified that establishing the type of fall from the analysis of BFT is difficult given the uniqueness of each fall event, the complexities involved with identify BFT and, in particular, the limited available research documenting fracture patterning and morphologies. Comparatively, skeletal BFT resulting from fatal falls is well documented in the forensic pathology and clinical medicine literature. These disciplines cover a wide range of fall types (free falls, falls in juveniles, specific fractures produced from falls, falls down staircases, falls resulting in impalements, and 'other' fall types), provide details on how the nature of the fall influences the skeletal fracturing, and documents the anatomical regions susceptible to fracturing. Whilst these contributions may assist forensic anthropologists, they provide limited details of fracture patterns and morphologies and thus further research investigating the details of skeletal BFT resulting from fatal falls is required.
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Affiliation(s)
| | - Soren Blau
- Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, Australia
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Rocos B, Chesser TJ. Injuries in jumpers - are there any patterns? World J Orthop 2016; 7:182-187. [PMID: 27004166 PMCID: PMC4794537 DOI: 10.5312/wjo.v7.i3.182] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/31/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
Suicide as a cause of death, affects every health system, and is a particular problem in heavily urbanised states and low and middle income countries (which account for 75% of suicide deaths). The World Health Organisation records that 800000 commit suicide each year, representing 1.4% of annual global deaths, and that suicide was the second leading cause of death in 15-29 year-olds across the world in 2012. In the United Kingdom, jumping from height accounts for 3%-5% of the 140000 suicide attempts annually is similar incidence to the rest of Europe. The Medline and EMBASE were interrogated for studies examining suicide caused by jumping from height. Manual screening of titles and abstracts was used to identify relevant works before data was extracted and systematically reviewed to identify the characteristics of a patient who jumps from height to commit suicide, delineate their patterns of injury and explore techniques that could be used to limit its occurrence. Emergency departments receiving patients who jump from a height need to have an understanding of the potential pathology that is likely to be encountered in order to deliver multidisciplinary, efficient and timely care in order that the impact of this devastating physical, psychological and social problem could modified to the benefit of the patients involved.
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Rocos B, Acharya M, Chesser TJS. The Pattern of Injury and Workload Associated with Managing Patients After Suicide Attempt by Jumping from a Height. Open Orthop J 2015; 9:395-8. [PMID: 26401162 PMCID: PMC4578128 DOI: 10.2174/1874325001509010395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of this study is to examine the pattern of injuries sustained and the hospital workload generated by patients who deliberately jump from height. METHOD One regional trauma centre's admissions were scrutinized to find all patients who jumped, or were suspected of jumping from one storey or greater over a four year period. Patients who died prior to admission were excluded. RESULTS 41 patients were included. Each patient suffered a mean of 3 injuries. The probability of calcaneal fracture was 0.32, of ankle injury 0.2, tibial fracture 0.2, femoral fracture 0.17, pelvic fracture 0.34, spinal injury 0.51, upper limb injury 0.26, head injury 0.2 and trunk injury 0.32. The mean length of inpatient stay was 7.9 days, rising to 17.9 for the 11 patients requiring intensive care. The average number of operations per patient was 1.5. CONCLUSION Patients who jump from height generate large volumes of operative and inpatient workloads. Our data show that there may be a protective effect of limb trauma against lethal head, chest or pelvic injury. Injury to the upper limb is associated with a 4 times greater risk of head injury. The incidence of pelvic injury in this series is higher than in previous work. There was a high incidence of spinal fracture. Patients generated 64 surgical procedures and consumed a mean of 17.9 inpatient days, including prolonged stay in intensive care.
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Affiliation(s)
- B Rocos
- Department of Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - M Acharya
- Department of Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - T J S Chesser
- Department of Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
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Kafadar S, Kafadar H. The medico-legal evaluation of injuries from falls in pediatric age groups. J Forensic Leg Med 2015; 31:52-5. [PMID: 25735785 DOI: 10.1016/j.jflm.2015.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/18/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022]
Abstract
Blunt trauma from accidental falls or intentional jumping from great heights occurs frequently in forensic medicine. The goal of this study was to investigate injuries due to falls in children under 19 years of age. Injuries from falls are the leading cause of visits to emergency departments and to deaths due to injuries. Various methods are used in the classification of falls. In this study, we have classified falls as "high-level" (≥ 5 m), "low-level" (<5 m) and "ground-level". We have retrospectively evaluated 814 boys (61.18%) and 512 girls (38.62%), making up a total of 1326 children (under 19 years old) with the mean age of 7.85 ± 3.46, that were admitted to State Hospital between January 2009 and December 2013 due to falls from heights and falls on ground-level. Falls were low-level in 738 cases, high-level in 176 cases, and ground-level in 412 cases. Cases were categorized by gender, age, age group, fall height, Glasgow Coma Scale (GCS), injured body part(s), mortality rate, and distribution according to months. In conclusion, falls merit attention because of their high risk of mortality and morbidity, as well as their burden on medical budgets. If the medico-legal aspects of falls were evaluated with regard to preventive event or death, the importance of the topic could be better understood.
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Affiliation(s)
| | - Hüseyin Kafadar
- Firat University, Department of Forensic Medicine, 23110, Elazığ, Turkey.
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Fall from height in a stairwell – mechanics and simulation analysis. Forensic Sci Int 2014; 244:136-51. [DOI: 10.1016/j.forsciint.2014.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/25/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022]
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Pérez-Suárez E, Jiménez-García R, Iglesias-Bouzas M, Serrano A, Porto-Abad R, Casado-Flores J. Caídas desde grandes alturas en Pediatría. Epidemiología y evolución de 54 pacientes. Med Intensiva 2012; 36:89-94. [DOI: 10.1016/j.medin.2011.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/09/2011] [Accepted: 08/30/2011] [Indexed: 11/25/2022]
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Etiologic factors in falls from height in pediatric cases. Eur J Trauma Emerg Surg 2012; 38:313-7. [PMID: 26815964 DOI: 10.1007/s00068-011-0172-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 12/11/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE In this study, factors causing falls from height and precautions taken for their prevention were investigated. METHODS The study was carried out prospectively between June 2009 and June 2010. Patients under 18 years of age presenting at the emergency department of a university hospital, for whom the primary reason for admission was an accidental fall from a height of at least one meter, were included in the study. The demographic characteristics of the patients, the characteristics of the falls, and clinical features were recorded. RESULTS Data for 133 patients were evaluated. Among these patients, 72 (54.1%) were male; the median age was 4 (IQR 2-7). The most common fall site was a balcony (38%). Falls frequently happened in the spring and the summer. The mean fall height was 2.9 ± 2.5 m, the median GCS score was 15 (IQR 14-15), and the median PTS was 10 (IQR 9-11). The fall heights was higher in patients who lost consciousness (p < 0.001). Among the 95 patients who were 0-6 years old, it was found that about 55% were unaccompanied by their parents. The most common pathology in the patients was head trauma (63%), while 17.3% had multiple traumas. CONCLUSION Since the vast majority of the fall cases were in the pre-school age group, most were due to falls from a balcony, and more than half of the cases were unaccompanied by parents or caregivers, there are two issues that need to be addressed in relation to pediatric falls from height: family education and legal regulations considering child safety in the design of doors, windows, and balconies of buildings.
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Borg T, Holstad M, Larsson S. Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping. Scand J Surg 2010; 99:180-6. [PMID: 21044937 DOI: 10.1177/145749691009900314] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS jumping from great height is an aggressive method of suicide attempt where the frequent combination of psychiatric disorder and somatic injuries makes treatment difficult. Our aim was to evaluate survival rate and get patient-reported outcome in patients operated for a pelvic or acetabular fracture sustained when jumping from a height as a suicide attempt. PATIENTS AND METHODS during the period 2003-2004, 12 patients (11 women) of whom eight were below 30 years of age, were prospectively included. At two years HRQoL (Health-Related Quality of Life) questionnaires (SF-36 and LiSat-11) were used to describe outcome, and at four years a structured psychiatric interview SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) was done. RESULTS at four years all patients were alive. One patient had made a new suicide attempt. Eight patients gave adequate reply on SF-36 and LiSat-11 at two years. In all domains patients scored lower than a norm group with the relatively lowest values in physical domains. Younger patients assessed life as better when compared with middle aged patients. CONCLUSIONS this study showed a very low recurrence rate into suicidal behaviour in a group of jumpers and all patients were alive at four years after a suicidal attempt by jumping. The high proportion of psychiatric disorder in these patients highlights the need for a combined treatment effort between orthopaedic and psychiatric expertise.
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Affiliation(s)
- T Borg
- Department of Orthopaedic Surgery, Uppsala University, Uppsala, Sweden.
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Jacobsen C, Schön CA, Kneubuehl B, Thali MJ, Aghayev E. Unusually extensive head trauma in a hydraulic elevator accident: Post-mortem MSCT findings, autopsy results and scene reconstruction. J Forensic Leg Med 2008; 15:462-6. [DOI: 10.1016/j.jflm.2008.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 03/06/2008] [Indexed: 11/25/2022]
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Bulut M, Koksal O, Korkmaz A, Turan M, Ozguc H. Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score. Emerg Med J 2006; 23:540-5. [PMID: 16794098 PMCID: PMC2579549 DOI: 10.1136/emj.2005.029439] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to determine the general characteristics of childhood falls, factors affecting on mortality, and to compare the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) as predictors of mortality and length of hospital stay in childhood falls. METHODS We retrospectively analysed over a period of 8 years children aged younger than14 years who had sustained falls and who were admitted to our emergency department. Data on the patients' age, sex, type of fall, height fallen, arrival type, type of injuries, scoring systems, and outcome were investigated retrospectively. The ISS and NISS were calculated for each patient. Comparisons between ISS and NISS for prediction of mortality were made by receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (HL) goodness of fit statistics. RESULTS In total, there were 2061 paediatric trauma patients. Falls comprised 36 (n = 749) of these admissions. There were 479 male and 270 female patients. The mean (SD) age was 5.01 (3.48) years, and height fallen was 3.8 (3) metres. Over half (56.6%) of patients were referred by other centres. The most common type of fall was from balconies (38.5%), and head trauma was the most common injury (50%). The overall mortality rate was 3.6%. The cut off value for both the ISS and NISS in predicting mortality was 22 (sensitivity 90.5%, specificity 95.4% for ISS; sensitivity 100%, specificity 88.7% for NISS) (p>0.05). Significant factors affecting mortality in logistic regression analysis were Glasgow Coma Scale (GCS) <9, ISS >22, and NISS >22. There were no significant differences in ROC between three scoring systems. The HL statistic showed poorer calibration (p = 0.02 v p = 0.37, respectively) of the NISS compared with the ISS. CONCLUSIONS In our series, the head was the most frequent site of injury, and the most common type of fall was from balconies. Scores on the GCS, NISS, and ISS are significantly associated with mortality. The performance of the NISS and ISS in predicting mortality in childhood falls was similar.
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Affiliation(s)
- M Bulut
- Department of Emergency Medicine, Uludag University Medical School, Bursa, Turkey.
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Yagmur Y, Güloğlu C, Aldemir M, Orak M. Falls from flat-roofed houses: a surgical experience of 1643 patients. Injury 2004; 35:425-8. [PMID: 15037379 DOI: 10.1016/s0020-1383(03)00198-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2003] [Indexed: 02/02/2023]
Abstract
PURPOSE High falls from flat-roofed houses are a common cause of death and disability in the south-east part of Turkey; the aim of this study was to describe our experience of such falls seen over a 4-year period in Diyarbakir. METHODS One thousand six hundred and forty-three patients (570 females and 1073 males) who sustained injuries after an accidental fall from a flat-roofed house were entered into the study. RESULTS The mean age was 18 (1-95) years; 49.4% of patients were under 10 years old; 81.5% were under 30 years old. The mean fall height was 4.5m (1-20 m). The mortality rate was 5.8% (96 patients). The mean fall height in children under the age of 15 years who died from the fall was 4m (67 patients) and in patients over the age of 15 years, 9m (29 patients). The most common injuries were to the head (45.1%) and 93.75% of those (n = 90) who died had a head injury. One hundred patients (6%) were followed because of abdominal bleeding: one of these had fallen from 2m, the reminder from 4 to 9 m; 12 were operated on and 88 treated conservatively. CONCLUSION Craniocerebral trauma is the most common injury in fatal falls from flat roofs and blunt abdominal trauma is an uncommon injury after falling from less than 4m.
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Affiliation(s)
- Yusuf Yagmur
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey.
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