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Çakmur BB, Duramaz A, Çakmur KN, Duramaz A. Do the management and functional outcomes of the surgically treated spinal fractures change in suicidal jumpers? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3695-3702. [PMID: 38652295 DOI: 10.1007/s00586-024-08259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/20/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The aim of the study was to determine the effect of trauma etiology on the management, functional outcomes and psychiatric characteristics of suicide jumpers and patients who accidentally fall from height. METHODS 89 patients (48 accidental falls and 41 suicidal jumpers) who had undergone spinal surgery were included in the study. The patients were evaluated clinically and radiologically. Visual Analog Scale (VAS), Roland Morris Disability Questionnaire (RMDQ) and McGill Pain Questionnaire (MPQ) were performed for functional evaluation. BECK hopelessness scale (BHS), BECK depression inventory (BDI), and SF-36 scales were used for the psychiatric evaluation. All outcomes were compared between suicidal jumpers and accidental falls. RESULTS The RMDQ and ODI questionnaires stated a higher disability in the suicide jump group (p = 0.001 and p = 0.029, respectively). However, the VAS and MPQ questionnaires did not differ in significance between groups (p = 0.182 and p = 0.306, respectively). The SF-36 scale showed that physical function, role emotional, vitality and mental health subdomains were worse in the suicide jump group (p = 0.001, p = 0.029, p = 0.014 and p = 0.030, respectively). BDI scores were significantly higher in the suicide jump group while no difference was observed between the groups in terms of BSH (p = 0.017 and p = 0.940, respectively). CONCLUSION Psychiatric disorders are more common in patients in the suicidal jumpers. The presence of underlying psychiatric problems adversely affects the postoperative functional outcomes of patients with surgically treated spinal fractures. A multidisciplinary approach together with raising awareness in this way can improve the clinical outcomes after orthopedic treatment, even if there is physical disability.
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Affiliation(s)
- Başar Burak Çakmur
- Department of Orthopedics and Traumatology, Hamidiye Medical School, Istanbul Başakşehir Çam ve Sakura City Hospital, University of Health Sciences, Başakşehir St., G-434 Ave., Number 2L Başakşehir, 34494, Istanbul, Turkey
| | - Altuğ Duramaz
- Department of Orthopedics and Traumatology, Hamidiye Medical School, Bakırköy Dr. Sadi Konuk Education and Research Hospital, University of Health Sciences, Tevfik Sağlam St. Number 11, Bakırköy, 34147, Istanbul, Turkey.
| | - Kadriye Nur Çakmur
- Department of Psychiatry, Hamidiye Medical School, Bakırköy Prof Mazhar Osman Education and Research Hospital for Psychiatry Neurology and Neurosurgery, University of Health Sciences, Tevfik Sağlam St. Number 11 Bakırköy, 34147, Istanbul, Turkey
| | - Altan Duramaz
- Republic of Turkey Ministry of National Education, Gazi Mustafa Kemal Street, Number 1 Yenişehir, 27090, Mersin, Turkey
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Riva HR, Polmear MM, Petersen C, Guillet JY, Yong TM, Adler AH, Rajani R, Singh V, Wang DCS. Spine Injuries Sustained After Falls While Crossing the U.S.-Mexico Border. Neurotrauma Rep 2024; 5:367-375. [PMID: 38655116 PMCID: PMC11035857 DOI: 10.1089/neur.2024.0035] [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] [Indexed: 04/26/2024] Open
Abstract
This study is to report the demographics, incidence, and patterns of spinal injuries associated with border crossings resulting from a fall from a significant height. A retrospective cohort study was performed at a Level I trauma center from January 2016 to December 2021 to identify all patients who fell from a significant height while traversing the U.S.-Mexico border and were subsequently admitted. A total of 448 patients were identified. Of the 448 patients, 117 (26.2%) had spine injuries and 39 (33.3%) underwent operative fixation. Females had a significantly higher incidence of spine injuries (60% vs. 40%; p < 0.00330). Patients with a spine fracture fell from a higher median fall height (6.1 vs. 4.6 m; p < 0.001), which resulted in longer median length of stay (LOS; 12 vs. 7 days; p < 0.001), greater median Injury Severity Score (ISS; 20 vs. 9; p < 0.001), and greater relative risk (RR) of ISS >15 (RR = 3.2; p < 0.001). Patients with operative spine injuries had significantly longer median intensive care unit (ICU) LOS than patients with non-operative spine injuries (4 vs. 2 days; p < 0.001). Patients with spinal cord injuries and ISS >15 sustained falls from a higher distance (median 6.1 vs. 5.5 m) and had a longer length of ICU stay (median 3 vs. 0 days). All patients with operative spine injuries had an ISS >15 relative to 50% of patients with non-operative spine injuries (median ISS 20 vs. 15; p < 0.001). Patients with spine trauma requiring surgery had a higher incidence of head (RR = 3.5; p 0.0353) and chest injuries (RR = 6.0; p = 0.0238), but a lower incidence of lower extremity injuries (RR = 0.5; p < 0.001). Thoracolumbar injuries occurred in 68.4% of all patients with spine injuries. Patients with operative spine injuries had a higher incidence of burst fracture (RR = 15.5; p < 0.001) and flexion-distraction injury (RR = 25.7; p = 0.0257). All patients with non-operative spine injuries had American Spinal Injury Association (ASIA) D or E presentations, and patients with operative spine injuries had a higher incidence of spinal cord injury: ASIA D or lower at time of presentation (RR = 6.3; p < 0.001). Falls from walls in border crossings result in significant injuries to the head, spine, long bones, and body, resulting in polytrauma casualties. Falls from higher height were associated with a higher frequency and severity of spinal injuries, greater ISS, and longer ICU length of stay. Operative spine injuries, compared with non-operative spine injuries, had longer ICU length of stay, greater ISS, and different fracture morphology. Spine surgeons and neurocritical care teams should be prepared to care for injuries associated with falls from height in this unique population.
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Affiliation(s)
- Hannah R. Riva
- Paul L. Foster School of Medicine, El Paso, Texas, USA
- Division of Neurosurgery, University Medical Center, El Paso, Texas, USA
| | | | | | - June Y. Guillet
- Division of Neurosurgery, University Medical Center, El Paso, Texas, USA
| | | | - Adam H. Adler
- Division of Orthopaedic Surgery, El Paso, Texas, USA
| | - Rajiv Rajani
- Division of Orthopaedic Surgery, El Paso, Texas, USA
| | - Vishwajeet Singh
- Biostatistics and Epidemiology Consulting Lab; Texas Tech University Health Sciences Center, El Paso, Texas, USA
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Rieger LK, Shah A, Schick S, Draper DB, Cutlan R, Peldschus S, Stemper BD. Subject-Specific Geometry of FE Lumbar Spine Models for the Replication of Fracture Locations Using Dynamic Drop Tests. Ann Biomed Eng 2024; 52:816-831. [PMID: 38374520 DOI: 10.1007/s10439-023-03402-y] [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: 04/19/2023] [Accepted: 10/28/2023] [Indexed: 02/21/2024]
Abstract
For traumatic lumbar spine injuries, the mechanisms and influence of anthropometrical variation are not yet fully understood under dynamic loading. Our objective was to evaluate whether geometrically subject-specific explicit finite element (FE) lumbar spine models based on state-of-the-art clinical CT data combined with general material properties from the literature could replicate the experimental responses and the fracture locations via a dynamic drop tower-test setup. The experimental CT datasets from a dynamic drop tower-test setup were used to create anatomical details of four lumbar spine models (T12 to L5). The soft tissues from THUMS v4.1 were integrated by morphing. Each model was simulated with the corresponding loading and boundary conditions from the dynamic lumbar spine tests that produced differing injuries and injury locations. The simulations resulted in force, moment, and kinematic responses that effectively matched the experimental data. The pressure distribution within the models was used to compare the fracture occurrence and location. The spinal levels that sustained vertebral body fracture in the experiment showed higher simulation pressure values in the anterior elements than those in the levels that did not fracture in the reference experiments. Similarly, the spinal levels that sustained posterior element fracture in the experiments showed higher simulation pressure values in the vertebral posterior structures compared to those in the levels that did not sustain fracture. Our study showed that the incorporation of the spinal geometry and orientation could be used to replicate the fracture type and location under dynamic loading. Our results provided an understanding of the lumbar injury mechanisms and knowledge on the load thresholds that could be used for injury prediction with explicit FE lumbar spine models.
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Affiliation(s)
- Laura K Rieger
- Biomechanics and Accident Analysis, Ludwig-Maximilians-Universität (LMU), Munich, Germany.
- Occupant Protection System & Virtual Function Development, Volkswagen AG, Letter Box 011/1606, 38436, Wolfsburg, Germany.
| | - Alok Shah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
- Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Sylvia Schick
- Biomechanics and Accident Analysis, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Dustin B Draper
- Biomechanics and Accident Analysis, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Rachel Cutlan
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steffen Peldschus
- Biomechanics and Accident Analysis, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Brian D Stemper
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
- Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
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Lambe G, Dempsey P, Bolger M, Bolster F. Self-harm, suicide and brain death: the role of the radiologist. Clin Radiol 2024; 79:239-249. [PMID: 38341342 DOI: 10.1016/j.crad.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Suicide is a leading cause of death worldwide and takes many forms, which include hanging, jumping from a height, sharp force trauma, ingestion/poisoning, drowning, and firearm injuries. Self-harm and suicide are associated with particular injuries and patterns of injury. Many of these patterns are apparent on imaging. Self-harm or suicidal intent may be overlooked initially in such cases, particularly when the patient is unconscious or uncooperative. Correct identification of these findings by the radiologist will allow a patient's management to be tailored accordingly and may prevent future suicide attempts. The initial role of the radiologists in these cases is to identify life-threatening injuries that require urgent medical attention. The radiologist can add value by drawing attention to associated injuries, which may have been missed on initial clinical assessment. In many cases of self-harm and suicide, imaging is more reliable than clinical assessment. The radiologist may be able to provide important prognostic information that allows clinicians to manage expectations and plan appropriately. Furthermore, some imaging studies will provide essential forensic information. Unfortunately, many cases of attempted suicide will end in brain death. The radiologist may have a role in these cases in identifying evidence of hypoxic-ischaemic brain injury, confirming a diagnosis of brain death through judicious use of ancillary tests and, finally, in donor screening for organ transplantation. A review is presented to illustrate the imaging features of self-harm, suicide, and brain death, and to highlight the important role of the radiologist in these cases.
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Affiliation(s)
- G Lambe
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - P Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - M Bolger
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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Jun J, Lee JH, Han J, Kim SH, Kim S, Cho GC, Park EJ, Lee DH, Hong JY, Kim MJ. Characteristics of fall-from-height patients: a retrospective comparison of jumpers and fallers using a multi-institutional registry. Clin Exp Emerg Med 2024; 11:79-87. [PMID: 38018072 PMCID: PMC11009701 DOI: 10.15441/ceem.23.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. METHODS This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. RESULTS Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746-9.240). CONCLUSION Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.
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Affiliation(s)
- Jinhae Jun
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Juhee Han
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sunpyo Kim
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Eun Jung Park
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ju Young Hong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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Polmear MM, Nicholson TC, Blair JA, Thabet AM, Adler AH, Rajani R. Injuries Sustained With Falls From Height in Crossing the United States-Mexico Border at a Level I Trauma Center: A Prospective Cohort Study. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00004. [PMID: 37285513 DOI: 10.5435/jaaosglobal-d-23-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/04/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The US Department of Homeland Security has reported increases in encounters and apprehensions at the US Southwest border for the past several years. The purposes of this study were to assess the demographics, patterns of injuries, and surgical interventions, associated with falls from height along the US-Mexico border. METHODS A prospective cohort study was conducted at a Level I trauma center from January 2016 through December 2021 of all patients who fell from height crossing the US-Mexico border and presented with injuries requiring admission. RESULTS A total of 448 patients were admitted with a median age of 30 years (interquartile range [IQR] 16, range 6 to 65). Monthly frequency of admissions increased markedly with a median of 18.5 (IQR 5.3) in 2021. Patients presented with limited health data, and comorbidities were identified in 111 patients (24.7%). Median height fallen was 5.5 m (18 ft). Patients sustaining a fall from ≥ 5.5 m were markedly more likely to have an Injury Severity Score (ISS) of > 15. Median length of stay was 9 days (IQR 11). There were a total of 1,066 injuries with 723 extremity and pelvic; 236 spine; and 107 head or neck, face, thorax, or abdominal injuries. Median ISS was 9.0 (IQR 7, range 1 to 75, 33% > 15). Tibial plafond fracture and spine injury were markedly associated with longer lengths of stay and ISS > 15. All injuries resulted in 635 separate surgical events and 930 procedures. Clinical follow-up occurred in 55 patients (12.2%), with median duration of 28 days (range 6 days to 8 months). DISCUSSION Injuries associated with border crossings and falls from height were serious and increased in frequency. As the US policy on border security evolves, surgeons in these regions should be prepared to handle the associated injuries and sequelae. Prevention of these serious and debilitating injuries should be undertaken to decrease the burden of disease.
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Affiliation(s)
- Michael M Polmear
- From theDepartment of Orthopaedic Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas (Dr. Polmear, Dr. Nicholson, Dr. Thabet, Dr. Adler, and Dr. Rajani); the Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA (Dr. Blair)
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Kort I, Hmandi O, Grayaa M, Bellali M, Kouada R, Gharbaoui M, Zhioua M, Allouche M. A comparative study of the injury pattern between suicidal and accidental falls from height in Northern Tunisia. J Forensic Leg Med 2023; 97:102531. [PMID: 37210812 DOI: 10.1016/j.jflm.2023.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/24/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Falls from height are a common cause of marbidity and mortality. The aim of this study is to examine the characteristics of the victims, the circumstances of the fall and distribution of the injuries of accidental and suicidal falls from height. MATERIALS AND METHODS It was a retrospective cross-sectional study, based on autopsies performed over 16 years (January 2005 to December 2020). The recorded variables included demographic data of the victim, height of fall, death scene findings, length of hospital stay, autopsy findings, and toxicological results. RESULTS Of the 753 victims of fall from height, 607 were fallers and 146 were jumpers. We found that male victims were predominant in the accidental group (86.8% vs. 69.2%). The mean age at death was 43.6 ± 17.9 years. Suicidal falls occurred in a private house in the majority of cases (70.5%), while accidental falls occurred most frequently at workplace (43.8%). Suicidal falls were higher than accidental falls (10.4 ± 7.3 m vs. 7.1 ± 5.7 m). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequentl in the suicidal falls group. Pelvic fractures were 2.1 times more likely to occur in the suicidal falls. Head injuries were more frequent in the accidental falls group. The survival delay was shorter in the suicidal falls group. CONCLUSIONS our study highlights the differences in the profile of the victims and in the pattern of injuries caused by falls from height, depending on the victim's intention to fall.
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Affiliation(s)
- Ikram Kort
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Ons Hmandi
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mariem Grayaa
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Mohamed Bellali
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Rihem Kouada
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Meriem Gharbaoui
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mongi Zhioua
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mohamed Allouche
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
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Henriques M, Saliba-Serre B, Martrille L, Blum A, Chaumoître K, Donato P, Campos N, Cunha E, Adalian P. Discrimination between falls and blows from the localization and the number of fractures on computed tomography scans of the skull and the trunk. Forensic Sci Res 2023; 8:30-40. [PMID: 37415795 PMCID: PMC10265964 DOI: 10.1093/fsr/owad006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/27/2022] [Indexed: 11/04/2023] Open
Abstract
The distinction between falls and blows is a common and difficult task in forensic sciences. One of the most often used criteria to address this issue is the hat brim line (HBL) rule, which states that fall-related injuries do not lie above the HBL. Some studies, however, have found that the use of HBL rule is not so relevant. This study assesses the aetiologies, the number of fractures, and their location on the skull and the trunk in a sample of 400 individuals aged 20-49 years, which were CT scanned after traumas. This may facilitate the interpretation of such injuries in skeletonized or heavily decomposed bodies in which soft tissues are no longer available. Our aim is to improve the distinction rate between falls and blows by combining several criteria and assessing their predictability. Skeletal lesions were analysed using retrospective CT scans. Cases selected comprise 235 falls and 165 blows. We registered the presence and the number of fractures in 14 skeletal anatomical regions related to the two different aetiologies. We showed that the HBL rule should be used with caution, but there is nevertheless a possibility of discussing the aetiology of blunt fractures. Possibly, parameters like the anatomical location and the number of fractures by region can be used to distinguish falls and blows.
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Affiliation(s)
- Mélanie Henriques
- Centre for Functional Ecology (CEF), Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- Aix Marseille University, CNRS, EFS, ADES, Marseille, France
| | | | | | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), Nancy, France
| | - Kathia Chaumoître
- Department of Radiology and Medical Imaging, CHU Nord, Assistance Publique – Hôpitaux de Marseille, Marseille Cedex, France
| | - Paulo Donato
- Department of Radiology, University Centre Hospitals of Coimbra (CHUC), Coimbra, Portugal
| | - Nuno Campos
- Department of Radiology, University Centre Hospitals of Coimbra (CHUC), Coimbra, Portugal
| | - Eugénia Cunha
- Centre for Functional Ecology (CEF), Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- National Institute of Legal Medicine and Forensic Sciences, Coimbra, Portugal
| | - Pascal Adalian
- Aix Marseille University, CNRS, EFS, ADES, Marseille, France
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Henriques M, Bonhomme V, Cunha E, Adalian P. Blows or Falls? Distinction by Random Forest Classification. BIOLOGY 2023; 12:206. [PMID: 36829485 PMCID: PMC9952774 DOI: 10.3390/biology12020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/10/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023]
Abstract
In this study, we propose a classification method between falls and blows using random forests. In total, 400 anonymized patients presenting with fractures from falls or blows aged between 20 and 49 years old were used. There were 549 types of fractures for 57 bones and 12 anatomical regions observed. We first tested various models according to the sensibility of random forest parameters and their effects on model accuracies. The best model was based on the binary coding of 12 anatomical regions or 28 bones with or without baseline (age and sex). Our method achieved the highest accuracy rate of 83% in the distinction between falls and blows. Our findings pave the way for applications to help forensic experts and archaeologists.
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Affiliation(s)
- Mélanie Henriques
- Centre for Functional Ecology (CEF), Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
- Aix Marseille Univ, CNRS, EFS, ADES, 13007 Marseille, France
| | | | - Eugénia Cunha
- Centre for Functional Ecology (CEF), Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
- National Institute of Legal Medicine and Forensic Sciences, 3000-456 Coimbra, Portugal
| | - Pascal Adalian
- Aix Marseille Univ, CNRS, EFS, ADES, 13007 Marseille, France
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Darwish M, McGraw C, Foote CW, Chen C, Sohini V, Bar-Or D, Palacio CH. Border-fence falls versus domestic falls at a South Texas trauma center. Trauma Surg Acute Care Open 2023; 8:e001020. [PMID: 36875918 PMCID: PMC9980355 DOI: 10.1136/tsaco-2022-001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/11/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives Falling from height may lead to significant injuries and time hospitalized; however, there are few studies comparing the specific mechanism of fall. The purpose of this study was to compare injuries from falls after attempting to cross the USA-Mexico border fence (intentional) with injuries from domestic falls (unintentional) of comparable height. Methods This retrospective cohort study included all patients admitted after a fall from a height of 15-30 ft to a level II trauma center between April 2014 and November 2019. Patient characteristics were compared by falls from the border fence with those who fell domestically. Fisher's exact test, χ2 test and Wilcoxon Mann-Whitney U test were used as appropriate. A significance level of α<0.05 was used. Results Of the 124 patients included, 64 (52%) were falls from the border fence while 60 (48%) were domestic falls. Patients sustaining injuries from border falls were on average younger than patients who had domestic falls (32.6 (10) vs 40.0 (16), p=0.002), more likely males (58% vs 41%, p<0.001), fell from a significantly higher distance (20 (20-25) vs 16.5 (15-25), p<0.001), and had a significantly lower median injury severity score (ISS) (5 (4-10) vs 9 (5-16.5), p=0.001). Additionally, compared with domestic falls, border falls had fewer injuries to the head (3% vs 25%, p=0.004) and chest (5% vs 27%, p=0.007), yet more extremity injuries (73% vs 42%, p=0.003), and less had an intensive care unit (ICU) stay (30% vs 63%, p=0.002). No significant differences in mortality were found. Conclusion Patients sustaining injuries from border crossing falls were slightly younger, and although fell from higher, had a lower ISS, more extremity injuries, and fewer were admitted to the ICU compared with patients sustaining falls domestically. There was no difference in mortality between groups. Level of evidence Level III, retrospective study.
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Affiliation(s)
- Muhammad Darwish
- Trauma Services Department, South Texas Health System, McAllen, Texas, USA
| | - Constance McGraw
- Trauma Research, Injury Outcomes Network, Englewood, Colorado, USA
| | | | - Chaoyang Chen
- Trauma Services Department, South Texas Health System, McAllen, Texas, USA
| | - Vidhur Sohini
- Trauma Services Department, South Texas Health System, McAllen, Texas, USA
| | - David Bar-Or
- Trauma Research, Injury Outcomes Network, Englewood, Colorado, USA
| | - Carlos H Palacio
- Trauma Services Department, South Texas Health System, McAllen, Texas, USA
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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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12
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The Design of a Structural Hyper-Resisting Element for Life-Threatening Earthquake Risk (SHELTER) for Building Collapse Scenarios: The Safety Chairs. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Project SHELTER, Structural Hyper-resisting Element for Life-Threatening Earthquake Risk, aims at developing a strong and stiff functional unit to protect its occupants in case of severe earthquakes that lead to structural collapse. In case of collapse, these units will suffer impacts, particularly if they are installed in upper floors. To avoid severe injuries or death of occupants caused by collapse, safety chairs were designed, provided with shock-absorber systems and auxiliary retaining devices, to keep the occupants properly seated and safe. Three downfall scenarios were evaluated, consisting of vertical and tilted positions. A comprehensive numerical model to represent the human body was developed, mainly focused on chest behaviour and considering the anatomic limits of the vertebral spine. The mechanical ability of the safety chair to ensure the occupants’ safety was evaluated under these harsh conditions. Experimental downfall-and-impact tests will later be performed on shelter units, with crash-test dummies seated on the safety chairs for final validation.
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13
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Keys K, Ross AH. Identifying Blunt Force Traumatic Injury on Thermally Altered Remains: A Pilot Study Using Sus scrofa. BIOLOGY 2022; 11:biology11010087. [PMID: 35053085 PMCID: PMC8773201 DOI: 10.3390/biology11010087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
Simple Summary Human remains are often burned in an effort to conceal the identity of the victim and/or obscure traumatic injuries related to the death event. Thermal exposure can produce artifacts resembling trauma and disguise preexisting trauma. However, there is a paucity of experimental studies with varied results addressing the differentiation of thermally induced artifacts from traumatic signatures. To address this gap in the literature, we conducted a small-scale study using domestic pigs as correlates to test the impact of thermal alteration on blunt force trauma to the cranium. Two tools (e.g., hammer and crowbar) were utilized to manually inflict injuries on the human analogs before controlled burning in an outdoor environment. The results of this experiment demonstrated that the most diagnostic variable to differentiate thermally induced alternations from blunt force fractures was fracture pattern. Abstract In forensic scenarios involving homicide, human remains are often exposed to fire as a means of disposal and/or obscuring identity. Burning human remains can result in the concealment of traumatic injury, the creation of artifacts resembling injury, or the destruction of preexisting trauma. Since fire exposure can greatly influence trauma preservation, methods to differentiate trauma signatures from burning artifacts are necessary to conduct forensic analyses. Specifically, in the field of forensic anthropology, criteria to distinguish trauma from fire signatures on bone is inconsistent and sparse. This study aims to supplement current forensic anthropological literature by identifying criteria found to be the most diagnostic of fire damage or blunt force trauma. Using the skulls of 11 adult pigs (Sus scrofa), blunt force trauma was manually produced using a crowbar and flat-faced hammer. Three specimens received no impacts and were utilized as controls. All skulls were relocated to an outdoor, open-air fire where they were burned until a calcined state was achieved across all samples. Results from this experiment found that blunt force trauma signatures remained after burning and were identifiable in all samples where reassociation of fragments was possible. This study concludes that distinct patterns attributed to thermal fractures and blunt force fractures are identifiable, allowing for diagnostic criteria to be narrowed down for future analyses.
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14
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Kakimoto K, Shibahashi K, Oishio M, Sugiyama K, Hamabe Y. Mortality of hospital
walk‐in
trauma patients: a multicenter retrospective cohort study. Acute Med Surg 2022; 9:e784. [PMID: 36092465 PMCID: PMC9448715 DOI: 10.1002/ams2.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/17/2022] [Indexed: 01/09/2023] Open
Abstract
Aim To investigate the characteristics of patients who visited the emergency department by themselves after experiencing trauma and subsequently died, and to identify the prognostic factors of mortality in such patients. Methods Adult patients with trauma visiting the emergency department by themselves between 2004 and 2019 in Japan were identified using a nationwide trauma registry (the Japan Trauma Data Bank). The characteristics of patients who died were compared with those who survived, and multivariable logistic regression analysis was used to determine the independent association of each preselected variable with in‐hospital mortality (end‐point). Results Of the 9753 patients eligible for analysis, 4369 (44.8%) were men, and the median age was 75 years. Of these patients, 130 (1.3%) died in the hospital. The following factors had a significant association with in‐hospital mortality: age, male sex, Charlson Comorbidity Index (CCI) 3–4 and ≥5 with CCI = 0 as a reference, circumstances of injury (free fall and fall at ground level), Glasgow Coma Scale score, Shock Index ≥ 0.9, severe injuries of the head, abdomen and lower extremities, and Injury Severity Score ≥ 15. Conclusions Several risk factors, including older age, male sex, higher CCI, circumstances of injury (free fall and fall at ground level), lower Glasgow Coma Scale score, higher Shock Index, and severe injuries of the head, abdomen, and lower extremities, were identified as being associated with the death of trauma patients visiting the emergency department by themselves. Early identification of patients with these risk factors and appropriate treatment may reduce mortality posttrauma.
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Affiliation(s)
- Kohei Kakimoto
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Keita Shibahashi
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Masato Oishio
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
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15
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Falls from height: Ambulation following spinal cord injury and lower extremity polytrauma. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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16
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Kang BH, Jung K, Huh Y. Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls. Clin Exp Emerg Med 2021; 8:16-20. [PMID: 33845518 PMCID: PMC8041581 DOI: 10.15441/ceem.20.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/06/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Suicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality. METHODS From March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality. RESULTS Of 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433-0.764], P<0.001), body mass index (1.638 [1.194-2.247], P=0.002), suicide intent (9.789 [1.026-93.404], P=0.047) and Injury Severity Score (1.091 [1.000-1.190], P=0.049) were identified as risk factors for mortality. CONCLUSION Suicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.
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Affiliation(s)
- Byung Hee Kang
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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17
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Fall from heights: possible factors influencing the onset of complications. Musculoskelet Surg 2021; 106:297-301. [PMID: 33580450 DOI: 10.1007/s12306-021-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Fall from a height is high energy trauma. The causes include both accidental falls and suicide attempts. The literature and also our previous study demonstrated that this kind of patients, during their recovery time, need a high multidisciplinary workload with significant costs. The present study is the first researching the patterns of the non-acute orthopedic complications after a trauma precipitation that required a new hospitalization and surgical procedure. METHODS Retrospective study and analysis of orthopedic complication characteristics of patients fallen from height. We researched the possible relation between the complication pattern (soft tissue or bone involvement) and the case character (psychiatric or non-psychiatric patients, type of fracture and kind of fixation). RESULTS The 18.83% of all patients (154 cases included) needed a new admission to perform further surgical procedures (9.74% of psychiatric patients and 9.09% of unvoluntary victims). Our data showed that patients with psychiatric disorder were associated with a statistically significant (p < 0.05) increase in soft tissue complications (46.67%) and onset of non-union after internal osteosynthesis and external fixation (72.72%), respectively. CONCLUSION According to the results obtained, we can conclude that osteosynthesis in psychiatric patients is related to well-defined and predictable complications.
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18
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Casati A, Granieri S, Cimbanassi S, Reitano E, Chiara O. Falls from Height. Analysis of Predictors of Death in a Single-Center Retrospective Study. J Clin Med 2020; 9:jcm9103175. [PMID: 33007955 PMCID: PMC7601239 DOI: 10.3390/jcm9103175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
Falls from height (FFH) represent a distinct form of blunt trauma in urban areas. This study aimed to identify independent predictors of in-hospital mortality after accidental or intentional falls in different age groups. We conducted a retrospective study of all patients consecutively admitted after a fall in eight years, recording mechanism, intentionality, height of fall, age, site, classification of injuries, and outcome. We built multivariate regression models to identify independent predictors of mortality. A total of 948 patients with 82 deaths were observed. Among the accidental falls, mortality was 5.2%, whereas intentional jumpers showed a mortality of 20.4%. The death rate was higher for increasing heights, age >65, suicidal attempts, and injuries with AIS ≥3 (Abbreviated Injury Scale). Older patients reported a higher in-hospital mortality rate. Multivariate analysis identified height of fall, dynamic and severe head and chest injuries as independent predictors of mortality in the young adults’ group (18–65 years). For patients aged more than 65 years, the only risk factor independently related to death was severe head injuries. Our data demonstrate that in people older than 65, the height of fall may not represent a predictor of death.
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Affiliation(s)
- Alberto Casati
- General Surgery Unit, Policlinico Sant’Orsola-Malpighi, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy;
| | - Stefano Granieri
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.G.); (S.C.); (E.R.)
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.G.); (S.C.); (E.R.)
| | - Elisa Reitano
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.G.); (S.C.); (E.R.)
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.G.); (S.C.); (E.R.)
- Correspondence: ; Tel.: +39-02-6444-2541; Fax: +39-02-6444-2392
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19
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Faggiani M, Aragno E, Aprato A, Rosso G, Conforti LG, Maina G, Massè A. Falls from height: orthopaedic and psychiatric evaluation. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:79-84. [PMID: 32555080 PMCID: PMC7944834 DOI: 10.23750/abm.v91i4-s.9366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fall from a height is one of the major causes of significant trauma with high morbidity and mortality rates. Traumatological damage control is often the primary treatment both for suicide attempt survivors and for accidental fall victims, but management of the hospitalization of psychiatric patients requires more resources than other patients. METHODS Retrospective multidisciplinary study (psychiatric and orthopaedic evaluation) and analysis of psychiatric and trauma characteristics of patients fallen from height admitted to our trauma centre. We analysed patterns of patients after suicidal jumps and accidental falls to look for possible trends that may trigger projects for further improvement of care. RESULTS 205 patients were analysed, 137 were included: 65 suicide attempt survivors and 72 accidental fall victims. Between these two groups there are no differences about the anaesthesiologic acute management or the number of damage control procedures. However, the psychiatric patients stay longer in hospital especially in intensive care unit with prolonged intubation (p<0.001). Suicide attempt survivors are significant correlated with fractures of feet, but the orthopaedic lesions do not involve an increase of definitive interventions (p< 0.05). CONCLUSION We showed that the suicide attempt survivors and accidental victims need the same acute management. The orthopedic definitive surgical procedures are similar between the two groups, but in spite of this patients with psychiatric disorder were associated with a statistically significant increase of care in intensive care unit and hospitalization. Our results allow to create a new multidisciplinary approach for these patients.
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Affiliation(s)
- Marianna Faggiani
- 1. Department of Orthopedics and Traumatology, C.T.O., Città della Salute e della Scienza, Turin, TO, Italy..
| | - Elena Aragno
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Italy.
| | - Alessandro Aprato
- 1. Department of Orthopedics and Traumatology, C.T.O., Città della Salute e della Scienza, Turin, TO, Italy..
| | - Gianluca Rosso
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Italy. San Luigi Gonzaga University Hospital of Orbassano (Turin), Italy..
| | - Luigi Giulio Conforti
- 1. Department of Orthopedics and Traumatology, C.T.O., Città della Salute e della Scienza, Turin, TO, Italy..
| | - Giuseppe Maina
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Italy. San Luigi Gonzaga University Hospital of Orbassano (Turin), Italy..
| | - Alessandro Massè
- 1. Department of Orthopedics and Traumatology, C.T.O., Città della Salute e della Scienza, Turin, TO, Italy.
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20
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Papadakis SA, Pallis D, Galanakos S, Georgiou DF, Kateros K, Macheras G, Sapkas G. Falls from height due to accident and suicide attempt in Greece. A comparison of the injury patterns. Injury 2020; 51:230-234. [PMID: 31902573 DOI: 10.1016/j.injury.2019.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls from height are a common cause of death and disability. Falls from height can be divided between accidental and suicide attempts. The aim of this study is to ascertain the demographic characteristics of these patients, and to identify the fracture patterns. METHODS In this retrospective cross sectional comparative study we present 244 patients who sustained injuries as a result of a fall from height. They were divided into those with accidental falls (n = 180, group I) and those with suicide attempts (n = 64, group II). Data collected included age, gender, associated trauma, injury severity score (ISS), Glasgow Coma Scale (GCS), haemodynamic status, length of intensive care unit (ICU) and hospital stay. The diagnosis of mental disorder was ascertained by psychiatric specialists using the criteria of the International Classification of Disease Ninth Version Clinical Modification (ICD - 9CM). Postoperative follow-up ranged from 12 months to 10 years. RESULTS The injuries sustained were as follows: Abdominal trauma in 9 cases (5 in group I, 4 in II), thoracic trauma in 81 cases (49 in group I, 32 in II), head injury in 23 cases (7 in group I, 16 in II), 383 extremities fractures (184 in group I, 199 in II) and 133 spinal fractures (101 in group I, 32 in II). Twenty-one patients died in hospital while 223 patients survived to hospital discharge. The mean height from which the fall occurred was 5.4 m (range, 3 - 25 m). The mean Injury Severity Score was 19 (range, 6 to 58) for all fall victims. CONCLUSIONS Patients following an accidental high fall mostly had upper limb fractures. Patients following a suicidal high fall mostly had lower limb fractures, pelvis, spinal fractures and head injuries. Spinal fractures are common either when the fall is accidental or following suicide attempt.
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Affiliation(s)
- Stamatios A Papadakis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece.
| | - Dimitrios Pallis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Spyridon Galanakos
- D' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Dimitrios Florin Georgiou
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - Konstantinos Kateros
- A' Department of Orthopaedics, "G Gennimatas" General Hospital, Athens 15343, Greece
| | - George Macheras
- D' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, Kifisia 14561, Greece
| | - George Sapkas
- Orthopaedic Department, Metropolitan Hospital, Athens, Greece
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Casali MB, Blandino A, Grignaschi S, Florio EM, Travaini G, Genovese UR. The pathological diagnosis of the height of fatal falls: A mathematical approach. Forensic Sci Int 2019; 302:109883. [PMID: 31450068 DOI: 10.1016/j.forsciint.2019.109883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/18/2019] [Accepted: 07/20/2019] [Indexed: 11/18/2022]
Abstract
The authors analyzed the injury pattern of 385 victims of fall from a height which underwent a complete autopsy, with the objective to investigate whether it was possible to construct a mathematical model to be used for height of the fall diagnosis. The cases were selected and enrolled according to a balanced stratification of the heights of the fall, allowing a subdivision into seven classes consisting of 55 subjects each: 6m or less, 9m, 12m, 15m, 18m, 21m, 24m or more (maximum 36m). For each case anthropologic and necroscopic data was collected and analyzed to obtain a standardized description of the injury pattern was obtained, dividing the body into 4 major anatomical areas (Head, Thorax, Abdomen, Skeleton), each of them further divided in 5 major organs. Every organ was finally divided into 5 objective degrees of injury. Statistical analysis was performed on all the available data using IBM SPSS Statistics 20, to test the performance of the "injury pattern assessment table" in the diagnosis of the height of the fall and to develop a related mathematical model. Our findings confirm that the height of the fall is significantly associated with age, weight of the body and the injury pattern. An Injury Pattern Assessment Table and two mathematical models which correlates the height of the fall with analyzed variables are presented.
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Affiliation(s)
- Michelangelo Bruno Casali
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Alberto Blandino
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Silvia Grignaschi
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Elena Maria Florio
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Guido Travaini
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Umberto Rosario Genovese
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
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Suicide attempts by jumping and length of stay in general hospital: A retrospective study of 225 patients. J Psychosom Res 2019; 119:34-41. [PMID: 30947815 DOI: 10.1016/j.jpsychores.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Violent suicide attempts, such as jumping from a height, frequently lead to hospitalization in general hospital with high length of stay (LOS). We investigated features associated with LOS in this context. METHODS We retrospectively included all patients admitted after suicide attempts by jumping in non-psychiatric wards of a university hospital between 2008 and 2016. Several socio-demographic and clinical data were collected, including psychiatric diagnoses, coded with the International Classification of Diseases-10th Revision. We used general linear models to identify factors associated with LOS. RESULTS Among 225 patients (125 men; mean age ± sd: 37.5 ± 15.4 years), several clinical factors were independently associated with a longer LOS: number of injuries (β = 8.2 p < .001), external fixator (β = 18.1 p = .01), psychotic disorder (β = 14.6 p = .02) and delirium (β = 16.6 p = .005). Admission in psychiatric ward at discharge tended to be associated with lower LOS (β = -15.3 p = .07). CONCLUSION In patients admitted in non-psychiatric wards after suicide attempt by jumping, the presence of a psychotic disorder may increase LOS by several days, and indirectly costs of hospitalization, to a similar extent of non-psychiatric factors. The association of transfer in psychiatric ward with lower LOS suggests that the psychiatric disorder might interfere with medical care.
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Piazzalunga D, Rubertà F, Fugazzola P, Allievi N, Ceresoli M, Magnone S, Pisano M, Coccolini F, Tomasoni M, Montori G, Ansaloni L. Suicidal fall from heights trauma: difficult management and poor results. Eur J Trauma Emerg Surg 2019; 46:383-388. [PMID: 30840092 DOI: 10.1007/s00068-019-01110-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Self-inflicted injuries represent a consistent cause of trauma and falls from heights (FFH) represent a common dynamic used for suicidal attempts. The aim of the current report is to compare, among FFH patients, unintentional fallers and intentional jumpers in terms of demographical characteristics, clinical-pathological parameters and mortality, describing the population at risk for suicide by jumping and the particular patterns of injury of FFH patients. MATERIALS AND METHODS The present study is a retrospective analysis of prospectively collected data regarding FFH patients, extracted from the Trauma Registry of the Papa Giovanni XXIII Hospital in Bergamo, Italy. Demographic characteristics, clinical-pathological parameters, patterns of injury, outcomes including mortality rates of jumpers and fallers were analyzed and compared. RESULTS The FFH trauma group included 299 patients between April 2014 and July 2016: 259 of them (86.6%) were fallers and 40 (13.4%) were jumpers. At multivariate analysis both young age (p = 0.01) and female sex (p < 0.001) were statistical significant risk factors for suicidal attempt with FFH. Systolic blood pressure (SBP) at the arrival was lower and ISS was higher in the self-inflicted injury group (SBP 133.35 ± 23.46 in fallers vs 109.89 ± 29.93 in jumpers, p < 0.001; ISS in fallers 12.61 ± 10.65 vs 18.88 ± 11.80 in jumpers, p = 0.001). Jumpers reported higher AIS score than fallers for injuries to: face (p = 0.023), abdomen (p < 0.001) and extremities (p = 0.004). The global percentage of patients who required advanced or definitive airway control was significantly higher in the jumper group (35.0% vs 16.2%, p = 0.005). In total, 75% of jumpers and the 34% of fallers received surgical intervention (p < 0.001). A higher number of jumpers needed ICU admission, as compared to fallers (57.5% vs 23.6%, p < 0.001); jumpers showed longer total length of stay (26.00 ± 24.34 vs 14.89 ± 13.04, p = 0.007) and higher early mortality than fallers (7.5% vs 1.2%, p = 0.008). CONCLUSIONS In Northern Italy, the population at highest risk of suicide by jumping and requiring Trauma Team activation is greatly composed by middle-aged women. Furthermore, FFH is the most common suicidal method. Jumpers show tendency to "feet-first landing" and seem to have more severe injuries, worse outcome and a higher early mortality rate, as compared to fallers. The Trauma Registry can be a useful tool to describe clusters of patients at high risk for suicidal attempts and to plan preventive and clinical actions, with the aim of optimizing hospital care for FFH trauma patients.
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Affiliation(s)
- Dario Piazzalunga
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Rubertà
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Fugazzola
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy. .,Ospedale M. Bufalini, Viale Ghirotti, 286, 47521, Cesena, Italy.
| | - Niccolò Allievi
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Ceresoli
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Magnone
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Pisano
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Coccolini
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy.,Ospedale M. Bufalini, Viale Ghirotti, 286, 47521, Cesena, Italy
| | - Matteo Tomasoni
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy.,Ospedale M. Bufalini, Viale Ghirotti, 286, 47521, Cesena, Italy
| | - Giulia Montori
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Ansaloni
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy.,Ospedale M. Bufalini, Viale Ghirotti, 286, 47521, Cesena, Italy
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Abstract
STUDY DESIGN This was a retrospective case series at a single institution. OBJECTIVE The study was performed to investigate the characteristics of spinal injuries in survivors of suicidal jumping. SUMMARY OF BACKGROUND DATA Spinal fracture/dislocation is associated with high-energy trauma such as that induced by motor vehicle accidents. Survivors of suicidal jumping sometimes sustain spinal injuries. However, the characteristics of such spinal injuries are unclear. METHODS We identified 87 survivors of suicidal jumping who sustained spinal injuries from 2007 to 2016 in our institution. We compared the demographic data, radiological findings, neurological status, associated injuries, treatments, and mental health conditions between these 87 survivors and 204 non-suicidal patients with spinal injury. RESULTS Suicidal jumpers were predominantly female (67%) and 10 years younger than non-suicidal patients. Mental health problems, mainly schizophrenia and depression, were diagnosed in 77% of suicidal jumpers. Neurological damage from spinal trauma was generally less severe in suicidal jumpers than in non-suicidal patients. Most spinal injuries in suicidal jumpers were located in the thoracic or lumbar spine region (85%). Among comorbid injuries, extremity injuries were highly associated with spine injury in suicidal jumpers. Nearly 70% of suicidal jumpers exhibited extremity injury in contrast to 33% of non-suicidal patients. Approximately, 25% of suicidal jumpers underwent surgical treatment. Surgical treatment was similarly performed on suicidal jumpers and non-suicidal patients regardless of the discrepancy in neurological damage between these two groups. CONCLUSION Spinal injuries in suicidal jumpers differed from spinal injuries in non-suicidal patients with regard to sex, age, mental health condition, injury location, neurologic damage, and associated injuries. Most survivors of suicidal jumping were young female patients with mental health problems. They tended to have thoracic and lumbar spine trauma rather than cervical trauma with less severe neurological deficits and a higher incidence of accompanying limb injury. LEVEL OF EVIDENCE 3.
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Carey S, Carr M, Ferdous K, Moffa GM, Axelband J, Quazi S. Accuracy of Height Estimation Among Bystanders. West J Emerg Med 2018; 19:813-819. [PMID: 30202492 PMCID: PMC6123090 DOI: 10.5811/westjem.2018.5.34877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 04/20/2018] [Accepted: 05/28/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION High-risk mechanisms in trauma usually dictate certain treatment and evaluation in protocolized care. A 10-15 feet (ft) fall is traditionally cited as an example of a high-risk mechanism, triggering trauma team activations and costly work-ups. The height and other details of mechanism are usually reported by lay bystanders or prehospital personnel. This small observational study was designed to evaluate how accurate or inaccurate height estimation may be among typical bystanders. METHODS This was a blinded, prospective study conducted on the grounds of a community hospital. Four panels with lines corresponding to varying heights from 1-25 ft were hung within a building structure that did not have stories or other possibly confounding factors by which to judge height. The participants were asked to estimate the height of each line using a multiple-choice survey-style ballot. Participants were adult volunteers composed of various hospital and non-hospital affiliated persons, of varying ages and genders. In total, there were 96 respondents. RESULTS For heights equal to or greater than 15 ft, less than 50% of participants of each job description were able to correctly identify the height. When arranged into a scatter plot, as height increased, the likelihood to underestimate the correct height was evident, having a strong correlation coefficient (R=+0.926) with a statistically significant p value = <0.001. CONCLUSION The use of vertical height as a predictor of injury severity is part of current practice in trauma triage. This data is often an estimation provided by prehospital personnel or bystanders. Our small study showed bystanders may not estimate heights accurately in the field. The greater the reported height, the less likely it is to be accurate. Additionally, there is a higher likelihood that falls from greater than 15 ft may be underestimated.
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Affiliation(s)
- Sara Carey
- Aria Health, Department of Family Medicine and Emergency Medicine, Philadelphia, Pennsylvania
| | - Michaeleena Carr
- Aria Health, Department of Family Medicine and Emergency Medicine, Philadelphia, Pennsylvania
| | - Komaira Ferdous
- Aria Health, Department of Family Medicine and Emergency Medicine, Philadelphia, Pennsylvania
| | - Gina Marie Moffa
- Aria Health, Department of Family Medicine and Emergency Medicine, Philadelphia, Pennsylvania
| | - Jennifer Axelband
- St. Luke’s University Hospital and Health Network, Department of Critical Care Medicine and Emergency Medicine, Bethlehem, Pennsylvania
| | - Shaila Quazi
- Aria Health, Department of Emergency Medicine, Philadelphia, Pennsylvania
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26
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Abstract
The difficulty in classifying manner of death in falls from a height provides offenders an opportunity to avoid detection by having a homicide appear otherwise. Twelve fall homicides were qualitatively examined. Results showed that most homicidal falls occurred at remote outdoor locations, were planned by offenders who were in controlling intimate relationships with the victim, and were motivated by gain. Homicide was established using inconsistencies in offender's statements and the physical evidence, inappropriate postoffense behavior, evidence of planning, and improbable alleged victim behavior. Fall homicides pose unique challenges for investigators and may negatively impact on the criminal justice process.
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Rowbotham SK, Blau S, Hislop-Jambrich J, Francis V. An Anthropological Examination of the Types of Skeletal Fractures Resulting from Fatal High (˃3 m) Free Falls. J Forensic Sci 2018; 64:375-384. [PMID: 30107638 DOI: 10.1111/1556-4029.13887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 12/01/2022]
Abstract
Fatal falls from heights (˃3 m) often result in blunt force trauma (BFT) to the skeleton. The fracture patterns that result from this BFT mechanism are well understood in forensic anthropology and forensic pathology; however, details of the specific types of fractures that result remain poorly documented. The aim of this study was to provide a detailed examination of the types of fractures that may result from fatal high falls. Fractures were recorded from 95 full-body postmortem computed tomography scans of individuals known to have died from a high fall. Trauma was then analyzed taking into account the extrinsic and intrinsic variables known to influence a fall using multiple logistic regression. A total of 339 types of fractures were classified, of which 16 were significantly associated with this BFT mechanism. Classified fracture types will augment anthropological interpretations of the circumstances of death from BFT in cases of suspected high falls.
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Affiliation(s)
- Samantha K Rowbotham
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Soren Blau
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Jacqueline Hislop-Jambrich
- Centre for Medical Research, Toshiba Medical, 12 - 24 Talavera Road, North Ryde, New South Wales, 2113, Australia
| | - Victoria Francis
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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Experimental Study of Thoracoabdominal Injuries Suffered from Caudocephalad Impacts Using Pigs. Appl Bionics Biomech 2018; 2018:2321053. [PMID: 29861783 PMCID: PMC5971294 DOI: 10.1155/2018/2321053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/26/2018] [Accepted: 03/12/2018] [Indexed: 11/17/2022] Open
Abstract
To know the caudocephalad impact- (CCI-) induced injuries more clearly, 21 adult minipigs, randomly divided into three groups: control group (n = 3), group I (n = 9), and group II (n = 9), were used to perform the CCI experiments on a modified deceleration sled. Configured impact velocity was 0 m/s in the control group, 8 m/s in group I, and 11 m/s in group II. The kinematics and mechanical responses of the subjects were recorded and investigated. The functional change examination and the autopsies were carried out, with which the injuries were evaluated from the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). The subjects in group I and group II experienced the caudocephalad loading at the peak pelvic accelerations of 108.92 ± 58.87 g and 139.13 g ± 78.54 g, with the peak abdomen pressures, 41.24 ± 16.89 kPa and 63.61 ± 65.83 kPa, respectively. The injuries of the spleen, lung, heart, and spine were detected frequently among the tested subjects. The maximal AIS (MAIS) of chest injuries was 4 in group I and 5 in group II, while both the MAIS of abdomen injuries in group I and group II were 5. The ISS in group II was 52.71 ± 6.13, significantly higher than in group I, 26.67 ± 5.02 (p < 0.05). The thoracoabdomen CCI injuries and the mechanical response addressed presently may be useful to conduct both the prevention studies against military or civilian injuries.
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Alizo G, Sciarretta JD, Gibson S, Muertos K, Romano A, Davis J, Pepe A. Fall from heights: does height really matter? Eur J Trauma Emerg Surg 2018; 44:411-416. [PMID: 28643032 DOI: 10.1007/s00068-017-0799-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/29/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Fall from heights is high energy injuries and constitutes a fraction of all fall-related trauma evaluations while bearing an increase in morbidity and mortality. We hypothesize that despite advancements in trauma care, the overall survivability has not improved in this subset of trauma patients. METHODS All adult trauma patients treated after sustaining a fall from heights during a 40-month period were retrospectively reviewed. Admission demographics, clinical data, fall height (ft), injury patterns, ISS, GCS, length of stay, and mortality were reviewed. RESULTS 116 patients sustained a fall from heights, 90.4% accidental. A mean age of 37± 14.7 years, 86% male, and a fall height of 19 ± 10 ft were encountered. Admission GCS was 13 ± 2 with ISS 10 ± 11. Overall LOS was 6.6 ± 14.9 days and an ICU LOS of 2.8 ± 8.9 days. Falls ≥ 25 ft.(16%) had lower GCS 10.4 ± 5.8, increased ISS 22.6 ± 13.8, a fall height 37.9 ± 13.1 ft and associated increased mortality (p < 0.001). Mortality was 5.2%, a mean distance fallen of 39 ± 22 ft. and an ISS of 31.5 ±16.5. Brain injury was the leading cause of death, 50% with open skull fractures. CONCLUSION Level of height fallen is a good predictor of overall outcome and survival. Despite advances in trauma care, death rates remain unchanged. Safety awareness and injury prevention programs are needed to reduce the risk of high-level falls.
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Affiliation(s)
- G Alizo
- Grand Strand Medical Center, University of South Carolina, 809 82nd Parkway, Myrtle Beach, SC, 29572, USA
| | - J D Sciarretta
- Grand Strand Medical Center, University of South Carolina, 849 82nd Parkway, Myrtle Beach, SC, 29572, USA.
| | - S Gibson
- Grand Strand Medical Center, University of South Carolina, 809 82nd Parkway, Myrtle Beach, SC, 29572, USA
| | - K Muertos
- Grand Strand Medical Center, University of South Carolina, 849 82nd Parkway, Myrtle Beach, SC, 29572, USA
| | - A Romano
- Grand Strand Medical Center, University of South Carolina, 849 82nd Parkway, Myrtle Beach, SC, 29572, USA
| | - J Davis
- Grand Strand Medical Center, University of South Carolina, 809 82nd Parkway, Myrtle Beach, SC, 29572, USA
| | - A Pepe
- Grand Strand Medical Center, University of South Carolina, 849 82nd Parkway, Myrtle Beach, SC, 29572, USA
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Stemper BD, Chirvi S, Doan N, Baisden JL, Maiman DJ, Curry WH, Yoganandan N, Pintar FA, Paskoff G, Shender BS. Biomechanical tolerance of whole lumbar spines in straightened posture subjected to axial acceleration. J Orthop Res 2018; 36:1747-1756. [PMID: 29194745 DOI: 10.1002/jor.23826] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/29/2017] [Indexed: 02/04/2023]
Abstract
Quantification of biomechanical tolerance is necessary for injury prediction and protection of vehicular occupants. This study experimentally quantified lumbar spine axial tolerance during accelerative environments simulating a variety of military and civilian scenarios. Intact human lumbar spines (T12-L5) were dynamically loaded using a custom-built drop tower. Twenty-three specimens were tested at sub-failure and failure levels consisting of peak axial forces between 2.6 and 7.9 kN and corresponding peak accelerations between 7 and 57 g. Military aircraft ejection and helicopter crashes fall within these high axial acceleration ranges. Testing was stopped following injury detection. Both peak force and acceleration were significant (p < 0.0001) injury predictors. Injury probability curves using parametric survival analysis were created for peak acceleration and peak force. Fifty-percent probability of injury (95%CI) for force and acceleration were 4.5 (3.9-5.2 kN), and 16 (13-19 g). A majority of injuries affected the L1 spinal level. Peak axial forces and accelerations were greater for specimens that sustained multiple injuries or injuries at L2-L5 spinal levels. In general, force-based tolerance was consistent with previous shorter-segment lumbar spine testing (3-5 vertebrae), although studies incorporating isolated vertebral bodies reported higher tolerance attributable to a different injury mechanism involving structural failure of the cortical shell. This study identified novel outcomes with regard to injury patterns, wherein more violent exposures produced more injuries in the caudal lumbar spine. This caudal migration was likely attributable to increased injury tolerance at lower lumbar spinal levels and a faster inertial mass recruitment process for high rate load application. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res 36:1747-1756, 2018.
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Affiliation(s)
- Brian D Stemper
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, 5000 West National Avenue, Research 151, Milwaukee, Wisconsin, 53295.,Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Sajal Chirvi
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Jamie L Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Dennis J Maiman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - William H Curry
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Frank A Pintar
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, 5000 West National Avenue, Research 151, Milwaukee, Wisconsin, 53295.,Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Glenn Paskoff
- Aircraft Division, Naval Air Warfare Center, Patuxent River, Maryland
| | - Barry S Shender
- Aircraft Division, Naval Air Warfare Center, Patuxent River, Maryland
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Rowbotham SK, Blau S, Hislop-Jambrich J, Francis V. An Assessment of the Skeletal Fracture Patterns Resulting from Fatal High (˃3 m) Free Falls. J Forensic Sci 2018; 64:58-68. [PMID: 29694673 DOI: 10.1111/1556-4029.13803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/21/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
The injury patterns resulting from fatal high (˃3 m) free falls have previously been documented in clinical and medico-legal contexts; however, details relating specifically to the skeletal blunt force trauma (BFT) have been limited. This study aimed to augment what is known of the skeletal fracture patterns resulting from fatal high free falls. Skeletal trauma was analyzed from full-body postmortem computed tomography scans of 95 individuals who died following a high free fall. Fracture patterns were documented using the five general anatomical regions, axial and appendicular regions, and postcranial unilateral and bilateral regions. Patterns were analyzed in the context of the extrinsic and intrinsic variables that may influence fractures using multiple logistic regression. Fracture patterns involved all aspects of the skeleton, with 98.9% exhibiting polytrauma, and were influenced primarily by the height fallen, manner of death, and landing surface. This improved understanding of fracture patterns will augment anthropological interpretations of the mechanism of BFT in cases of suspected high falls.
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Affiliation(s)
- Samantha K Rowbotham
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Soren Blau
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Jacqueline Hislop-Jambrich
- Centre for Medical Research, Toshiba Medical, 12 - 24 Talavera Road, North Ryde, New South Wales, 2113, Australia
| | - Victoria Francis
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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Yoganandan N, Moore J, Pintar FA, Banerjee A, DeVogel N, Zhang J. Role of disc area and trabecular bone density on lumbar spinal column fracture risk curves under vertical impact. J Biomech 2018; 72:90-98. [DOI: 10.1016/j.jbiomech.2018.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
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Rowbotham SK, Blau S, Hislop-Jambrich J, Francis V. Skeletal Trauma Resulting From Fatal Low (≤3 m) Free Falls: An Analysis of Fracture Patterns and Morphologies. J Forensic Sci 2017; 63:1010-1020. [DOI: 10.1111/1556-4029.13701] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Samantha K. Rowbotham
- Department of Forensic Medicine; Monash University; 65 Kavanagh Street Southbank Vic 3006 Australia
| | - Soren Blau
- Department of Forensic Medicine; Monash University; 65 Kavanagh Street Southbank Vic 3006 Australia
- Victorian Institute of Forensic Medicine; 65 Kavanagh Street Southbank Vic 3006 Australia
| | | | - Victoria Francis
- Victorian Institute of Forensic Medicine; 65 Kavanagh Street Southbank Vic 3006 Australia
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Macoveciuc I, Márquez-Grant N, Horsfall I, Zioupos P. Sharp and blunt force trauma concealment by thermal alteration in homicides: An in-vitro experiment for methodology and protocol development in forensic anthropological analysis of burnt bones. Forensic Sci Int 2017; 275:260-271. [DOI: 10.1016/j.forsciint.2017.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 01/16/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
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Burk DR, Pah AR, Ruth JT. Analysis of Musculoskeletal Injuries Sustained in Falls From the United States-Mexico Border Fence. Orthopedics 2017; 40:e432-e435. [PMID: 28112782 DOI: 10.3928/01477447-20170117-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/22/2016] [Indexed: 02/03/2023]
Abstract
Injuries sustained by unauthorized individuals who jump or fall from the United States-Mexico border fence are frequently treated by trauma centers in border states. The authors investigated patterns of musculoskeletal injury occurring in these individuals to improve emergency department assessment and to identify strategies to prevent future injuries. A retrospective chart review was performed for patients presenting to an urban, level I trauma center with musculoskeletal injuries sustained in a jump or fall from the United States-Mexico border fence between February 2004 and February 2010. Frequency of fracture by site, frequency of open fracture, and associated patterns of injury were recorded. The population was stratified by age and sex to identify disparity in injury pattern. Average length of stay and number of surgical interventions were also recorded. During the study period, 174 individuals who had jumped or fallen from the United States-Mexico border fence were identified. The population contained 93 (53%) women and 81 (47%) men with an average age of 31.5 years (range, 11-56 years). On average (±standard error), men sustained slightly more fractures than women (1.77±0.12 vs 1.43±0.07; P=.015). There were no significant differences in the number of fractures sustained between age groups. Average length of stay for patients admitted to the hospital was 3.5 days. Patients underwent an average of 0.75 surgical interventions during admission. Falls from the United States-Mexico border fence are a significant cause of morbidity among unauthorized immigrants. [Orthopedics. 2017; 40(3):e432-e435.].
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Abstract
INTRODUCTION Falls from heights are an important cause of unintentional fatal injury. We investigated the relationship between the characteristics of fatal falls and resulting injury patterns. MATERIALS AND METHODS We reviewed prospectively collected data from the Office of Chief Medical Examiner in New York City between 2000 and 2010. Data included fall height, work or non-work related, use of safety equipment, intentionality, specific organ injuries, and death on impact. The primary outcome was organ injury based on fall height. RESULTS Higher falls were associated with hemorrhage as well as rib and various organ injuries. Organ injury pattern did not differ based on work status. The presence of equipment misuse or malfunction was associated with more deaths upon impact. Victims of falls from 200 ft or higher were 11.59 times more likely to die on impact than from lower than 25 ft. CONCLUSIONS Fall height and work-related falls were significantly associated with death on impact. This is a public health issue, as 13% of falls were work related and 4% of falls were due to improper use of safety equipment. Some work-related falls are potentially preventable with proper safety equipment use. Understanding patterns of injury may play a role in prevention and management of survivors in the acute period.
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BODO MICHÈLE, ROTH SÉBASTIEN. UNCERTAINTIES OF IMPACT CONFIGURATION FOR NUMERICAL REPLICATIONS OF REAL-WORLD TRAUMA: A FE ANALYSIS. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416400182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study deals with free fall accident analysis involving adults, and their numerical replications using a finite element model of the human thorax. The main purpose is to determine the role of body position at impact in the thorax injury risk appearance. For this study, cases of real-world free-fall provided by an emergency department were selected and investigated. These cases involved both male and female with an age range of 20 to 63 years, who sustained accidental free-fall with both injured and uninjured cases. The examination of the patients' medical record provided helpful information to accurately perform numerical replications with the finite element model HUByx (Hermaphrodite Universal Biomechanical yx model) which was already validated for various experimental tests in the field of automobile, ballistic impacts and blast. The results of simulations at different impact location allowed highlighting the crucial influence of the body orientation in the risk of thoracic injury occurrence.
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Affiliation(s)
- MICHÈLE BODO
- Université de Bourgogne Franche-Comté, Université de Technologie de Belfort-Montbéliard UTBM, 90010 BELFORT Cedex, France
| | - SÉBASTIEN ROTH
- Université de Bourgogne Franche-Comté, Université de Technologie de Belfort-Montbéliard UTBM, 90010 BELFORT Cedex, France
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Dethleff D, Weinrich N, Seide K, Jürgens C, Stuhr M. Absturzunfall in einer Onshore-Windenergieanlage. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0181-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
In the abrupt vertical deceleration that occurs on impact after a free fall, tissue damage is caused by the absorption by the body of the energy accumulated during the free fall. Patients sustain a unique injury pattern that is predicatably different from that seen with other forms of blunt multiple trauma. The present paper reviews the pathophysiology and pattern of injury sustained following free fall.
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Affiliation(s)
- S Tan
- South Birmingham Trauma Unit, Selly Oak Hospital, Birmingham, UK,
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40
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Abstract
The World Health Organization estimates that in the year 2000, approximately one million people died from suicide worldwide. Over the last 45 years, suicide rates have increased by 60%, with a particularly precipitous rise among young people. The underlying psychology of suicide is complex and individual. However, certain themes emerge from studying individuals who have attempted or completed suicides. This paper will provide an overview of suicide and suicidal behaviour as it relates to trauma practitioners, detailing risk factors, biologic and genetic interactions, and opportunities for prevention and treatment.
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Affiliation(s)
- Marie Crandall
- Department of Surgery, Northwestern University, Chicago, IL 60611, USA,
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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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Geldenhuys EM, Burger EH, Alblas A, Greyling LM, Kotzé SH. The association between healed skeletal fractures indicative of interpersonal violence and alcoholic liver disease in a cadaver cohort from the Western Cape, South Africa. Alcohol 2016; 52:41-48. [PMID: 27139236 DOI: 10.1016/j.alcohol.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 12/20/2022]
Abstract
Interpersonal violence (IPV) and heavy alcohol consumption are major problems in the Western Cape Province of South Africa. Cranio-maxillofacial fractures, particularly nasal and zygomatic bone fractures, as well as isolated radial fractures (Colles fractures) and ulnar shaft fractures (parry fractures), are indicative of IPV, while alcoholic liver disease (ALD) is the consequence of chronic alcohol abuse. We therefore aim to investigate whether a significant association exists between the prevalence of cranio-maxillofacial fractures and parry fractures and ALD in a Western Cape population. Embalmed cadavers (n = 124) used for medical students' anatomy training at the Division of Anatomy and Histology, Faculty of Medicine and Health Sciences, Stellenbosch University were studied. The cadavers were dissected according to departmental protocol. The liver of each cadaver was investigated for macroscopic pathology lesions. Tissue samples were removed, processed to wax, and sectioned and stained with hematoxylin and eosin (H&E). All soft tissue was removed from the skulls, radii, and ulnae, which were then investigated for healed skeletal trauma. The results showed 37/124 (29.8%) cadavers had healed cranio-maxillofacial fractures and 24/124 (19.4%) cadavers had morphologic features of ALD. A total of 12/124 (9.7%) cadavers showed signs of both ALD and healed cranio-maxillofacial trauma. More males were affected than females, and left-sided facial fractures were statistically more common compared to the right side. This study illustrated a significant trend between alcohol abuse and cranio-maxillofacial fractures in individuals from communities with a low socio-economic status (SES) where IPV is a major problem.
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Affiliation(s)
- Elsje-Márie Geldenhuys
- Division of Anatomy and Histology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Elsie H Burger
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Amanda Alblas
- Division of Anatomy and Histology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Linda M Greyling
- Division of Anatomy and Histology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Sanet H Kotzé
- Division of Anatomy and Histology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
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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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35 m Vertical Free Fall: How Impact Surface Influences Survival. Case Rep Orthop 2014; 2014:805213. [PMID: 25405045 PMCID: PMC4227496 DOI: 10.1155/2014/805213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/24/2014] [Accepted: 10/08/2014] [Indexed: 12/22/2022] Open
Abstract
We describe the accidental free fall of a 23-year-old construction worker, who fell 13 stories (approximately 35 meters) from a false work landing on a toilet container. On impact he broke through the roof of the container, which attenuated his fall and made his survival possible. The patient sustained a central spleen rupture, liver laceration, subdural hematoma, blunt thoracic trauma with a left-sided hematothorax and right-sided pneumothorax with serial bilateral rib fractures, and an unstable fracture of the 10th thoracic vertebra. Two thoracic drainages were inserted in the emergency department before the patient underwent emergency surgery for the management of his intra-abdominal injuries. On the third day after trauma the unstable fracture of the 10th thoracic vertebra was stabilized with an internal fixator. Following extubation on day 8 after trauma the patient did not show any peripheral neurological deficits but cerebral affection with a general slowdown. After only 21 days, the patient was discharged from the hospital to a rehabilitation center where work specific rehabilitation was started. Although the patient is not suffering from physical afflictions from the injury his daily life abilities are still limited due to cerebral damage.
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Kim DY, Choi HJ, Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE, Jin BH. Burst Fractures as a Result of Attempted Suicide by Jumping. Korean J Neurotrauma 2014; 10:70-5. [PMID: 27169037 PMCID: PMC4852615 DOI: 10.13004/kjnt.2014.10.2.70] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 09/13/2014] [Accepted: 09/26/2014] [Indexed: 11/21/2022] Open
Abstract
Objective Jumping from high place for the purpose of suicide results in various damages to body area. A burst fracture of vertebrae is representative of them and we reviewed eight patients who were diagnosed with spinal burst fracture following suicide falling-down. The demographics, characteristics, performed operation, combined injuries, psychological past histories of the patients were analyzed. Methods A retrospective study was made of patients who are diagnosed with vertebral burst fracture from falling-down with the purpose of suicide admitted to department of neurosurgery of the author's hospital, covering the period between 2003 and 2012. Results Total eight patients were suicidal jumper. There were eleven vertebral burst fractures in eight patients and mean age was 26.5 years old. Seven patients already had psychological past history and there were various combined injuries except vertebrae burst fracture. The ankle fracture such as calcaneus, talus, navicular and malleolus was the most common injury and there were also various combined injury. Conclusion Suicidal jumper is different from incidental faller in some aspects because of different injury mechanism. For managing suicidal jumper, physician had to consider patients' age, affected site, psychiatric problem and combined injuries. Each department related to the injuries of patient have to cooperate each other with departments of psychiatry and rehabilitation from beginning to end.
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Affiliation(s)
- Do Young Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hong June Choi
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Jeong Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Kyu Chin
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Su Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Ho Jin
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
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Con J, Friese RS, Long DM, Zangbar B, O'Keeffe T, Joseph B, Rhee P, Tang AL. Falls from ladders: age matters more than height. J Surg Res 2014; 191:262-7. [PMID: 25066188 PMCID: PMC4419695 DOI: 10.1016/j.jss.2014.05.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/16/2014] [Accepted: 05/23/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Falls from ladders account for a significant number of hospital visits. However, the epidemiology, injury pattern, and how age affects such falls are poorly described in the literature. MATERIALS AND METHODS Patients ≥18 y who suffered falls from ladders over a 5½-y period were identified in our trauma registry. Dividing patients into three age groups (18-45, 46-65, and >66 y), we compared demographic characteristics, clinical data, and outcomes including injury pattern and mortality. The odds ratios (ORs) were calculated with the group 18-45 y as reference; group means were compared with one-way analysis of variance. RESULTS Of 27,155 trauma patients, 340 (1.3%) had suffered falls from ladders. The average age was 55 y, with a male predominance of 89.3%. Average fall height was 9.8 ft, and mean Injury Severity Score was 10.6. Increasing age was associated with a decrease in the mean fall height (P < 0.001), an increase in the mean Injury Severity Score (P < 0.05), and higher likelihood of admission (>66 y: OR, 5.3; confidence interval [CI], 2.5-11.5). In univariate analysis, patients in the >66-y age group were more likely to sustain traumatic brain injuries (OR, 3.4; CI, 1.5-7.8) and truncal injuries (OR, 3.6; CI, 1.9-7.0) and less likely to sustain hand and/or forearm fractures (OR, 0.3; CI, 0.1-0.9). CONCLUSIONS Older people are particularly vulnerable after falling from ladders. Although they fell from lower heights, the elderly sustained different and more severe injury patterns. Ladder safety education should be particularly tailored at the elderly.
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Affiliation(s)
- Jorge Con
- Department of Surgery, West Virginia University, Morgantown, West Virginia.
| | | | - Dustin M Long
- Department of Biostatistics, West Virginia University, Morgantown, West Virginia
| | - Bardiya Zangbar
- Department of Surgery, University of Arizona, Tucson, Arizona
| | | | - Bellal Joseph
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Peter Rhee
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew L Tang
- Department of Surgery, University of Arizona, Tucson, Arizona
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Casali MB, Bruno CM, Battistini A, Alessio B, Blandino A, Alberto B, Cattaneo C, Cristina C. The injury pattern in fatal suicidal falls from a height: an examination of 307 cases. Forensic Sci Int 2014; 244:57-62. [PMID: 25194643 DOI: 10.1016/j.forsciint.2014.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/11/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
Falls from a height are a common cause of suicidal death in urban settings. The aim of the present work is to describe and discuss a specific set of 307 autopsies performed in a metropolitan city such as Milan, Italy from 2006 to 2011, with a special focus on the relationship between the injury pattern and height of the fall, age at death and weight at death. The rib cage (92%), the lungs (76%), the heart (53%) and the liver (58%) turned out to be the most injured structures in the whole population. Age resulted statistically significant for heart, thoracic aorta, mesentery, kidney hilus, hip bones and right forearm injuries. Weight resulted statistically significant for subtentorial brain, facial skull, rib cage, lungs and liver injuries. Height was significant for the facial skull (including the jaw), lungs, heart, thoracic aorta, diaphragm, liver, cervical spine, sacroiliac joints, pubic symphysis, right arm and left leg. A simple Injury Extension Score was also calculated which showed a correlation with height. A great variability does exist across all the available forensic literature concerning falls from a height. As a strong common denominator for the injury pattern across all the available literature there is however the very low prevalence of neck injuries, the very high prevalence of rib cage fractures and a definite thorax and upper abdomen injury.
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Affiliation(s)
| | - Casali Michelangelo Bruno
- Institute of Forensic Medicine of Milan, Università degli Studi di Milano, v. L. Mangiagalli 37, Italy.
| | | | - Battistini Alessio
- Institute of Forensic Medicine of Milan, Università degli Studi di Milano, v. L. Mangiagalli 37, Italy
| | | | - Blandino Alberto
- Institute of Forensic Medicine of Milan, Università degli Studi di Milano, v. L. Mangiagalli 37, Italy
| | | | - Cattaneo Cristina
- Institute of Forensic Medicine of Milan, Università degli Studi di Milano, v. L. Mangiagalli 37, Italy
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Choi JH, Kim SH, Kim SP, Jung KY, Ryu JY, Choi SC, Park IC. Characteristics of intentional fall injuries in the ED. Am J Emerg Med 2014; 32:529-34. [PMID: 24612594 DOI: 10.1016/j.ajem.2014.01.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION This study was conducted to examine the characteristics of intentional fall injuries and the factors associated with their prognosis. METHODS The study included 8992 patients with unintentional falls from a height (nonintentional group) and 144 patients with intentional falls from a height (intentional group). General and clinical characteristics were compared between the 2 groups. Intentional fall cases were divided into severe and nonsevere groups, and the factors associated with severe injury were evaluated by comparing these groups. RESULTS The most common age group was younger than 14 years in the nonintentional group and between 30 and 44 years old in the intentional group. For the nonintentional group, 65% of the patients were male, and 48% were male in the intentional group. Fall heights of more than 4 m were most common in the intentional group. Discharge was the most common result in the nonintentional group; however, death before arrival at the emergency department (ED) or during ED treatment occurred in 54.9% of patients in the intentional group. In the severe injury group within the intentional group, patients were older, and the height of the fall was higher. Factors associated with severe injury in the intentional group included being a high school graduate rather than a college graduate and greater fall height. CONCLUSION The risk of severe injury increased with fall height in the intentional group, and a high school level of education rather than a college level of education was associated with more severe injury.
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Affiliation(s)
- Jae Hoon Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 682-714, Republic of Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 682-714, Republic of Korea.
| | - Sun Pyo Kim
- Department of Emergency Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Koo Young Jung
- Department of Emergency Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ji Yeong Ryu
- Department of Emergency Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Sang Cheon Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - In Cheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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