Injuries in fatal cases of falls downstairs
Introduction
In the literature, several publications on falls from high altitude exist [1], [2], [3]; however, only few authors have reported on the special issue of fatal falls downstairs [4].
In most cases, falls downstairs involve elderly and intoxicated individuals and frequently occur within a domestic environment [3], [7].
If a lifeless individual is found in close proximity to a flight of stairs, a fall should be strongly suspected. Medical rescue teams, usually the first to arrive at the scene of such an incident, are, following initial examination, usually not able to determine whether death occurred as a result of sustained injuries or due to a so called ‘agonal fall’, subsequent to sudden death, e.g., due to a heart attack.
Release mechanisms for falls down or on stairs may fundamentally be regarded as acute occurrence or deterioration of natural disorders (e.g., cardiac or cerebral syncopes), accidents or third parties influence. Unless the latter leaves no isolated, defining and conclusive traces, a fall affected by third parties influence can hardly ever be verified [8], [9]. Herein lies the essential forensic problem regarding falls downstairs as well as those from extreme heights [6], [10], [11].
The position of the injured or deceased individuals on or in relation to the stairs, possible areas of contact during the course of the fall, the use of glasses or walking aids and the condition of clothing provides information which can be of importance in clarifying the cause of the fall. Familiarity with injury patterns associated with falls downstairs, whereby the actual extent of a present injury is not immediately recognizable, is significant in the treatment of patients with non-fatal injuries.
In the majority of these cases, however, only autopsy and further forensic examination can provide more conclusive information as to the possible cause of the fall and its consequences [2], [12]. However, the discrimination between fall or blow can be quite difficult in practical case work. To establish a final diagnosis in such cases, many factors have to be considered, whereas autopsy findings can be regarded of high importance.
The aim of this retrospective study, apart from describing typical injury patterns which are also of significance for attending physicians, was the investigation of classical causes of falls downstairs and associated fatalities. Furthermore, the analysis of possible surrounding circumstances (location, intoxication, gender, age) to provide a decision support for the investigation of falls downstairs in practical case work.
Section snippets
Materials and methods: subjects of research
All autopsy cases which had a history of fall downstairs and been subjected to postmortem examination performed by the Institutes of Forensic Medicine of the Universities of Greifswald (HGW) and Bonn (BN) between 1990 and 2000, were enrolled. In total, 116 cases were studied, of which Greifswald provided 57 and Bonn provided 59 cases for evaluation.
In detail, the autopsy reports were studied with regard to personal data of the victim (gender, age), cause of fall, cause of death and pattern of
Circumstances
The proportional number of falls downstairs amounted to less than 2% of all performed autopsies. More than double the number of males than females were victims of such falls (males, n=81; females, n=35).
The age distribution (Fig. 1) clearly showed a maximum of cases amongst those between 50 and 60 years of age. A break down, according to age and gender, indicated that males between 50 and 60 years of age are the most frequent victims of falls downstairs. Amongst the females, eight victims were
Discussion
The retrospective analysis of 116 fatal falls downstairs revealed, that based on sole external examination of injury patterns, no discrimination between agonal or vital injuries can be made. Remarkably, also persons who had fallen downstairs due to acute myocardial infarction or fulminant pulmonary embolism, partially exhibited severe injuries of various body regions, which thoroughly appeared as vital injuries. If at all, only an autopsy can determine the cause of death beyond doubt. The cause
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2010, Forensic Science InternationalCitation Excerpt :This retrospective study covers a period of 13 years, starting 1992. Prior to this analysis, fatal falls down stairs were handled by Preuß et al. [24]. Personal data like age and gender were collected as well as data relating to the fall (manner and site), to the autopsy findings (injuries, previously existing pathologic findings and cause of death), to a possible alcoholisation and as the case may be to the survival time.
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2007, Forensic Science InternationalCitation Excerpt :Among drunken victims blood alcohol concentrations were high, significantly higher than among those who fell due to severe internal disease. In a similar study Preuß et al. [1] found that alcoholization was an important cause in falling downstairs. The authors reported BACs up to 5‰[1,2].