Injuries in fatal cases of falls downstairs

https://doi.org/10.1016/j.forsciint.2003.12.016Get rights and content

Abstract

Downstairs falls frequently occur within domestic environments and are mainly associated with elderly and intoxicated individuals, often feature multiple injuries on various parts of the body. In most cases it is not possible to determine the cause of the fall and/or death solely by means of external examination. In this retrospective study, which covers a period of 11 years, all cases of death which included a fall downstairs in their case history, were collected from the Forensic Institutes of the Universities of Bonn and Greifswald, Germany. Falls downstairs made up to 2% (166 cases) of all postmortem examinations carried out within this period. Interestingly, almost double of the amount of such falls applied to males as to females.

The primary cause of death was cranio-cerebral trauma and the vast majority of skull injuries associated with falls downstairs were found above ‘the hat brim line’. Injuries were also often found on several other parts of the body at once. Nineteen of the 116 examined individuals exhibited agonal injuries. In these cases, postmortem examination revealed pre-existing disease or intoxication to be the cause of death and thus, cause of the fall. The injury pattern only allows a tendency towards vital or agonal incident as a conclusion.

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

References (16)

  • G. Berghaus

    Mathematisch-statistische Differenzierungsmöglichkeiten zwischen Selbstmord und Unfall bei Sturz aus der Höhe

    Z. Rechtsmedizin

    (1978)
  • A. Goonetilleke

    Injuries caused by falls from heights

    Med. Sci. Law

    (1980)
  • H.J. Nellen, Statistische Studien zur Charakterisierung von Sturzverletzungen, Med. Diss., Bonn,...
  • F. Driever et al.

    Zur Lokalisation von Verletzungen bei Treppenstürzen

    Arch. F. Krim.

    (2001)
  • P.M. Hein et al.

    Die sturzbedingte Schädelhirnverletzung

    Beitr. Gerichtl. Med.

    (1989)
  • O. Prokop, G. Radam, Tod durch Sturz, in: Atlas der Gerichtlichen Medizin, vol. 2, Karger, Basel, 1987, pp....
  • N. Specht-Leible et al.

    Stürze im Alter

    Dtsch. Med. Wschr.

    (1997)
  • E. Lignitz, G. Geserick, D. Patzelt, Experimentelle Untersuchungen zum Orbitazeichen sowie anderer Zeichen beim Sturz...
There are more references available in the full text version of this article.

Cited by (30)

  • Investigation of injuries sustained from falls down stairs

    2023, Journal of Forensic and Legal Medicine
  • Skeletal fractures resulting from fatal falls: A review of the literature

    2016, Forensic Science International
    Citation Excerpt :

    Locations of the traumatised bone indicate almost all cranial regions are susceptible to fracturing in fatal falls down stairs. Preuß et al. [129] found basal skull fractures to be the most common and also a fairly high proportion of facial fractures. Behera et al. [128] found that the majority of fracturing was to the parietals and temporals, and Bux et al. [130] found trauma to both the upper and lower head portions.

  • Retrospective analysis of fatal falls

    2010, Forensic Science International
    Citation 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.

  • Causes and circumstances of fatal falls downstairs

    2007, Forensic Science International
    Citation 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].

View all citing articles on Scopus
View full text