A 13-Year Study of Fatal Falls From Height in Northern Tunisia

Abstract

IntroductionFalls from height are a major cause of unintentional injury death, resulting in high disability and mortality. We investigated the characteristics of fatal falls and their relationship with intentionality, injury patterns, and death on impact.Materials and MethodsIn this retrospective study, we examined 545 cases of fatal falls from height that underwent autopsy in the forensic department of the Charles Nicolle hospital of Tunis (Tunisia) between January 2008 and December 2020. Cases were reviewed in terms of demographics, fall characteristics, and autopsy findings.ResultsThe population was predominately male (86.6%). Four hundred twenty-one (77.3%) originated from accidents, 120 (22%) were found to be suicidal, with 4 homicide cases. A notable decline in cases was noticed following the Jasmine revolution, 2011 (R squared = 0.8). The mean height of falls was 8 m. Higher falls were associated with a set of organ-specific injuries. Organ injury pattern did not differ based on intentionality. Female victims were 2.4 times more likely to sustain pelvic injuries than males. The majority of victims deceased before reaching health care structures. Death on impact was strongly associated with higher falls, cranial impact, and organ-specific injuries, including cardiac, pulmonary, and skull injuries.Falls from height are in many cases preventable. A clearly defined fall safety policy, strict implementation of evidence-based interventions, efficient allocation of resources, and raising safety awareness must to be urgently implemented.ConclusionUnderstanding patterns of injury and the factors that influence death on impact may be of further interest in the prevention and management of survivors in the acute period.

Factors Influencing the Pattern of Injuries in Falls From Height

“…Besides, the literature suggests that feet-first impacts are common in falls from heights ranging from 36 to 54 m, and side-first impacts are common up to falls from 60-m heights 2 . Thus, I believe that the categorization of height of falls into larger ranges in the study of Kort et al 1 could provide an additional understanding of the pattern of injury in falls from height.…”

“…The article provides comprehensive data on fall from height cases in Northern Tunisia, such as demography of the cases, places of incidence (work or nonwork related), specific sites of fall (roof, stairs, window, etc), manner of fall, psychiatric history of the victims, organ injuries according to height and death on impact, which are helpful for policymakers in ascertaining preventive measures to avoid fatal falls. Apart from the points of regional interest, the authors have discussed factors that influence the pattern of injury in falls from height including characteristics of the fall (height of fall, landing position, surface, and duration of impact) and personal factors (age, body mass index, preexisting diseases, bone fragility in older individuals, and toxicological analysis of the cases), which are of interest to forensic pathologist 1 . However, there are a few additional issues that could influence the injury patterns and the understanding of the injury patterns in fall from height cases.…”

“…One of the decisive factors in the pattern of injury in falls from height is the height of the fall. The height of fall has been divided into three categories by the authors: low falls more than 2.5 m, midrange falls: 2.5 to 5 m, and high falls higher than 5 m and various organ injuries are divided according to the height of fall 1 . The mean height of the falls was 8 m (range, 2.5–50 m).…”

“…The mean height of the falls was 8 m (range, 2.5–50 m). The authors have discussed that according to a few studies, head injuries show a height-related pattern and predominate in falls from heights lower than 10 m and higher than 30 m 1 . Besides, the literature suggests that feet-first impacts are common in falls from heights ranging from 36 to 54 m, and side-first impacts are common up to falls from 60-m heights 2 .…”

“…Another factor the authors mentioned that influences the pattern of the injury is the age of the individual. The age ranged from 4 months to 89 years in the study of Kort et al 1 The authors have emphasized the role of bone fragility in older individuals, which makes them more susceptible to fractures and consequent fatality even after a fall from a low height 1 . Similarly, the injury pattern in children is also different from that of adults in falls from height.…”