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PubMed2004

Homicidal and dyadic falls from a height: rarities in Singapore.

A review of homicidal falls from a height, over a ten-year-period (1991-2000), demonstrated the rarity of such deaths in Singapore, despite the high frequency of fatal falls from a height that prevails in the city-state. During that time, there were four cases (involving five individuals) of pure homicide and nine episodes (involving 19 individuals) of dyadic death involving vertical deceleration from a considerable height in the approximate range of 17-31 m (6-11 floors) and 17-50 m (6-18 floors), respectively. The index cases were gleaned from a total of 533 homicides and 3,963 fatal falls from a height. Hence, the corresponding ten-year prevalence rates of homicidal falls were 0.9% in terms of all homicidal deaths and 0.1% in relation to all fatal falls, and 3.6% and 0.5% for dyadic falls, respectively. The majority of victims were children, with almost equal numbers of males and females, aged between two months and six years for pure homicides and between 20 months and 13 years for homicide-suicides. Over a third (9/24) of these subjects attained the maximum Injury Severity Score (ISS) of 75. With respect to the dyadic deaths, the majority of the perpetrators (6/9) were females, comprising four mothers and two live-in maids. It would appear that strained or broken relationships, probable or actual mental illness, or a combination of both factors, had largely predisposed them to these tragic events which may, potentially, carry diplomatic implications when foreign nationals are involved.

Adult↗

PubMedDate not supplied

[Level of total injury severity as a possible parameter for evaluation of height in fatal falls].

The injuries caused by high falls from over the seventh floor are considered mostly fatal. It is possible to survive the high fall from over 30 metres at landing on the surface of high deformity (snow or water). The Injury Severity Score (ISS) due to a high fall is influenced by the height from which the body has fallen, then, the body and surface features, and finally, the manner of body impact on to the surface. The aim of the study was determining the possibility of the height estimation that caused the fatality of the impact, considering the severity of injury expressed by ISS. A retrospective autopsy study was done on the materials of Institute of Forensic Medicine in Belgrade, during a twenty-year period: 1981-2000. The autopsy records were analyzed together with clinical medical data, of the deadly injured due to high falls on to a solid surface. ISS value was determined in each case. The height of fall was determined on the basis of police reports, i.e. death scene analysis. The results were done statistically (linear correlation). The sample included 660 cases: 469 males (71%) and 191 females (29%). The average age of the examined sample was 44.66 (SD=6.62). The number of 290 cases (44%) were accidental deaths, while 370 were suicidal ones (56%). Only few injured due to high falls up to 7 metres had ISS value below 26. Deaths in these cases were caused by complications of the injuries. The ISS value in the injured rose with the height from which the victim had fallen: ISS was 25 in all falls over 7 metres of height. In all cases were severe, critical injuries of one organic system (mostly severe head injuries). According to the analysis of our sample, we concluded that it was not possible to determine the precise height of fatal falls only on the basis of the injury severity score estimation by ISS. This determination, approximate one, was possible only in falls on to a solid surface up to 30 metres. The same determination was not possible by the analysis of the time of survival. It is obvious that determining the height of fall is more possible by types and combinations of single injuries which are, single or combined with other injuries, characteristic for single mechanisms of primary body contact with the solid surface depending on the height of fall.

Accidental Falls↗

PubMed2005

Kids can't fly: preventing fall injuries in children.

Falls are the leading cause of unintentional injury in children. Pediatric fall injuries can be grouped into roughly 4 categories: (1) falls while walking or running, (2) falls from heights, (3) falls while participating in recreational activities, and (4) falls during competitive sports activities. Because injury statistics collected by the US Consumer Product Safety Commission are product-related, there is little data on falls from walking or running. Falling down stairs is the most common height-related fall injury, followed by playground-related falls. Bicycle-related injury leads the third category in frequency. Over 30% of parents report that their child has been injured while playing a team sport; although not all sports-related injuries are caused by falling, most result in a fall. Strategies for preventing fall injuries are based on finding risk factors that can be modified; these modifications can be pre-event, event-specific, or post-event. Office-based injury prevention counseling plays an important role in preventing pediatric fall injury.

Accident Prevention↗

PubMed2004

Victims of falls from a height surviving to hospital admission in two Singapore hospitals.

Falls from a height are a common problem in Singapore. However, there has been no analysis of the injury patterns and outcomes of patients who survived initial resuscitation after falls from a height in Singapore. One hundred and thirty-nine patients admitted over a two-and-a-half year period after falls of greater than one storey were studied. The higher the fall, the greater the likelihood of hypotension and neurological injury. The length of stay in hospital, the number of operative procedures and mortality also correlated with the height of the fall. The overall mortality rate was 11% but rose to 47% among patients who were hypotensive on admission. About half of the deaths were due to head injury with haemorrhage being the second most common cause. The majority of patients who fell from five or more storeys did so intentionally, and had more severe torso and extremity injuries compared with those who fell accidentally. These findings suggest that efforts in injury prevention and aggressive evaluation and treatment of fall victims arriving alive at the hospital continue to be important.

Accidental Falls↗

PubMed1997

Pubertal growth, sexual maturation, and final height in children with IDDM. Effects of age at onset and metabolic control.

OBJECTIVE: To evaluate growth and pubertal development in children with IDDM and the influence of the age at onset of IDDM and the degree of metabolic control on final height. RESEARCH DESIGN AND METHODS: We conducted a retrospective evaluation of 62 subjects followed longitudinally both clinically and metabolically from the onset of IDDM until final height was reached. RESULTS: Height at diagnosis was within the normal percentiles in boys (0.5 +/- 1.0 standard deviation score [SDS]) and girls (0.4 +/- 1.0 SDS), but above the genetic target height (-1.0 +/- 0.9 SDS in boys and -1.1 +/- 0.6 SDS in girls; P = 0.0001 for both comparisons). Although a lesser height gain was observed during the ensuing years, the final height reached by boys (-0.4 +/- 1.1 SDS) and girls (-0.4 +/- 0.9 SDS) was higher than the genetic target height. Blunted total pubertal growth was observed both in boys (24.5 +/- 3.6 cm) and girls (20.1 +/- 4.2 cm). The decrease in height gain was independent of the duration of IDDM, the degree of metabolic control, or the insulin requirement. The greater the height at diagnosis, with respect to the genetic target height, the lesser was the subsequent height gain to reach final adult height (r = 0.34, p < 0.01). BMI increased with age as normally occurs in healthy children, independent of the duration of disease and the degree of metabolic control. Pubertal development began and progressed normally both in boys and girls. In boys, a testicular volume of 4 ml was reached at a mean age of 12.1 +/- 0.9 years. In girls, breast enlargement occurred at a mean age of 10.4 +/- 1.2 years and the mean age of menarche was 12.8 +/- 1.4 years. Pubertal development and progression occurred independent of the age at onset of IDDM, the glycemic control, or the insulin requirement during the pubertal period. CONCLUSIONS: Children with IDDM have normal onset of puberty and normal sexual maturation. Even though final height falls within the normal percentiles, the diminished height gain after diagnosis requires further investigation.

Adult↗

PubMed1998

Common protective movements govern unexpected falls from standing height.

Simple energy considerations suggest that any fall from standing height has the potential to cause hip fracture. However, only 1-2% of falls among the elderly actually result in hip fracture, and less than 10% cause serious injury. This suggests that highly effective movement strategies exist for preventing injury during a fall. To determine the nature of these, we measured body segment movements as subjects (aged 22-35 yr) stood upon a gymnasium mattress and attempted to prevent themselves from falling after the mattress was made to translate abruptly. Subjects were more than twice as likely to fall after anterior translations of the feet, when compared to posterior or lateral translations. In falls which resulted in impact to the pelvis, a complex sequence of upper extremity movements allowed subjects to impact their wrist at nearly the same instant as the pelvis (average time interval between contacts = 38 ms), suggesting a sharing of contact energy between the two body parts. Finally, marked trunk rotation was exhibited in falls due to lateral (but not anterior or posterior) perturbations, resulting in the avoidance of impact to the lateral aspect of the hip. These results suggest that body segment movements during falls, rather than being random and unpredictable, involve a repeatable series of responses which facilitate safe landing.

Accidental Falls↗

PubMed2005

[Fall from a height of 13.5 meters of a child without major injuries].

High-velocity traumas, especially falls from a height, are a major cause of morbidity and mortality in children. Despite the height of fall is a poor predictor of major injury, we must be aware of relevant injuries especially of the head and the musculoskeletal system. The aim is to recognize all relevant problems, or better to avoid the fall. We report a case from a fall of 13.5 meters with an ellbow-fracture and contusions of the head.

Female↗

PubMed1995

Dynamic models for sideways falls from standing height.

Despite our growing understanding of the importance of fall mechanics in the etiology of hip fracture, previous studies have largely ignored the kinematics and dynamics of falls from standing height. Beginning from basic principles, we estimated peak impact force on the greater trochanter in a sideways fall from standing height. Using a one degree-of-freedom impact model, this force is determined by the impact velocity of the hip, the effective mass of that part of the body that is moving prior to impact, and the overall stiffness of the soft tissue overlying the hip. To determine impact velocity and effective mass, three different paradigms of increasing complexity were used: 1) a falling point mass or a rigid bar pivoting at its base; 2) two-link models consisting of a leg segment and a torso; and 3) three-link models including a knee. The total mechanical energy of each model before falling was equated to the total mechanical energy just prior to impact in order to estimate the hip impact velocity. In addition, the configuration of the model just before impact was used to estimate the effective mass. Our model predictions were compared with the results of an earlier experimental study with young subjects falling on a 10-inch thick mattress. Values from literature were used to estimate the soft tissue stiffness. For the models, predicted values for hip impact velocity and effective mass ranged from 2.47 to 4.34 m/s and from 15.9 to 70.0 kg, respectively. Predicted values for the peak force applied to the greater trochanter ranged from 2.90k to 9.99k N. Based on comparisons to the experimental falls, impact velocity and impact force were best predicted by a simple two-link model with the trunk at 45 degrees to the vertical at impact. A three-link model with a quadratic spring incorporated in the knee of the model was the best predictor of effective mass. Using our most accurate model, the peak impact force was 2.90k N for a 5th percentile female and 4.26k N for a 95th percentile female, thereby confirming the widely held perception that "the bigger they are, the harder they fall".

Accidental Falls↗

PubMed1993

A biomechanical study of bicycle helmets' effectiveness in childhood.

The authors present the results of a series of impact tests on pedal cycle helmets. 10 helmets were tested using a drop test under three different test conditions: Left frontal/temporal from 1 m, right frontal/temporal from 1.5 m and left occipital from 1 m. Impact force and the acceleration of the headform's centre of gravity in three axes were measured. As a result of the authors' field research on pedal cycle helmets in Australia the 1.5 m drop height was considered to be more representative of a "real" accident than the less severe 1 m height fall. The range of resultant maximal accelerations, 1 m drop height, was 81 g to 193 g; 1.5 m drop height 122 g to 209 g. In comparison a fall without helmet from 0.5 m produced a maximal resultant acceleration of 282 g. Head injury criteria values were for 1 m drops between 201 and 630; from 1.5 m 547 to 1078; and without helmet from 0.5 m 906. The individual helmets are compared on these figures and their merits discussed.

Adolescent↗

PubMed1990

Imaging evaluation of children after falls from a height: review of 45 cases.

The injury pattern in the child who falls from a height is markedly different from that in the adult, so a different imaging protocol is needed. To help establish such a protocol, the authors reviewed the charts and imaging records of 45 children and infants 12 years of age and younger who had fallen one to six stories. Extremity fractures were the most common injury, occurring in 20 patients. Head injuries (including skull fractures) occurred in 19 patients. Abdominal injuries were present in only one patient. Pneumothoraces were seen in four patients and lung contusions in two patients. Fractures of the pelvis, spine, and os calcis were uncommon. The height of the fall did not enable prediction of either the severity or type of injury. The authors recommend radiography of the cervical spine and chest alone in the initial evaluation of the injured child and greater willingness to obtain computed tomographic (CT) scans of the head in children than in adults. Radiographs of the pelvis, thoracolumbar spine, and lower extremities, as well as CT scans of the head and abdomen, should be obtained on a case-by-case basis, and not according to protocol, as is often the situation in adults.

Abdominal Injuries↗

PubMed1992

Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age.

Head injury in the youngest age group is distinct from that occurring in older children or adults because of differences in mechanisms, injury thresholds, and the frequency with which the question of child abuse is encountered. To analyze some of these characteristics in very young children, the authors prospectively studied 100 consecutively admitted head-injured patients 24 months of age or younger who were drawn from three institutions. Mechanism of injury, injury type, and associated injuries were recorded. All patients underwent ophthalmologic examination to document the presence of retinal hemorrhages. An algorithm incorporating injury type, best history, and associated findings was used to classify each injury as inflicted or accidental. The results confirmed that most head injuries in children younger than 2 years of age occurred from falls, and while different fall heights were associated with different injury types, most household falls were neurologically benign. Using strict criteria, 24% of injuries were presumed inflicted, and an additional 32% were suspicious for abuse, neglect, or social or family problems. Intradural hemorrhage was much more likely to occur from motor vehicle accidents and inflicted injury than from any other mechanism, with the latter being the most common cause of mortality. Retinal hemorrhages were seen in serious accidental head injury but were most commonly encountered in inflicted injury. The presence of more serious injuries associated with particular mechanisms may be related to a predominance of rotational rather than translational forces acting on the head.

Accidental Falls↗

PubMed1997

[Injury pattern in leaps from a window. A case analysis of 48 patients].

We report about 48 patients who sustained a deceleration trauma after jumping out of a window. The average free fall height was 11.6 m. 45.8% of the patients suffered from psychic disorders. 12.5% were addicted to opiates or hallucinogenics. The lethality of the analysed group was 12.5%. Within the group of spinal injuries (66.7%) compression- and bursting vertebra fractures of the thoracolumbar spine dominate. Injuries of the osseus pelvic ring (62.5%) and the thorax (64.6%) were equally often in all free falls. Abdominal- (25%) and head trauma (35.4%) occurred less at the patients in our clinic. At the extremities a predeliction of injuries of joint near and joint building osseus structures was noticeable. Out of the 103 injuries of the lower extremities 57.3% concerned foot, ankle and the distal lower leg. With increasing height of the falls the rate of multi-injuries and chain fractures raised. Out of the 37 injuries of the upper extremities 40.5% concerned hand and distal forearm and 29.7% the elbow.

Accidental Falls↗

PubMed1996

[Dens fracture and multiple fracture of the thoracic spine after fall from great height. Diagnostic standard].

Multiple level spine fractures after a fall from a great height frequently cause a neurological deficit with paraplegia. In general, survival after a free fall from 20 m height without any neurological deficit is very unlikely. Since a considerable part of the trauma may not be detected by conventional radiograms, it is recommended that CT scans of all affected spine regions always be carried out with 2 D reconstructions. In addition, 3 D reconstructions should be performed if rotatory instability is suspected. This case report illustrates the management and diagnostic problems of a serial spine trauma.

Accidental Falls↗

PubMedDate not supplied

[A comparative analysis of the incidence of the occurrence of injuries to the soft tissues, bones and internal chest organs in trauma from a fall from a height and from the collision of a moving car with a pedestrian].

The author compares the incidence of injuries to soft tissues, bones, and thoracic organs in two types of traumas: falling from height and collision of a pedestrian with a moving car. A total of 100 corpses of subjects who died from such traumas were examined. The incidence of the detected injuries is shown on figures. Comparison of the graphic images indicates that trauma from falling from height results in more massive and numerous injuries to the chest than from collision with a moving car. Fractures of the spine, bleedings to the pleural cavity, mediastinum, and the heart coating, and ruptures of the aorta, lungs, and heart more often result from falling from height. Collision of a pedestrian with a moving car more often leads to fractures of the clavicle, sternum at the level of the third or fourth sternocostal joining, and punctate hemorrhages under the lung pleura.

Accidental Falls↗

PubMed2005

Protective movements during sideways falls from standing height.

To examine the effect of protective movements during sideways falls from standing height (i.e., from the standing position), a two-step study was performed. In the first step, 80 young male and female volunteers freely fell onto a sport-mat. All falls were recorded on videotape, and replayed to analyze movements in response to the falls. Several protective movements were observed; forward flexion and lateral flexion were observed with a particularly high frequency. In the second step, impact velocities of the head and hip were measured by a three-dimensional motion analyzer regarding three types of falls: stiff falls, forward flexion falls and lateral flexion falls. Both types of flexion reduced impact velocities of the head, but not those of the hip. The reduction of the impact velocity on the head correlated with the lowering of the height of the head from the floor.

Accidental Falls↗

PubMed1989

Vertical trauma: injuries to patients who fall and land on their feet.

We reviewed the patterns of injuries sustained by 12 consecutive fallers and jumpers in whom primary impact was onto the feet. The fall heights ranged from 20 to 100 ft. The 12 patients sustained 49 significant injuries. Skeletal injuries were most frequent and included 15 lower extremity fractures, four pelvic fractures, and nine spinal fractures. In two patients, paraplegia resulted. Genitourinary tract injuries included bladder hematoma, renal artery transection, and renal contusion. Thoracic injuries included rib fractures, pneumothorax, and hemothorax. Secondary impact resulted in several craniofacial and upper extremity injuries. Chronic neurologic disability and prolonged morbidity were common. One patient died; the patient who fell 100 ft survived. After initial stabilization, survival is possible after falls or jumps from heights as great as 100 feet It is important to recognize the skeletal and internal organs at risk from high-magnitude vertical forces.

Accidental Falls↗

PubMed1995

[Injury pattern after fall from great height. An analysis of 101 cases].

There are few references discussing the typical injury patterns of adults after a fall from a height. We present the pattern of injury in 101 adult patients who were treated between 1987 and 1990 at our trauma center after falling from an average height of 7.2 m. In 62 patients the fall was accidental; 39 patients tried to commit suicide by jumping from a height. The most common injuries were fractures of the thoracic and lumbar spine (83.0%) with a preference for the thoracolumbar junction. Fracture of the lower limbs occurred in 45%. The most frequent injuries were fractures of the os calcis (64.4%) and the ankle joint (26.6%). Twenty-five percent of all patients suffered from fractures in the upper limbs with a preference for the distal radius (56.6%) and the elbow (44.0%). There were no differences between the injury patterns after a fall from a height of more than 7 m or less than 7 m. The incidence of thoracic and pelvic injuries (30.0%) increased after falls from more than 7 m. The neurological complications of injuries to the spine corresponded to increasing height. According to our analysis blunt abdominal trauma is an uncommon injury after falling from a great height. Head injuries, which would be expected to be the most common cause of death in all non-survivors in the literature, only occurred in 27% of our patients who all survived their transport to hospital.

Accidental Falls↗

PubMed2005

Playground safety in South Western Sydney.

OBJECTIVE: Recognition of the cost of injuries sustained in playgrounds has led to the development of Australian/New Zealand Standards for playground safety. This study assesses compliance of public playgrounds in South Western Sydney with the current Standards. METHODS: Playgrounds in South Western Sydney were randomly audited for compliance with Australian/New Zealand Standards for playground equipment pertaining to fall height, type of undersurface material, adequacy of maintenance of undersurface materials and adequacy of the safe fall zone. Comparisons were made with an audit of playgrounds in New South Wales undertaken in 1995 by Kidsafe. RESULTS: Of the 257 pieces of equipment from 87 playgrounds audited, only three (3.4%) playgrounds and 65 (25.3%) pieces of equipment complied with all criteria assessed. Compared with the 1995 study, there has been a significant improvement in equipment complying with height standards (84.4% vs 72.2%, P < 0.0001) and appropriate undersurface material (66.8% vs 45.4%, P < 0.0001). Pinebark is now the most common appropriate undersurface material used but is poorly maintained, particularly in high-traffic areas. Of 131 pieces of equipment with an appropriate undersurface material, only 38 (29%) had an adequate safe fall zone. CONCLUSIONS: Improvements in playground safety have occurred; however, very few playgrounds meet the Australian/New Zealand Standards. Compliance with Standards pertaining to maintenance of undersurface materials and safe fall zone is poor. Mechanisms need to be developed to support councils in the upgrading and maintenance of existing playgrounds.

Accident Prevention↗