A prospective cross-sectional study on the cases in a tertiary care hospital about the patterns of head injury caused by falling from heights

Abstract

One of the most common injuries and death in India are caused by falling from heights. Although a majority of these bereavements are accidental and are due to a slip from higher altitudes like multi storey buildings, trees, construction sites, etc., alcohol consumption also plays a vital role. In such occurrences of death due to falling from heights, head injury is a very common phenomenon and it complicates the investigation procedure for the investigators and the medico legal experts to arrive at a conclusion because these injuries impersonate the injuries sustained from other accident cases like a road accident per say. Due to the absence of eyewitness in most of these cases, a detailed analysis on the pattern and the nature of the injuries is required to arrive at a conclusion. These injuries sustained vary owing to the site of impact and the stature from where the victim had fallen and the critical answer to the medico legal queries lies in a detailed autopsy of the victim’s body and a thorough examination at the scene of occurrence. On the account of a comprehensive study insufficiency in Tamilnadu, a modest attempt was made to analyse the pattern of head injuries sustained on the victims of fall from different heights and is presented as a cross- sectional study.The case study on the fatal incidents of fall from height was recorded and analysed statically in a sampling of one hundred cases which was subjected to detailed autopsy in a tertiary care hospital. In this analysis the nature and pattern of injuries, data regarding the nature of fall, the site of primary impact, period of survival and a detailed examination of head injuries were all noted. The statistical analysis was carried out using Microsoft Excel 2009.From the analysis, it is observed that the maximum number of fall from height cases seemed to be from the age group of 31 years ~40 years (30%) and males contributed to a majority of these cases (90%). Amongst head injury cases, 82% of the cases had intracranial haemorrhage and 10% had facial bone fractures. In the 82% of cases, 76% of cases had both subarachnoid haemorrhage and subdural haemorrhage. Also skull fracture was seen in 40% of the cases and the base of the skull fracture was noted almost equally in 37% of the cases. Injuries to head and cervical spine constituted to the salient features of primary head impacts, SAH alone is rare in such cases.On the account of observation and analysis, it is noted that most of these cases were accidental in nature (93%) and Males (90%) in the age group of 31-40 years were in highest number (30%). Cranial injuries with subarachnoid and subdural haemorrhage seemed to be the most common cause of death amongst victims falling from heights. Also skull fracture were seen in 40% of the cases and base of skull fracture noted almost equally in 37% of the cases. While SAH alone in rare in these cases, injuries to head and cervical spine were the key impacts of primary head impacts.