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Çakı İE, Karadayı B, Çetin G. Relationship of injuries detected in fatal falls with sex, body mass index, and fall height: An autopsy study. J Forensic Leg Med 2021; 78:102113. [PMID: 33485089 DOI: 10.1016/j.jflm.2020.102113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/24/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
Falls from height are the most common cause of blunt trauma after traffic accidents. The focus of this retrospective study was to analyze the relationship between injuries in fatal falls and fall height, body mass index (BMI), and sex in 206 autopsy reports. Age, sex, weight, height, place of the fall, fall height, period between the incidence and death, external examination findings in the autopsy, intracranial findings, fractures, internal organ injuries, and information about the causes of death were recorded. Accidents and men were the largest groups. Injuries to the upper and lower extremities were frequently detected in accidents. Lower extremity injuries were more common in women. The occurrence of head and neck injuries were rare in overweight individuals. When evaluated by manner of death, there were differences in extremities and posterior body injuries. There was no difference between sex in terms of autopsy findings. It was observed that the injuries increased as the height increased. There was a statistical difference between the BMI groups in terms of liver, rib and sternum injuries. The most common cause of death was head injuries. Many factors have been known to affect injury patterns in cases of falls from height. Fall height, BMI, and gender are just a few of these factors. This study will be beneficial to support the findings of this study with larger-scale studies and statistical modeling that consider more factors affecting injuries in cases of falls.
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Affiliation(s)
| | - Beytullah Karadayı
- Istanbul University-Cerrahpaşa, Cerrahpasa Faculty of Medicine, Forensic Medicine Department, 34303, Istanbul, Turkey.
| | - Gürsel Çetin
- Istanbul University-Cerrahpaşa, Cerrahpasa Faculty of Medicine, Forensic Medicine Department, 34303, Istanbul, Turkey.
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2
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Mlayeh S, Ben Abderrahim S, Haggui F, Ghzel R, Jedidi M. Deadly falls into wells: A retrospective study of 72 autopsy cases from Kairouan, Tunisia. J Forensic Sci 2020; 66:934-939. [PMID: 33284464 DOI: 10.1111/1556-4029.14644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
Falls are a traumatic event that represents a major public health problem worldwide. The literature is rich in published studies of falls from heights, but only a few articles have focused on falls into wells. The region of Kairouan, in central Tunisia, is characterized by an arid climate, hence the abundance of wells for watering crops. In this study, 72 cases of deadly falls into wells were retrospectively investigated at the Department of Forensic Medicine in Kairouan over eight years (01/01/2008 to 31/12/2015). A male predominance was found (sex ratio of 2.42), with a mean age of 29 ± 16.1 years. Sixty-five cases (90.3%) were from rural areas, 62.5% had a low level of education, and 50% were unemployed. In our series, the deceased fell from a distance between 3 and 70 meters with an average of 28.3 m. The falls occurred into functional wells in 61.1%, which were filled with water in 51.4%, and were unprotected in 88.9%. Autopsy findings showed bone fractures in 51.4% of cases of which 44.4% were rib fractures. Visceral injuries were identified in 55.6% of cases. The predominant manner of death was suicide (73.2%), and severe polytrauma was the most frequent cause of death (52.8%). This study highlights the need for increased safety measures to keep wells covered and protected in order to prevent these falls.
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Affiliation(s)
- Souheil Mlayeh
- Department of Forensic Medicine, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Sarra Ben Abderrahim
- Department of Forensic Medicine, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Firas Haggui
- Department of Forensic Medicine, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Raja Ghzel
- Emergency Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Maher Jedidi
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
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3
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Casali MB, Blandino A, Grignaschi S, Florio EM, Travaini G, Genovese UR. The pathological diagnosis of the height of fatal falls: A mathematical approach. Forensic Sci Int 2019; 302:109883. [PMID: 31450068 DOI: 10.1016/j.forsciint.2019.109883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/18/2019] [Accepted: 07/20/2019] [Indexed: 11/18/2022]
Abstract
The authors analyzed the injury pattern of 385 victims of fall from a height which underwent a complete autopsy, with the objective to investigate whether it was possible to construct a mathematical model to be used for height of the fall diagnosis. The cases were selected and enrolled according to a balanced stratification of the heights of the fall, allowing a subdivision into seven classes consisting of 55 subjects each: 6m or less, 9m, 12m, 15m, 18m, 21m, 24m or more (maximum 36m). For each case anthropologic and necroscopic data was collected and analyzed to obtain a standardized description of the injury pattern was obtained, dividing the body into 4 major anatomical areas (Head, Thorax, Abdomen, Skeleton), each of them further divided in 5 major organs. Every organ was finally divided into 5 objective degrees of injury. Statistical analysis was performed on all the available data using IBM SPSS Statistics 20, to test the performance of the "injury pattern assessment table" in the diagnosis of the height of the fall and to develop a related mathematical model. Our findings confirm that the height of the fall is significantly associated with age, weight of the body and the injury pattern. An Injury Pattern Assessment Table and two mathematical models which correlates the height of the fall with analyzed variables are presented.
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Affiliation(s)
- Michelangelo Bruno Casali
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Alberto Blandino
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Silvia Grignaschi
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Elena Maria Florio
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Guido Travaini
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
| | - Umberto Rosario Genovese
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milan 20133, Italy.
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Kaplan O, Söğut Ö, Öztürk M, Çakmak S. SURVIVAL AFTER JUMPING FROM THE GOLDEN HORN BRIDGE DURING A FAILED SUICIDE ATTEMPT. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2019. [DOI: 10.33706/jemcr.609234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rowbotham SK, Blau S, Hislop-Jambrich J, Francis V. An Anthropological Examination of the Types of Skeletal Fractures Resulting from Fatal High (˃3 m) Free Falls. J Forensic Sci 2018; 64:375-384. [PMID: 30107638 DOI: 10.1111/1556-4029.13887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 12/01/2022]
Abstract
Fatal falls from heights (˃3 m) often result in blunt force trauma (BFT) to the skeleton. The fracture patterns that result from this BFT mechanism are well understood in forensic anthropology and forensic pathology; however, details of the specific types of fractures that result remain poorly documented. The aim of this study was to provide a detailed examination of the types of fractures that may result from fatal high falls. Fractures were recorded from 95 full-body postmortem computed tomography scans of individuals known to have died from a high fall. Trauma was then analyzed taking into account the extrinsic and intrinsic variables known to influence a fall using multiple logistic regression. A total of 339 types of fractures were classified, of which 16 were significantly associated with this BFT mechanism. Classified fracture types will augment anthropological interpretations of the circumstances of death from BFT in cases of suspected high falls.
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Affiliation(s)
- Samantha K Rowbotham
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Soren Blau
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Jacqueline Hislop-Jambrich
- Centre for Medical Research, Toshiba Medical, 12 - 24 Talavera Road, North Ryde, New South Wales, 2113, Australia
| | - Victoria Francis
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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6
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Rowbotham SK, Blau S, Hislop-Jambrich J, Francis V. An Assessment of the Skeletal Fracture Patterns Resulting from Fatal High (˃3 m) Free Falls. J Forensic Sci 2018; 64:58-68. [PMID: 29694673 DOI: 10.1111/1556-4029.13803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/21/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
The injury patterns resulting from fatal high (˃3 m) free falls have previously been documented in clinical and medico-legal contexts; however, details relating specifically to the skeletal blunt force trauma (BFT) have been limited. This study aimed to augment what is known of the skeletal fracture patterns resulting from fatal high free falls. Skeletal trauma was analyzed from full-body postmortem computed tomography scans of 95 individuals who died following a high free fall. Fracture patterns were documented using the five general anatomical regions, axial and appendicular regions, and postcranial unilateral and bilateral regions. Patterns were analyzed in the context of the extrinsic and intrinsic variables that may influence fractures using multiple logistic regression. Fracture patterns involved all aspects of the skeleton, with 98.9% exhibiting polytrauma, and were influenced primarily by the height fallen, manner of death, and landing surface. This improved understanding of fracture patterns will augment anthropological interpretations of the mechanism of BFT in cases of suspected high falls.
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Affiliation(s)
- Samantha K Rowbotham
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Soren Blau
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.,Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Jacqueline Hislop-Jambrich
- Centre for Medical Research, Toshiba Medical, 12 - 24 Talavera Road, North Ryde, New South Wales, 2113, Australia
| | - Victoria Francis
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
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Suicides by Jumping Off Istanbul Bridges Linking Asia and Europe. Am J Forensic Med Pathol 2017; 38:139-144. [PMID: 28230653 DOI: 10.1097/paf.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to determine the injury spectrum and characteristics of people who committed suicide by jumping into water from the July 15th Martyrs Bridge and Fatih Sultan Mehmet Bridges in Istanbul, Turkey. METHODS This study included all of the jumpers from the July 15th Martyrs Bridge and Fatih Sultan Mehmet Bridge who were autopsied by the Council of Forensic Medicine, Istanbul Morgue Department, between 2000 and 2013. All of the data were collected from archived case files. Trauma scores were calculated from the traumatic findings of the autopsy reports using the New Injury Severity Score (NISS). RESULTS A total of 80 jumping suicides were identified. The male-to-female ratio was 9:1, and the mean age was 34.06 ± 9.6 years. Most suicides occurred in 2009. The suicide rates were higher in the winter, particularly in December. The most frequent injuries were skin lesions, rib fractures, and lung lacerations. In 12% of the cases, the trauma was minor (NISS range, 0-14; mean, 7 ± 5.67), and in 88% of the cases, it was major (NISS range, 17-66; mean NISS, 44.5 ± 12.46). CONCLUSION The sociodemographic features of the jumpers who committed suicide were quite similar to those reported in previous studies. Preventative measures (installation of barriers or banning pedestrian access to bridges) reduced the suicide rate but were not completely effective. Establishing early warning systems and rescue strategies could save the lives of jumpers who have minor trauma.
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Hemmer A, Meier P, Reisch T. Comparing Different Suicide Prevention Measures at Bridges and Buildings: Lessons We Have Learned from a National Survey in Switzerland. PLoS One 2017; 12:e0169625. [PMID: 28060950 PMCID: PMC5218568 DOI: 10.1371/journal.pone.0169625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
The goal of the study was to compare the effectiveness of different suicide prevention measures implemented on bridges and other high structures in Switzerland. A national survey identified all jumping hotspots that have been secured in Switzerland; of the 15 that could be included in this study, 11 were secured by vertical barriers and 4 were secured by low-hanging horizontal safety nets. The study made an overall and individual pre-post analysis by using Mantel-Haenszel Tests, regression methods and calculating rate ratios. Barriers and safety nets were both effective, with mean suicide reduction of 68.7% (barriers) and 77.1% (safety nets), respectively. Measures that do not secure the whole hotspot and still allow jumps of 15 meters or more were less effective. Further, the analyses revealed that barriers of at least 2.3 m in height and safety-nets fixed significantly below pedestrian level deterred suicidal jumps. Secured bridgeheads and inbound angle barriers seemed to enhance the effectiveness of the measure. Findings can help to plan and improve the effectiveness of future suicide prevention measures on high structures.
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Affiliation(s)
- Alexander Hemmer
- Department of Psychology, Hospital of Psychiatry Muensingen, Bern, Switzerland
| | - Philipp Meier
- Department of Psychology, Hospital of Psychiatry Muensingen, Bern, Switzerland
| | - Thomas Reisch
- Department of Medicine, Hospital of Psychiatry Muensingen, Bern, Switzerland
- Department of Medicine, University Hospital of Psychiatry, Bern, Switzerland
- * E-mail:
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9
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Rowbotham SK, Blau S. The circumstances and characteristics of fatal falls in Victoria, Australia: a descriptive study. AUST J FORENSIC SCI 2016. [DOI: 10.1080/00450618.2016.1194472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Samantha K. Rowbotham
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Soren Blau
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria 3006, Australia
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10
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Rowbotham SK, Blau S. Skeletal fractures resulting from fatal falls: A review of the literature. Forensic Sci Int 2016; 266:582.e1-582.e15. [PMID: 27264682 DOI: 10.1016/j.forsciint.2016.04.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 02/11/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Abstract
To investigate what is currently known about skeletal blunt force trauma (BFT) resulting from falls, and how valuable that research is in contributing to forensic anthropology investigations and interpretations of circumstances of death, a comprehensive review of forensic anthropology, forensic pathology and clinical medicine literature was performed. Forensic anthropology literature identified that establishing the type of fall from the analysis of BFT is difficult given the uniqueness of each fall event, the complexities involved with identify BFT and, in particular, the limited available research documenting fracture patterning and morphologies. Comparatively, skeletal BFT resulting from fatal falls is well documented in the forensic pathology and clinical medicine literature. These disciplines cover a wide range of fall types (free falls, falls in juveniles, specific fractures produced from falls, falls down staircases, falls resulting in impalements, and 'other' fall types), provide details on how the nature of the fall influences the skeletal fracturing, and documents the anatomical regions susceptible to fracturing. Whilst these contributions may assist forensic anthropologists, they provide limited details of fracture patterns and morphologies and thus further research investigating the details of skeletal BFT resulting from fatal falls is required.
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Affiliation(s)
| | - Soren Blau
- Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, Australia
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11
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Casali MB, Bruno CM, Battistini A, Alessio B, Blandino A, Alberto B, Cattaneo C, Cristina C. The injury pattern in fatal suicidal falls from a height: an examination of 307 cases. Forensic Sci Int 2014; 244:57-62. [PMID: 25194643 DOI: 10.1016/j.forsciint.2014.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/11/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
Falls from a height are a common cause of suicidal death in urban settings. The aim of the present work is to describe and discuss a specific set of 307 autopsies performed in a metropolitan city such as Milan, Italy from 2006 to 2011, with a special focus on the relationship between the injury pattern and height of the fall, age at death and weight at death. The rib cage (92%), the lungs (76%), the heart (53%) and the liver (58%) turned out to be the most injured structures in the whole population. Age resulted statistically significant for heart, thoracic aorta, mesentery, kidney hilus, hip bones and right forearm injuries. Weight resulted statistically significant for subtentorial brain, facial skull, rib cage, lungs and liver injuries. Height was significant for the facial skull (including the jaw), lungs, heart, thoracic aorta, diaphragm, liver, cervical spine, sacroiliac joints, pubic symphysis, right arm and left leg. A simple Injury Extension Score was also calculated which showed a correlation with height. A great variability does exist across all the available forensic literature concerning falls from a height. As a strong common denominator for the injury pattern across all the available literature there is however the very low prevalence of neck injuries, the very high prevalence of rib cage fractures and a definite thorax and upper abdomen injury.
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Affiliation(s)
| | - Casali Michelangelo Bruno
- Institute of Forensic Medicine of Milan, Università degli Studi di Milano, v. L. Mangiagalli 37, Italy.
| | | | - Battistini Alessio
- Institute of Forensic Medicine of Milan, Università degli Studi di Milano, v. L. Mangiagalli 37, Italy
| | | | - Blandino Alberto
- Institute of Forensic Medicine of Milan, Università degli Studi di Milano, v. L. Mangiagalli 37, Italy
| | | | - Cattaneo Cristina
- Institute of Forensic Medicine of Milan, Università degli Studi di Milano, v. L. Mangiagalli 37, Italy
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12
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Dogan KH, Demirci S, Deniz I. Why do people hang themselves on trees? An evaluation of suicidal hangings on trees in Konya, Turkey, between 2001 and 2008. J Forensic Sci 2014; 60 Suppl 1:S87-92. [PMID: 25088533 DOI: 10.1111/1556-4029.12589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 11/28/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022]
Abstract
Hanging is the most common method of suicide in the world, and many public places offer a means or opportunity to carry out the activity. Of 4,452 death examinations and autopsies, there were 378 (8.5%) suicides and suicide method was hanging in 185 (48.9%) cases. In 20 of these (10.8%), the suspension point was the branch of a tree. The incident location was the garden of the victim's house in nine cases, the woodlands in seven cases. The suicides were attributed to psychiatric disorders in nine cases, economic problems in six cases, and family problems in five cases. It is concluded that hanging on a tree as a suicide method is often committed by males and the underlying motive may be different in suicidal hangings on trees occurring at daytime and night. For preventional purposes, the reporting of such suicides in public places by the media may be restricted by local authorities.
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Affiliation(s)
- Kamil Hakan Dogan
- Department of Forensic Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
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Abel SM, Ramsey S. Patterns of skeletal trauma in suicidal bridge jumpers: a retrospective study from the southeastern United States. Forensic Sci Int 2013; 231:399.e1-5. [PMID: 23806345 DOI: 10.1016/j.forsciint.2013.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/05/2013] [Accepted: 05/16/2013] [Indexed: 12/23/2022]
Abstract
In the discovery of human remains from water environments, manner of death may not be immediately obvious to medicolegal investigators due to several factors, including lack of associated material evidence, nondescript contextual environment, or possible poor preservation of remains due to delayed recovery. The determination of patterns of skeletal trauma in suicidal bridge jumpers assists investigators in determining whether the manner of death was suicide versus non-suicide. This study reports on the patterns of skeletal trauma sustained in individuals who jumped from one of four large bridges in Charleston Harbor, South Carolina, and explores victim demographics, bridge height, position of the body upon impact, and velocity at impact on skeletal trauma for this suicide population. Data for all bridge jumpers were collected from coroner files spanning the years 1990-2011. Skeletal trauma is more heavily focused in the thorax/ribs (63%) and craniofacial (30%) regions. Fifty-six percent of jumpers sustained polytrauma. Comparative data on drowning victims, bodies recovered from boating/airplane accidents, and individuals who died by other suicidal means all show patterns of injury different than bridge jumpers.
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Affiliation(s)
- Suzanne M Abel
- Charleston County Coroner's Office, 4050 Bridgeview Drive, Perimeter Center, Suite 500, North Charleston, SC, USA.
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14
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An investigation on body displacement after two drowning accidents. Forensic Sci Int 2013; 229:e6-12. [DOI: 10.1016/j.forsciint.2013.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 02/28/2013] [Accepted: 03/06/2013] [Indexed: 11/17/2022]
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Zuka M, Ohshima T. Tracheal injury added to cervical bone destruction due to the impact of hitting the water surface: four immersed adult bodies. Forensic Sci Int 2013; 228:e62-6. [PMID: 23465544 DOI: 10.1016/j.forsciint.2013.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 10/01/2012] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
In the forensic examinations of cases of falling, two properties of the water surface, namely its nature as a hard, flat object and as a soft and ungraspable substance must be appreciated. Namely, at the moment of impact, the water surface exerts a greater resistance against relatively broad areas like the head, face and trunk than against the extremities that have a small area. Therefore, total resistance against the whole body would promote flexure. We experienced 72 autopsy cases of immersed bodies during a 4-year period. The cause of death for 64 of these with or without cervical vertebra fracture was drowning. In these cases, the various heights of the falls could often be estimated at the scene. A characteristic pattern of cervical injury with involvement of hyoid bone and thyroid cartilage in addition to cervical vertebra fracture plus rare involvement of the trachea was identified. When a fall from a relatively low height is broken by the water surface, to a certain degree physical findings that differ from those seen in falls to the ground from extreme heights are left mediated by different underlying mechanisms.
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Affiliation(s)
- Masahiko Zuka
- Department of Environmental Science, Forensic and Social Environmental Medicine, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 9208640, Japan.
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Pirkis J, Spittal MJ, Cox G, Robinson J, Cheung YTD, Studdert D. The effectiveness of structural interventions at suicide hotspots: a meta-analysis. Int J Epidemiol 2013; 42:541-8. [PMID: 23505253 DOI: 10.1093/ije/dyt021] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Certain sites have gained notoriety as 'hotspots' for suicide by jumping. Structural interventions (e.g. barriers and safety nets) have been installed at some of these sites. Individual studies examining the effectiveness of these interventions have been underpowered. METHOD We conducted a meta-analysis, pooling data from nine studies. RESULTS Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%). CONCLUSIONS Structural interventions at 'hotspots' avert suicide at these sites. Some increases in suicide are evident at neighbouring sites, but there is an overall gain in terms of a reduction in all suicides by jumping.
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Affiliation(s)
- Jane Pirkis
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia.
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17
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Brice JH, Moss C, Purpura P, Delbridge TR. Epidemiology of low-level bridge jumping in Pittsburgh: a 10-year study. PREHOSP EMERG CARE 2012; 17:155-61. [PMID: 23148589 DOI: 10.3109/10903127.2012.722179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Outcomes of patients who fall from bridges lower than 160 feet above water have been poorly characterized. Pittsburgh offers a unique setting in which to study these patients as the city has 41 major bridges, only four of which are above 70 feet. OBJECTIVE This study examined patients who fell or jumped from Pittsburgh bridges over a 10-year period for their characteristics, injury patterns, and the effects of prehospital care on outcomes. METHODS We conducted a retrospective cohort study of patients who jumped or fell from bridges in Pittsburgh, Pennsylvania, over a 10-year period. Subjects were identified through manual searches of three data repositories: City of Pittsburgh Bureau of Emergency Medical Services (EMS), Pittsburgh River Rescue, and Allegheny County Medical Examiner records. Data abstracted included patient name, age, gender, date of birth, and address; incident date, time, location, and river conditions; prehospital interventions; emergency department intervention; hospital disposition; evidence of prior or subsequent psychiatric admission; toxicology results or evidence of substance involvement; and causes of death. RESULTS Seventy-four subjects were identified. Most were male (80%) young adults (mean age 34.3 years) who lived near the bridges from which they jumped or fell. Mortality from bridges less than 50 feet high was 18%; mortality from bridges 180 feet high was 75%. All patients who required prehospital interventions beyond warming or intravenous (IV) fluids died. Injury patterns were similar to those described for high-bridge patients, concentrated in the trunk or skull, but low-bridge injuries were milder and less common. Cause of death was predominantly drowning (84%). More than a third (47.3%) of the patients had previous psychiatric histories, but evidence of a previous attempt to jump was uncommon (5.4%). CONCLUSIONS People who jump from low- to medium-rise bridges may suffer injuries, but most often die from drowning. EMS interventions beyond water rescue are typically not helpful, emphasizing the importance of prevention and a water rescue plan.
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Affiliation(s)
- Jane H Brice
- Department of Emergency Medicine, Division of Emergency Medical Services, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7594, USA.
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Coskun M, Zoroglu S, Ghaziuddin N. Suicide rates among Turkish and American youth: a cross-cultural comparison. Arch Suicide Res 2012; 16:59-72. [PMID: 22289028 DOI: 10.1080/13811118.2012.640612] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study compares youth (<24 years) suicide rates in Turkey and the United States; a demographic and cross-cultural comparison and exploration of possible causative factors. Publicly available data were compared for children, adolescents, and young adults for years 1992-2004. The mean general population suicide rate in Turkey (per 100,000) was, male = 3.53 and female = 2.31 (for the US, males = 18.37, females = 4.31); for ages below 15 years the rate was, males = 0.28 and females = 0.39 (for the US, males = 1.09 and females = 0.38); while for aged 15-24 years the rate was, males = 4.58 and females = 5.22 (for the US, males = 18.84 and females = 3.36). The patterns for Turkey are: (a) Female youth had a higher suicide rate than male youth; this was the reverse of the U.S. pattern, (b) Youth suicide increased during the time period in Turkey, whereas it was relatively stable in the US, (c) However, suicide rates in Turkey were generally lower than the US, (d) Fifty percent of all female suicide victims in Turkey were under the age of 24 years (versus 11% in the US). Possible psychosocial causative factors may include (a) negative social status of females (forced marriage, young marriage age, low literacy, honor killings); (b) substantial rural to urban migration which disrupts ties and exposes migrants to a less traditional cultural system; (c) shortage of mental health services; (d) and possibly, reduced religious education enrollment may be an additional factor.
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Affiliation(s)
- Murat Coskun
- Child and Adolescent Psychiatrist, Numune Training and Research Hospital, Child and Adolescent Psychiatry Clinic, Trabzon, Turkey.
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Wong PWC, Chan WSC, Lau TK, Morgan PR, Yip PSF. Suicides by jumping from iconic bridges in Hong Kong. CRISIS 2009; 30:79-84. [PMID: 19525166 DOI: 10.1027/0227-5910.30.2.79] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Three bridges in Hong Kong have become iconic sites for suicide since their openings 11 years ago. AIMS This retrospective record-based study aimed to examine suicides by jumping from a group of three iconic bridges in Hong Kong, and to explore potential preventive strategies on these bridges to prevent future suicide. METHODS We examined the Coroner's files of 12 people who killed themselves by jumping from the bridges between 1997 and 2007. We also examined the Coroner's files of other suicides in 2003, and compared them with the bridge suicides. RESULTS The majority of the suicides were male, middle-age (40-59 years), married or cohabiting, not living alone, employed or self-employed, and in financial difficulty. None of these cases had a reported psychiatric diagnosis or psychiatric care history, and only one case had a history of suicidal attempt. Compared with other suicides in Hong Kong, the bridge jumpers were more likely to be younger, holding a job, indebted, free from a psychiatric and attempt history, and to leave a suicide note (p < .05). The bridge suicide cases in Hong Kong also appeared to be different from the profiles of bridge jumpers in other countries. CONCLUSIONS Erection of an effective safety barrier has been found to prevent bridge suicides in many countries. Given the different characteristics of bridge jumpers in Hong Kong and the technical difficulties, more innovative ways may be needed to prevent suicides by such means. Potential prevention measures are discussed and, hopefully, will better inform the future design and development of bridges of significance.
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Affiliation(s)
- P W C Wong
- The University of Hong Kong, Pokfulam, Hong Kong SAR, People's Republic of China.
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Reisch T, Schuster U, Michel K. Suicide by jumping from bridges and other heights: social and diagnostic factors. Psychiatry Res 2008; 161:97-104. [PMID: 18799221 DOI: 10.1016/j.psychres.2007.06.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 02/23/2007] [Accepted: 06/30/2007] [Indexed: 12/23/2022]
Abstract
The goal of the study was to determine social and diagnostic characteristics of persons who end their lives by jumping from heights and to compare the characteristics of those who jump from bridges with those jumping from other sites. Data on suicide in Switzerland between 1990 and 2003 were collected from the Swiss Federal Statistical Office and from local authorities. Persons who jumped from heights in general were more likely to suffer from schizophrenia than those who used other methods. Persons who jumped from bridges were younger than those committing suicide by other methods. Compared with those who jumped from other sites, subjects were on average 14.3 years younger and more often male. Individuals who jumped from bridges close to psychiatric hospitals were more likely to suffer from psychiatric illness. Individuals who jump from bridges differ in certain characteristics from those who jump from other sites. For future classification it may be helpful to distinguish suicides from bridges from suicides from other heights. For prevention of suicide from bridges, attention should be paid to characteristics of young persons at risk.
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Affiliation(s)
- Thomas Reisch
- University Hospital of Psychiatry, Department of Psychiatry, Bolligenstr. 111, 3000 Bern 60, Switzerland.
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de la Grandmaison GL, Krimi S, Durigon M. Frequency of Laryngeal and Hyoid Bone Trauma in Nonhomicidal Cases Who Died After a Fall From a Height. Am J Forensic Med Pathol 2006; 27:85-6. [PMID: 16501357 DOI: 10.1097/01.paf.0000201104.10652.08] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A retrospective study was carried out on 93 autopsy cases who died after a fall from a height. For each case, following parameters were reported: age, sex, manner of death, estimated height of fall, ground type, estimated site of primary impact, type of laryngeal and hyoid bone trauma, presence of associated local trauma in the neck and cephalic region. Mean age of the studied population was about 33 years. Sex ratio (men/women) was 1.8. Mean height of fall was about 15 m. Manner of death was, respectively, suicide and accident in 70 and 23 cases. The type of ground was concrete in 94% of the cases. The site of primary impact was, respectively, head, front of the body, back of the body, feet/lower limbs, and lateral body in 31, 26, 19, 12, and 5 cases. Cervical soft tissue bruising without laryngohyoid fractures was found in 5 cases. Laryngohyoid fractures were found in 5 cases. These fractures could be explained by direct impact of the neck structures against the ground. The mechanism of these fractures could also be indirect fractures due to high muscle strains on the hyoid bone or thyroid cartilage due to cervical hyperflexion or hyperextension or secondary to mandible or cervical vertebral column fractures.
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Abstract
The city of Bern has a high percentage of suicides by jumping (28.6%). Related to other local hotspots, the highest number of deaths (mean 2.5 per year) is found at the Muenster Terrace in the old city. In 1998, after a series of suicides, a safety net was built to prevent people from leaping from the terrace and to avoid further traumatization of people living in the street below. We analyzed the numbers of suicides by jumping before and after the installation of the net. We also assessed the number of media reports referring to this suicide method. After the installation of the net no suicides occurred from the terrace. The number of people jumping from all high places in Bern was significantly lower compared to the years before, indicating that no immediate shift to other nearby jumping sites took place. Furthermore, we found a moderate correlation between the number of media reports and the number of persons resident outside Bern committing suicide by jumping from high places in the city.
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Affiliation(s)
- Thomas Reisch
- University Psychiatric Services of Bern, Switzerland.
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Abstract
Deaths due to falls from height are common in urban settings. At the time the body is found, it is often unclear whether the mode of death is accident, suicide, or homicide. To assess the injury pattern in fatal falls from height with special regard to criteria that might be helpful in discrimination between accident, suicide, and homicide, respectively, we reviewed 68 medicolegal autopsy cases (22 females, 46 males, age range 13-89 years) of fatal falls from height regarding demographic data, findings at the death scene, results of the postmortem examination, psychiatric history, and toxicologic findings. Among the 68 cases, there were 34 suicides, 23 accidents, and 11 unclarified cases, in 3 of which homicide was suspected. In general, suicides were from greater heights than accidents (mean height 22.7 m for suicides and 10.8 m for accidents, respectively; 79% of suicides from more than 16 m). Strikingly, severe head injuries predominantly occurred in falls from heights below 10 m (84%) and above 25 m (90%), whereas in the group of falls from 10 to 25 m, these lesions were seen less frequently (28%). Neck injuries like muscle bleeds and fractures of the hyoid bone were found in 33% of falls from more than 10 m and did not occur from less than 10 m. Our data stress that the evaluation of pathologic features alone is not sufficient to assess the mode of death in fatal falls from height. Instead, postmortem findings have to be considered within the framework of the subject's social, medical, and psychiatric history in conjunction with findings at the death scene and toxicology results to obtain the clearest possible picture of the circumstances of death.
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Affiliation(s)
- Elisabeth E Türk
- Institute of Legal Medicine, University of Hamburg, Hamburg, Germany.
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Lindqvist P, Jonsson A, Eriksson A, Hedelin A, Björnstig U. Are suicides by jumping off bridges preventable? An analysis of 50 cases from Sweden. ACCIDENT; ANALYSIS AND PREVENTION 2004; 36:691-694. [PMID: 15094424 DOI: 10.1016/s0001-4575(03)00089-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2002] [Revised: 06/04/2003] [Accepted: 06/23/2003] [Indexed: 05/24/2023]
Abstract
This is a community-based sequential case series of 50 individuals who committed suicide by jumping from bridges in two regions of Sweden. Of the 50 subjects, 32 were men and 18 women, with a median age of 35 years. At least 40 had psychiatric problems. The frequency of suicide was highest during the summer months and during the weekends. A total of 27 bridges were used, with a total length of just under 9 km. Three bridges accounted for almost half of all suicides. Limiting the availability of one method of committing suicide is reported to reduce the overall suicide rate; why suicide and injury suicide preventive measures might be considered. Since this study demonstrates that few bridges attract suicide candidates, this injury mechanism needs to be acknowledged by the road system owners and included in the safety work.
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Affiliation(s)
- Per Lindqvist
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå SE-907 12, Sweden.
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