Fatal accidental fall from height in infants and children: a study from South Delhi

Med Sci Law 2010;50:22-24
doi:10.1258/msl.2009.009010
© 2010 British Academy of Forensic Science

 

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Fatal accidental fall from height in infants and children: a study from South Delhi

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C Behera MB MD *,
Ravi Rautji MB MD   and
T D Dogra MB MD *


* Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi 110029
Department of Forensic Medicine and Toxicology, Armed Forces Medical College, Pune 411040, India

Correspondence: Dr (Lt Col) Ravi Rautji. Email: rautjiravi{at}hotmail.com




Abstract

TOP

Abstract
Introduction

Material and methods

Results

Discussion

Conclusion

REFERENCES

 

One hundred and seventy-four deaths of infants and childrendue to accidental fall from height received from South Delhifor autopsy were studied during the 10-year period from January1998 to December 2007 at the All India Institute of MedicalSciences, New Delhi. Data were analysed with regard to age,sex, location of fall, height of fall, pattern of injury, causeof death and seasonal variation. These cases represented approximately22.56% of all deaths due to a fall from height and 1.31% ofall medicolegal autopsies conducted during the period. Therewere 106 male (60.9%) and 68 female (39.1%) victims. Age-specificrate of fall showed that the highest rate was in toddlers (39.65%),followed by 26.43% each in preschool children and school-goingchildren and the least in infants (7.47%). The head and facewas the most frequently injured body region (93.67%) and theskull was the commonest bone fractured (59.19%). The most commoncause of death was head injury (84.48%). Major fall sites indecreasing order of frequency were rooftop (38.50%), balcony(24.13%), household furniture (21.26%), staircase (6.89%), window(4.59%), wall (1.72%), rickshaw/bicycle (1.15%) and tree (0.57%).Most fatalities due to a fall from height were reported in therainy season.





Introduction

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Abstract

Introduction
Material and methods

Results

Discussion

Conclusion

REFERENCES

 

In children and young adults, trauma is a leading cause of morbidity and mortality. Among all causes of trauma, falls are considered the most common.1 The risk of accidental fall from height is present in all age groups, but younger children are more prone to fall because of insufficient development of sensory systems, neural control mechanisms, cognitive ability in terms of hazard awareness and avoidance skills.2 The distance of the fall andthe landing surface determine the severity of a fall-relatedinjury. Infants are at increased risk from falls associatedwith furniture, stairs and baby walkers. Toddlers are at a riskfrom window-related falls.

There is little published epidemiological data regarding deathsfrom fall from height in infants and children. However, in thispart of the world, information regarding mortality of childrendue to fall from height is limited. South Delhi is a highlyurbanized area with a population of about four million. Manypeople live and/or work in high-rise buildings. Approximately1500 medicolegal autopsies are performed annually at the AllIndia Institute of Medical Sciences (AIIMS), New Delhi.

The purpose of the present study was to investigate and quantifydeath due to falling from a height in infants and children interms of distribution, location, height of fall, cause of deathand pattern of injury. The resulting document may be helpfulin formulating future policies for prevention.





Material and methods

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Abstract

Introduction

Material and methods
Results

Discussion

Conclusion

REFERENCES

 

The present study analysed 174 deaths of infants and childrendue to accidental fall from height received from South Delhifor autopsy, during the 10-year period from January 1998 toDecember 2007 at AIIMS. The detailed analysis of these caseswas based on the medical records and the evaluation of autopsyreports. The victims were divided into four age groups basedon different stages of musculoskeletal development: infants(0–1 years), toddlers (1–3 years), preschool children(3–6 years) and school-going children (6–14 years).Cases where the fall had not been from a height were excludedfrom the study.





Results

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Abstract

Introduction

Material and methods

Results
Discussion

Conclusion

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The majority of cases were male (n = 106, 60.9%) as compared with female (n = 68, 39.1%). The male-to-female ratio was 1.56:1. The difference was statistically significant (2 = 8.29; P =0.004).

The age range of the victims was four months to 14 years (mean 4.87 years). The commonest age group involved was 1–3 years (39.7%), followed by 26.4% each in age groups 3–6 years and 6–14 years. The least common age group involved was 0–1 year (7.5%). Head and face was the most frequently injured body region (n = 163, 93.7%), followed by the extremities (n = 44, 25.3%), thorax (n = 19, 10.9%) abdomen and pelvis (n = 11, 6.3%), and neck (n = 4, 2.3%) (Table 1). The difference was statistically significant (2 = 360.72; P = 0.000).



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Table 1 Injured body region

 

Intracranial injury (85.1%) was the most common cause of death, followed by haemorrhagic shock resulting from visceral and bony injuries (8.6%) and septicaemia (5.2%). In two cases (1.1%) death was due to spinal shock consequent to fracture dislocation of the upper cervical vertebrae (Table 2). In intracranial injuries subarachnoid haemorrhage (n = 96, 65.3%) was the commonest cause followed by subdural haematoma (n = 60, 40.8%). Extradural haematoma was least common (n = 13, 8.8%) (Table 3). Fractured skull bone (59.2%) was the commonest form of skeletal injury followed by bones of upper limb (20.7%), lower limb (17.8%), vertebrae (5.7%) and pelvis (1.1%). The commonest visceral organs involved were lung (5.2%), followed by liver (4.6%) and spleen (0.6%) (Table 4).



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Table 2 Cause of death



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Table 3 Intracranial injuries



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Table 4 Visceral organ and bony structure injuries

 

The falls most commonly occurred from a rooftop (38.5%), followed by balcony (24.1%), household furniture (21.3%), staircase (6.9%), window (4.6%), wall (1.7%), rickshaw/bicycle (1.1%) and tree (0.6%) (Table 5). The height of fall ranged from two feet (0.61 m) to 48 feet (14.63 m). The average distance of fall was 17.65 feet (5.38 m) in vertical descent. The lowest height of fall was that of a six-month old infant from a bed and the highest distance of fall was from a rooftop of a four-storey apartment. As far as season is concerned, the maximum number of cases were reported in the rainy season (n = 62, 35.7%) followed by autumn and winter (n = 59, 33.8%), and spring and summer seasons (n = 53, 30.5%). The difference was not statistically significant (P = 0.696).



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Table 5 Location of fall





Discussion

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Abstract

Introduction

Material and methods

Results

Discussion
Conclusion

REFERENCES

 

In children, there have been several incidents of accidental fall from height, but the available literature regarding the epidemiology of such events is scarce. In our study, 174 deaths of infants and children due to accidental fall from height were reported amounting to 22.56% of all deaths due to fall from height and 1.31% of all medicolegal autopsies conducted during the same 10-year period. In a study by Suleyman et al.3 in Diyarbakir region of Turkey, 42.6% of deaths from a fall from height were reported in the age group of 0–15 years, which is higher than our study. According to the National Crime Records Bureau 2007 report,4 deaths from a fall from height accounted for 3.1% of all accidental deaths in India, but fatality data related to specific age groups are not available. In our study, males constituted 60.9% while 39.1% were females, the ratio being 1.56:1. The male preponderance is likely to be due to more male children in the population than female (1000:848 in Delhi) and the personal and behavioural characteristic of male children. A similar male preponderance has been reported in other studies.59 However, in infants the death incidence was higher in females (77%) as compared with males (23%). The exact reason for the difference is not known. However, the neglect of girl children by parents, leading to increased fatality, cannot be ruled out in this part of the country. The maximum incidence of fall from height was among toddlers, i.e. 1–3 years of age (39.7%), followed by 26.4% each in age groups 3–6 years and 6–14 years and the least common age group involved was 0–1 years (7.5%). Similar results were reported by Suleyman et al.3 The reason for the high incidence of fatalities in toddlers may be due to haphazard ambulatory skills with little understanding of the consequences of falling in their surroundings.1 However, in other studies by Adesunkanmi et al. in 19998 and Bulut et al. in 2002,5 the maximum incidence of fall was reportedin the pre-school age group (3–6 years).

Our study revealed that the head and face was the most frequently injured anatomical body region (93.7%) and intracranial injury (85.1%) was the commonest cause of death. The commonest fracture was of skull bones followed by bones of upper extremity and lower extremity and fractures of vertebrae. This is in accordance with the studies conducted by Bulut et al.5,6 and Wang et al.10 The reason for increased incidence of head injury in children is because of their greater head weight in relation to the rest of their body, hence higher centre of gravity, causing them to topple head first. As far as visceral injuries are concerned, pulmonary contusions/lacerations and liver lacerations were the commonest injuries. Wang et al.10 reported similar findingsin their study. In intracranial injuries, subarachnoid haemorrhagewas the commonest followed by subdural haematoma. Epidural haematomawas least common.

In our study, most falls occurred from the rooftop (38.5%),followed by balcony (24.1%), household furniture (21.3%) andstaircase (6.9%). During pre-school years, home is a potentiallydangerous environment as children play on or around the furnitureand acute-angled housing structures.

Seasonal variation was seen, with the number of deaths peaking during the rainy season. In contrast to our study, Lallier et al.7 reported most falls among children occurring during thesummer months.

Because of the retrospective nature of the present study, itslimitations include missing data regarding the exact heightof the fall and the type of landing surface.





Conclusion

TOP

Abstract

Introduction

Material and methods

Results

Discussion

Conclusion
REFERENCES

 

Although rarely fatal, falls from height in infants and childrencarry a significant morbidity and are a drain on the health-caresystem. To reduce the occurrence of injuries caused by falls,strategies should include parents’ education about the mechanismsof falls, awareness campaigns, increased parental supervisionduring playing activities and relevant legislative measures.

 

 

 

 

 




REFERENCES

TOP

Abstract

Introduction

Material and methods

Results

Discussion

Conclusion

REFERENCES

 

  1. Sawyer JR, Flynn JM, Dormans JP, Catalano JD, Denis S. Fracture patterns in children and young adults who fall from significant heights. J Pediatr Orthop 2000;20:197–202[Medline]
  2. Chang LT, Tsai MC. Craniofacial injuries from slip, trip, and fall accidents of children. J Trauma 2007;63:70–4[Medline]
  3. Suleyman G, Mehmet S, Yasar T, Fuat G. Fatal falls from heights in and around Diyarbakir, Turkey. Forensic Sci Int 2003;137:37–40[Medline]
  4. National Crime Record Bureau. Accidental Deaths in India. Report. Government of India, Ministry of Home Affairs, 2007
  5. Bulut M, Korkmaz A, Akkose S, Balci V, Ozguc H, Tokyay R. Epidemiologic and clinical features of childhood falls. Ulus Travma Derg 2002;8:220–3[Medline]
  6. Bulut M, Koksal O, Korkmaz A, Turan M, Ozgue H. Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score. Emerg Med J 2006;23:540–5[Abstract/Free Full Text]
  7. Lallier M, Bouchard S, St-Vil D, Dupont J, Tucci M. Fall from height among children: a retrospective view. J Pediatr Surg 1999;34:1060–3[Medline]
  8. Adesunkanmi AR, Oseni SA, Badru OS. Severity and outcome of falls in children. West Afr J Med 1999;18:281–5[Medline]
  9. Melanie LP, Magdy WA. Patterns of injury associated with routine childhood falls. Pediatr Emerg Care 2006;22:470–4[Medline]
  10. Wang MY, Kim KA, Griffith PM, et al. Injuries from fall in the pediatric population: an analysis of 729 cases. J Pediatric Surg 2001;36:1528–34[Medline]

Fatal accidental fall from height in infants and children: a study from South Delhi
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This Article
Fatal accidental fall from height in infants and children: a study from South Delhi

Abstract

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Fatal accidental fall from height in infants and children: a study from South Delhi
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Fatal accidental fall from height in infants and children: a study from South Delhi

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Fatal accidental fall from height in infants and children: a study from South Delhi
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Fatal accidental fall from height in infants and children: a study from South Delhi

Articles by Behera, C

Articles by Dogra, T D
Fatal accidental fall from height in infants and children: a study from South Delhi
Social Bookmarking
Fatal accidental fall from height in infants and children: a study from South Delhi
Fatal accidental fall from height in infants and children: a study from South Delhi

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