Characteristics of chest injury in falls from heights T.C. Atanasijevic * , V.M. Popovic, S.D. Nikolic Institute of Forensic Medicine, University School of Medicine, 31a Deligradska Str., 11000 Belgrade, Serbia article info Article history: Received 15 December 2008 Received in revised form 13 January 2009 Accepted 2 February 2009 Available online 17 March 2009 Keywords: Autopsy Fall from height Injury Blunt trauma Chest abstract This study included 660 victims injured due to high fall. All cases are with injuries caused by the free-fall model of high fall. The range of the heights was from 0 to 70 m. The sample was divided into three groups of growing height: low falls up to 7 m, high falls from 7 to 30 m, and very high falls above 30 m. Statistical analysis was performed using two way ANOVA according to Scheirer–Ray–Hare in complete uneven block. Males were 71% (469), females 29% (191). In the analyzed sample, apart from the height of fall, the number of accidents is about 44% (290 cases) and suicides about 56% (370 cases). Thirty six percent, i.e., 238 of 660 victims had consumed alcohol before death (alcoholemia >0.5‰). The objective of our study was to analyze characteristics of chest injuries made by falling from a height. The frequency of tho- racic injuries is statistically significantly related to the height of fall (p < 0.05); it increases constantly in falls from heights beyond 3 m, so that the rib fractures were present in all falls from heights beyond 40 m. The aortic ruptures were found in 21%, and the heart injuries in 16% of all cases. The frequency of aortic and heart ruptures was not statistically significantly related to the height of fall (p > 0.05). A rupture of the aorta was the most commonly located on its arch (82%). The heart ruptures were the most commonly located on the atrial posterior wall (70%). Ó 2009 Elsevier Ireland Ltd. All rights reserved. 1. Introduction When falling, injuries are caused as a result of direct impact and/or transmitted force. The nature and type of injuries primarily depends on the height from which the body has fallen. Various fac- tors determine the extent and distribution of injuries. Some of these factors include the amount of force delivered to the body, the duration of time during which the force is delivered, the area struck, the extent of the body’s surface over which the force is delivered, and the nature of the impact. Blunt trauma to the chest is a common injury after falling. The degree of thoracic injury can be estimated with the magnitude of the causative force. With an increase in height, the probability of chest injuries increases. Vertical deceleration causes severe chest trauma (e.g., aortic tears, cardiac rupture). The aim of this study was to define the correlation between the height of a fall and the frequency, extent, and type of thoracic injuries. 2. Materials and methods This study included 660 fatalities that were the result of falling from varying heights. The victims’ autopsies were performed at the Forensic Institute in Belgrade. All cases and injuries were caused by the free-fall model of high fall (jumps and accidental falls were in- cluded in the study, i.e., falls where the body is pushed or dropped from a height) onto a solid surface. The height of the falls ranged from 0 to 70 m. In the cases where only the floor number was recorded and not the height of fall, the height of each floor was estimated according to the established standard – i.e., the floor height is 3 m. The sample group was di- vided into 12 groups of increasing height, and the final results were summarized into three groups: low falls up to 7 m, high falls from 7 to 30 m, and very high falls above 30 m. The data on the cause of death in all 660 cases analyzed was ob- tained by summarizing autopsy and police records, as well as by heteroanamnesis. We considered blood alcohol concentrations higher then 0.5% as significant. The statistics of the results was performed by two way ANOVA. The level of significance was set at 0.05. 3. Results and discussion This study included 660 victims injured due to high falls: 469 males (71%) and 191 females (29%) (male–female ratio 3:1, p < 0.05). The sample distribution according to the height of the fall and gender is presented in Table 1. The number of males in the group who fell up to 7 m statistically was significantly higher than females (p < 0.05). The fact that in our entire sample group males showed a statis- tically significant predominance could be explained by the fre- 1344-6223/$ - see front matter Ó 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.legalmed.2009.02.017 * Corresponding author. Tel.: +381 11 2682 522; fax: +381 11 2641 140. E-mail address: bobanvladislav@yahoo.com (T.C. Atanasijevic). Legal Medicine 11 (2009) S315–S317 Contents lists available at ScienceDirect Legal Medicine journal homepage: www.elsevier.com/locate/legalmed