Comparative medico-legal analysis of falls from height injuries in adults and children: Patterns and predictors of mortality

J Forensic Leg Med. 2026 Apr 21;120:103153. doi: 10.1016/j.jflm.2026.103153. Online ahead of print.

ABSTRACT

Falls from height (FFH) lead to significant morbidity and mortality in many countries. This study analyzed the characteristics of FFH and identified predictors of mortality. The study prospectively examined 67 patients: pediatric (56.7%) and adult (43.3%) patients following FFH. Childhood falls were entirely accidental and primarily occurred at home, mainly from balconies (55.3%) and rooftops (34.2%). In adults, FFH occurred mainly in occupational (58.6%) and accidental (24.1%) circumstances. Suicidal FFH was reported in only five cases, constituting 17.2% of adult FFH. In adults, falls from scaffolds (62.1%) are common. Adults fell from significantly greater heights (median: 10 versus 7 m; p < 0.001). Upon hospital admission, adults had higher Injury Severity Scores (ISS) (median: 34 vs. 26; p = 0.024). Head injuries were the most prevalent among all patients (facial injuries: 79.1%; skull fractures: 49.3%). Subgaleal hematomas were exclusive to children (p = 0.032), whereas meningeal hemorrhages and cerebral injuries were significantly more common in adults (p < 0.05). Chest injuries occurred more frequently in adults (69% vs. 31.6%; p = 0.002), while abdominal injuries were more common among children, though not statistically significant. The overall mortality percentage was 31.3%, which was higher in adults (41.4%) than in children (23.7%). Head (88.9%) and spinal cord injuries (11.1%) were the causes of death in children. In adults, the causes of death were head (41.7%), chest (50 %), and abdominal injuries (8.3 %). Multivariate analysis identified falling from rooftops as the only predictor of mortality in children (OR = 9.000), while age (OR = 1.146) and suicidal intent (OR = 128.352) were mortality predictors in adults.

PMID:42035537 | DOI:10.1016/j.jflm.2026.103153