A comparative study of the injury patterns and inflammatory response between suicidal and unintentional falls from height in Germany

TL;DR

This study compares injury severity and treatment challenges in patients who fall from height due to suicide attempts versus accidental falls in Germany.

Contribution

The study provides a detailed comparison of injury patterns and inflammatory responses in suicidal versus unintentional falls, adjusted for fall height.

Findings

Suicidal falls resulted in significantly higher injury severity scores compared to unintentional falls.

Suicidal patients had higher complication rates, more surgeries, and worse coagulation status upon admission.

These findings remained significant even after adjusting for fall height.

Abstract

Patients who have fallen from great height with suicidal intent present unique challenges, including delayed medical attention, injury patterns that are often difficult to detect, severe hypothermia, and difficulties obtaining informed consent due to the patient’s mental state. Further delays to treatment can be caused by legal and logistical hurdles, such as coordinating with legal guardians or family members. These co-factors contribute to the high reported overall complication rates in these cases, which can reach up to 50%. This study aims to analyse injury patterns, inflammatory responses and complication rates in people who have jumped to their death, compared to those who have fallen unintentionally. It also aims to investigate the correlation between jump height and injury severity.

This retrospective monocentric study analysed patient data such as age, gender, injuries, treatments and duration of hospitalisation. A total of 68 suicidal falls were included during the period from January 2014 to January 2024. Subsequently, 68 unintentional falls from a height of more than three meters were included from the same period as a control group, which was analysed alongside the suicidal falls. We analysed injuries sustained in clinical and radiological findings, as well as the inflammatory response and coagulation status of patients in blood gas analysis (BGA) and laboratory analysis of blood drawn in the first hours/days after trauma (C-reactive protein, white blood cell count, lactate, pH value, base excess, procalcitonin and prothrombin time). During hospitalisation, we analysed mortality rates, complication rates, transfusions performed, and intensive care unit/hospital stay for each group.

The group of suicidal jumps had an equal number of male and female patients (50% and 50%, respectively). In contrast, a predominance of male patients was observed in the subgroup of unintentional falls (76.5%, p = 0.002). Overall, suicidal falls resulted in a significantly more severe injury pattern. The average mean reported fall height was 9.61 m (± 6.42 m) in the suicidal group compared to 6.14 m (± 4.08 m) in the unintentional group. The injury severity score (ISS) was significantly higher in the suicidal group with 32.04 (± 23.43) compared to 17.37 (± 14.01) in the unintentional group (p < 0.001). In accordance with this, higher complication rates (wound healing disorders and total number of complications) were observed in the suicidal group (52.5% vs. 29.9%, p = 0.011). A greater number of total surgeries were also required in this group (3.21 ± 4.27 vs. 1.69 ± 2.81, p = 0.016). Patients in the suicidal group had significantly worse measurable coagulation status (prothrombin time) upon admission (74.95 (± 21.89) vs. 89.09 (± 21.66), p < 0.001), resulting in a significantly higher requirement for transfusions of erythrocyte concentrates (4.07 (± 9.39) vs. 0.97 (± 2.29), p < 0.001). Interestingly, comparable trends in ISS, injury patterns, complication rates and coagulation status were observed in a subgroup analysis, even after adjusting the cohorts for fall height (8.41 ± 4.38 m vs. 8.52 ± 3.80 m; p = 0.495).

Patients who had attempted suicide by jumping suffered more severe injuries and had a significantly higher ISS than those in the group who had fallen unintentionally. This remained true even when fall height was considered. Suicidal patients exhibited a higher complication rate (p = 0.011), increased overall transfusion requirements, impaired coagulation status upon admission and a greater number of operations (including repeat operations) compared to the unintentional fall cohort. Our data suggest that these patients require more resources and are more challenging to treat. We therefore recommend that they be treated in level 1 trauma centres with interdisciplinary intensive care capacities.

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