[Level of total injury severity as a possible parameter for evaluation of height in fatal falls]

The injuries caused by high falls from over the seventh floor are considered mostly fatal. It is possible to survive the high fall from over 30 metres at landing on the surface of high deformity (snow or water). The Injury Severity Score (ISS) due to a high fall is influenced by the height from which the body has fallen, then, the body and surface features, and finally, the manner of body impact on to the surface. The aim of the study was determining the possibility of the height estimation that caused the fatality of the impact, considering the severity of injury expressed by ISS. A retrospective autopsy study was done on the materials of Institute of Forensic Medicine in Belgrade, during a twenty-year period: 1981-2000. The autopsy records were analyzed together with clinical medical data, of the deadly injured due to high falls on to a solid surface. ISS value was determined in each case. The height of fall was determined on the basis of police reports, i.e. death scene analysis. The results were done statistically (linear correlation). The sample included 660 cases: 469 males (71%) and 191 females (29%). The average age of the examined sample was 44.66 (SD=6.62). The number of 290 cases (44%) were accidental deaths, while 370 were suicidal ones (56%). Only few injured due to high falls up to 7 metres had ISS value below 26. Deaths in these cases were caused by complications of the injuries. The ISS value in the injured rose with the height from which the victim had fallen: ISS was 25 in all falls over 7 metres of height. In all cases were severe, critical injuries of one organic system (mostly severe head injuries). According to the analysis of our sample, we concluded that it was not possible to determine the precise height of fatal falls only on the basis of the injury severity score estimation by ISS. This determination, approximate one, was possible only in falls on to a solid surface up to 30 metres. The same determination was not possible by the analysis of the time of survival. It is obvious that determining the height of fall is more possible by types and combinations of single injuries which are, single or combined with other injuries, characteristic for single mechanisms of primary body contact with the solid surface depending on the height of fall.