Comparison of suicidal and accidental fall injury patterns: A 10-year retrospective study in Hong Kong

Falls from a height are a common cause of major trauma in urban areas. This study aims to investigate the differences in patient characteristics and injury patterns between suicidal and accidental falls from a height in Hong Kong.

From 2015-2024, patients aged ≥ 18 years recorded under the 'fall from height ≥ 2 m' category of the trauma registry in a tertiary hospital in Hong Kong were retrospectively reviewed. Patient characteristics and the nature of the falls were noted. Abbreviated injury scale (AIS) was the primary outcome. Injury severity score (ISS), skeletal fractures, clinical parameters and clinical outcomes were secondary outcomes.

Of 268 patients included, 50 were in the suicide group and 218 in the accident group. Patients in the suicide group had significantly higher ISS (median 29, IQR 20-45) and fall heights (median 9.0 m, IQR 6.0-10.0 m) than those in the accident group (ISS median 17, IQR 9-26; median fall height 3.0 m, IQR 2.5-5.0 m; both p < 0.001). Within major trauma patients (defined as ISS>15, n = 157), the suicide group had more serious injuries (defined as AIS ≥3) in the abdomen (41% vs 19%, p = 0.008) and extremities (83% vs 28%, p < 0.001), and less serious injuries in the head and neck (39% vs 62%, p = 0.018). Among the major trauma patients, those in the suicide group had more fractures of the ribs, lumbar spine, pelvis, hips and feet, while those in the accident group sustained more skull fractures. In particular, all deaths in the accident group had AIS head and neck ≥ 5. Subgroup analysis according to fall height in the major trauma cases found the differences in pelvic fractures between the two groups remained significant in falls < 10 m.

Falls from heights due to accidents more often result in serious head injuries, while those due to suicide more often have serious injuries in the lower part of the body. Serious head injury is a major cause of death in accidental falls.