Fatal Pediatric Head Injuries Caused By Short Distance Falls

by: Dr. John Plunkett, MD

Summary

The objective of this study was to determine whether there are witnessed or investigated fatal short distance falls that were concluded to be accidental. Many physicians believe that a simple fall cannot cause serious injury and that retinal hemorrhage is highly suggestive if not diagnostic for inflicted trauma. However, several have questioned these conclusions or urged caution when interpreting head injury in a child. This controversy exists because most infant injuries occur in the home and if there is a history of a fall, it is usually not witnessed or is seen only by the caretaker.

Objective data is needed to resolve this dispute. It would be helpful if there were a database of fatal falls that were witnessed or wherein medical and law enforcement investigation unequivocally concluded that the death was an accident.

This study utilizes various case histories that can be viewed in the link below. It discusses the biophysical characteristics of the brain and skull, the level and duration of force, subdural hemorrhages, lucid intervals, retinal hemorrhages, pre-existing conditions, cerebrovascular thrombosis and the limitations.

Conclusions:

1) Every fall is a complex event. There must be a biomechanical analysis for any incident in which the severity of the injury appears to be inconsistent with the history.

2) Retinal heamoraghe may occur whenever the intracranial pressure exceeds venous pressure or whenever there is venous obstruction. The characteristic of the bleeding cannot be used to determine the ultimate cause.

3) Axonal damage is unlikely to be the mechanism for lethal injury in a low velocity impact such as from a fall.

4) Cerebrovascular thrombosis or dissection must be considered in any injury with apparent delayed deterioration and especially in one with a cerebral infarct or an unusual distribution for cerebral edema.

5) A fall from less than 3 meters (10 feet) in an infant or child may  cause fatal head injury and may not cause immediate symptoms. The injury may be associated with bilateral retinal hemorrhage and an associated subdural hematoma may extend into the interhemispheric fissure. A history from the caretaker that the child may have fallen cannot be dismissed.

Source:

http://www.debbiewadle.org/research/Fatal_pediatric_head_injuries_caused_by_short-distance_falls_Am_J_Forens_Med_Pathol_2001-22_1-12.pdf