Abstract
Background
Self-inflicted injuries represent a consistent cause of trauma and falls from heights (FFH) represent a common dynamic used for suicidal attempts. The aim of the current report is to compare, among FFH patients, unintentional fallers and intentional jumpers in terms of demographical characteristics, clinical-pathological parameters and mortality, describing the population at risk for suicide by jumping and the particular patterns of injury of FFH patients.
Materials and methods
The present study is a retrospective analysis of prospectively collected data regarding FFH patients, extracted from the Trauma Registry of the Papa Giovanni XXIII Hospital in Bergamo, Italy. Demographic characteristics, clinical-pathological parameters, patterns of injury, outcomes including mortality rates of jumpers and fallers were analyzed and compared.
Results
The FFH trauma group included 299 patients between April 2014 and July 2016: 259 of them (86.6%) were fallers and 40 (13.4%) were jumpers. At multivariate analysis both young age (p = 0.01) and female sex (p < 0.001) were statistical significant risk factors for suicidal attempt with FFH. Systolic blood pressure (SBP) at the arrival was lower and ISS was higher in the self-inflicted injury group (SBP 133.35 ± 23.46 in fallers vs 109.89 ± 29.93 in jumpers, p < 0.001; ISS in fallers 12.61 ± 10.65 vs 18.88 ± 11.80 in jumpers, p = 0.001). Jumpers reported higher AIS score than fallers for injuries to: face (p = 0.023), abdomen (p < 0.001) and extremities (p = 0.004). The global percentage of patients who required advanced or definitive airway control was significantly higher in the jumper group (35.0% vs 16.2%, p = 0.005). In total, 75% of jumpers and the 34% of fallers received surgical intervention (p < 0.001). A higher number of jumpers needed ICU admission, as compared to fallers (57.5% vs 23.6%, p < 0.001); jumpers showed longer total length of stay (26.00 ± 24.34 vs 14.89 ± 13.04, p = 0.007) and higher early mortality than fallers (7.5% vs 1.2%, p = 0.008).
Conclusions
In Northern Italy, the population at highest risk of suicide by jumping and requiring Trauma Team activation is greatly composed by middle-aged women. Furthermore, FFH is the most common suicidal method. Jumpers show tendency to “feet-first landing” and seem to have more severe injuries, worse outcome and a higher early mortality rate, as compared to fallers. The Trauma Registry can be a useful tool to describe clusters of patients at high risk for suicidal attempts and to plan preventive and clinical actions, with the aim of optimizing hospital care for FFH trauma patients.
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References
World Health Organisation. Preventing suicide: a global imperative. Geneva: World Health Organisation; 2014.
World Health Organization. The global burden of disease-estimates for 2000–2012. Geneva: World Health Organisation; 2015.
Värnik A, Kõlves K, van der Feltz-Cornelis CM et al. Suicide methods in Europe: a gender-specific analysis of countries participating in the “European Alliance Against Depression”. J Epidemiol Community Health. 2008;62(6):545–51.
Värnik A, Kõlves K, Allik J et al. Gender issues in suicide rates, trends and methods among youths aged 15–24 in 15 European countries. J Affect Disord. 2009;113(3):216–26.
Choi JH, Kim SH, Kim SP, Jung KY, Ryu JY, Choi SC, Park IC. Characteristics of intentional fall injuries in the ED. Am J Emerg Med. 2014;32:529–34.
ISTAT. Malattie fisiche e mentali associate al suicidio: un’analisi sulle cause multiple di morte; 2017.
Rocos B, Chesse TJ. Injuries in jumpers—are there any patterns? World J Orthop. 2016;7(3):182–7.
Li L, Smialek J. The investigation of fatal falls and jumps from heights in Maryland (1987–1992). Am J Forensic Med Pathol. 1994;15(4):295–9.
Rocos B, Acharya M, Chesser TJ. The pattern of injury and workload associated with managing patients after suicide attempt by jumping from a height. Open Orthop J. 2015;9:395–8.
de Pourtalès MA, Hazen C, Cottencin O, Consoli SM. Adolescence, substance abuse and suicide attempt by jumping from a window. Presse Med. 2010;39:177–86.
Dickinson A, Roberts M, Kumar A, Weaver A, Lockey DJ. Falls from height: injury and mortality. J R Army Med Corps. 2012;158:123–7.
Kennedy P, Rogers B, Speer S, Frankel H. Spinal cord injuries and attempted suicide: a retrospective review. Spinal Cord. 1999;37:847–52.
Copeland A. Suicide by jumping from buildings. Am J Forensic Med Pathol. 1989;10:295–8.
Kontaxakis V, Markidis M, Vaslamatzis G, Ioannidis H, Stefanis C. Attempted suicide by jumping: clinical and social features. Acta Psychiatr Scand. 1988;77:435–37.
Bennewith O, Nowers M, Gunnell D. Effect of barriers on the Clifton suspension bridge, England, on local patterns of suicide: implications for prevention. Br J Psychiatry. 2007;190:266–67.
American College of Surgeons. 2019. https://www.facs.org/quality-programs/trauma/ipc/falls.
Teh J, Firth M, Sharma A. Jumpers and fallers: a comparison of the distribution of skeletal injury. Clin Radiol. 2003;58(6):482–6.
Richter D, Hahn MP, Ostermann PA, Ekkernkamp A, Muhr G. Vertical deceleration injuries: a comparative study of the injury patterns of 101 patients after accidental and intentional high falls. Injury. 1996;27:655–9.
Hahn MP, Richter D, Ostermann PA, Muhr G. Injury pattern after fall from great height. An analysis of 101 cases. Unfallchirurg. 1995;98:609–13.
Abel SM, Ramsey S. Pattern of skeletal trauma in suicidal bridge jumpers: a retrospective study from the southeastern United States. Forensic Sc Int. 2013;399.e1–399e5.
Lowenstein SR, Yaron M, Carrero R, Devereux D, Jacobs LM. Vertical trauma: injuries to patients who fall and land on their feet. Ann Emerg Med. 1989;18(2):161–5.
Gill JR. Fatal descent from height in New York City. J Forensic Sci. 2001;46:1132–37.
Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper’s fracture. Spine (Phila Pa 1976). 1985;10:838–45.
Stanford RE, Stanford RE, Soden R, Bartrop R, Mikk M, Taylor TK. Spinal cord and related injuries after attempted suicide: psychiatric diagnosis and long-term follow-up. Spinal Cord. 2007;45:437–43.
Acknowledgements
The authors would like to deeply thank and express gratitude to ‘Associazione Marco Piazzalunga’- Friends of the Trauma Registry of the Papa Giovanni XXIII Hospital of Bergamo, Italy. Their constant financial and intellectual support to the activities of the Trauma Registry was essential for the realization of the current study and for the maintenance of the Trauma Registry.
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Piazzalunga, D., Rubertà, F., Fugazzola, P. et al. Suicidal fall from heights trauma: difficult management and poor results. Eur J Trauma Emerg Surg 46, 383–388 (2020). https://doi.org/10.1007/s00068-019-01110-8
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DOI: https://doi.org/10.1007/s00068-019-01110-8