Differentiating injury patterns and outcomes in accidental, suicidal and occupational falls from heights

BACKGROUND: Falls from significant heights are a leading cause of severe injuries and can result from accidents, suicide attempts, or occupational incidents. While previous studies have explored general injury patterns associated with falls, little is known about the specific differences between accidental, suicidal, and occupational falls. This study aims to identify distinct injury patterns and outcomes among these fall types, thereby enhancing primary care and decision-making algorithms. METHODS: (2014-2023), focusing on patients who experienced falls from heights. Only patients admitted to trauma centers with trauma team activation and a Maximum Abbreviated Injury Scale (MAIS) severity ≥ 3 were included. All falls were categorized in accidental, suicidal, or occupational and distinguished between high (≥ 3 m) and low (< 3 m) falls. Statistical analyses included chi-squared tests for categorical variables and Mann-Whitney U tests for continuous variables, with significance set at p < 0.05. RESULTS: Among 188,708 patients, 29,991 (15.9%) experienced high falls, while 50,674 (26.9%) fell from low height. High falls were predominantly accidental (82.3%), with suicidal falls accounting for 17.7%. Accidental high falls mainly caused thoracic (58.9%) and head injuries (46.2%), whereas suicidal falls frequently involved pelvic (55.7%) and lower limb injuries (56.5%). Suicidal falls resulted in significantly higher injury severity (ISS 30.6 vs. 21.4 in accidents, p < 0.001) and mortality (25.4% vs. 11.0%, p < 0.001). Occupational falls, predominantly affecting men, demonstrated a lower mortality rate (6.5%) compared to non-occupational high falls (16.1%). CONCLUSION: This study reveals that suicidal falls from height lead to more severe injuries and higher mortality compared to accidental or occupational falls. Accidental falls are more associated with head trauma, while suicidal falls primarily involve the lower extremities and pelvis. Occupational falls have a lower mortality rate, possibly due to faster medical intervention. Understanding these patterns is crucial for tailoring early clinical management and improving patient outcomes.