152例高坠死亡案件回顾性分析

目的对于高坠死亡案例进行回顾性调查分析,为相关研究和鉴定提供参考。方法收集2011年至2014年间,武汉市汉阳区范围内公安部门受理的所有高坠案件,共152例,对案件性质、高坠地点特征、死者年龄、性别、损伤情况等项目进行统计分析。结果 152例高坠死亡案件中自杀118例、意外28例,6例性质未能确定;高坠案件无论性质为何,发生地点均以居民住宅区最多;女性在自杀中占比略高,且年龄偏大(50岁),而意外高坠中全部为男性;损伤在两类性质的案件中均以头部和四肢为最多;自杀案件中有四分之一左右的死者有精神疾病史。结论国内高坠案件随着社会生活的发展有其独特的特征,而对高坠的尸体检验需要更加仔细和全面。     

574例高坠死亡案件分析

目的通过对大量高坠死亡案件的现场分析、尸体的损伤形态学观察并结合案情调查资料,构建高坠案件法医病理学案例库,为研究疑难坠落死亡案件奠定基础。方法收集并回顾分析5省市574例高坠死亡案件资料,包括死者个人信息、现场勘查资料、尸检结果、精神疾病史和毒物检验结果。结果男性的意外死亡率明显高于女性;在0～10岁年龄组未见自杀案例;在60岁以上年龄组,自杀率明显高于意外死亡;大多数的意外案例都发生在工作地点;坠落高度在10m以下的案例中,落地最先接触部位以头部居多,而在10～25m高度,足或下肢多见。结论大多数高坠案例都有明确的结论,但部分案例成伤机制及死亡方式判断呈现明显分歧,应为今后坠落伤研究的重点方向。     

391例高坠死亡案件鉴定分析——以上海市徐汇区为视角

目的对上海市徐汇区近十年高坠死亡案件的检验资料进行回顾性研究,对比其他区域统计数据,并结合国内外进展,以期对同行处理高坠死亡案件有所帮助。方法对上海市徐汇区2005-2013年度发生的391例高坠死亡案件的资料进行分项统计分析。结果 391例高坠中自杀案例占了多数(82.6%),意外案例占了少数(17.4%),在意外高坠中男性占了多数(86.3%),并且随着年龄的上升,自杀的比例逐渐上升,意外的比例逐渐下降。意外案件的坠落高度可高可低,但总体高度较低,自杀案件的坠落高度一般较高。意外案件中头部着地的比例较高(56.3%)。结论本区目前高坠案件勘验工作仍有不足,运用CT进行虚拟解剖,数字人体模型进行现场模拟等方法是未来的发展方向。     

62例锐器自杀损伤特征分析

目的分析62例锐器自杀死亡案件中人体损伤的特点。方法收集武汉市江岸区和上海市浦东新区最近十年来记录有详细损伤特征的62例单纯性使用锐器自杀的死亡案件,然后对案件中人体损伤的特点进行比较分析。结果最常见出现锐器自杀的损伤部位依次为颈部(37例)、左腕(23例)、胸腹部(16例)、右腕(8例)、左上臂(7例)和腹股沟(4例);锐器自杀死者中,女性患有精神病的比例显著多于男性(31.82%∶10%);男性出现胸腹部致命伤显著多于女性(25%∶4.55%);精神疾病和腕部致命伤呈显著负关联(r=-0.251),精神疾病和颈部的致命伤呈显著正关联(r=0.296);身体疾病和试切创呈显著正关联(r=0.380);试切创和左腕出现的损伤呈显著正关联(r=0.268)试切创和胸腹部出现的损伤呈显著负关联(r=-0.295);试切创和左腕部致命伤呈显著正关联(r=0.304)。结论在62例使用锐器自杀死者中,女性精神病患者比例比男性高;女性很少出现胸腹部的致命伤;精神病患者的自杀部位更偏向于颈部,身体疾病患者的自杀经常伴随着试切创;在胸腹部为致命伤的锐器自杀死者中,试切创较少发现;在左腕部为致命伤的锐器自杀死者中,试切创比较常见。     

昆明市103例高坠死亡案件的坠落高度以及案件性质分析

目的对103例高坠死亡案例进行回顾性分析,研究尸体损伤与坠落高度、坠落高度与水平移行距离、水平移行距离与案件性质之间的关系。方法收集2001~2015年间昆明市公安局所受理的高坠案例共103例,所得数据均经spss17.0进行统计检验。结果颅骨骨折在坠落高度为11米以上时的概率较大,四肢骨折在各高度出现的概率均比较大,肋骨骨折在坠落高度为21米以上时的概率较大,尸体的坠落高度与水平移行距离存在正相关关系。坠落高度在11米以上时自杀多见,水平移行距离在1.1m以上时自杀多见。结论尸体损伤、水平移行距离可作为辅助手段估算坠落高度,水平移行距离可作为判断案件性质的参考数据。     

205例高坠案件局部机械性损伤与死亡性质关系分析

目的探讨高坠案件中局部机械性损伤行为心理分析与死亡性质的关系,为此类案件的定性提供参考。方法收集2008—2013年高坠死亡案件311例,其中存在高坠难以形成的局部机械性损伤案例205例。对损伤形成特点、现场痕迹、高坠致命伤、文字信息等进行分析。结果 205例中,根据初步现场痕迹、高坠致命伤、文字信息等分析后,明确自杀86例,意外24例,性质不明95例。95例性质不明案例经对局部机械性损伤进行行为心理分析后,认定自杀80例,意外11例,他杀4例。结论高坠难以形成的局部机械性损伤与死亡性质具有关联性,根据局部机械性损伤行为心理分析推断高坠死亡性质基本准确。     

52例坠崖自杀案例分析

目的：通过对山岳型景区高坠自杀案件的现场分析、损伤形态及案情调查情况进行分析,为高坠死亡案件的定性提供参考。方法收集52例黄山景区2002—2012年内坠崖自杀案例的资料,从年龄、性别、籍贯、事发时段、坠落地点、损伤检验、行为方式等方面进行分析。结果52例坠崖自杀案例中,男性的自杀率明显高于女性,外省籍比例明显高于本省籍,年龄分布于19~50岁,案发时间段多在16：00~24：00,损伤形态以复合伤为主,均不同程度伴有颅脑损伤、胸腹腔器官损伤及体表划擦伤。结论高坠死亡案件的定性需要进行现场勘验、案情调查走访等综合分析。     

上海地区成人高坠死亡45例尸体解剖分析

对45例成人高坠死亡的尸体解剖资料进行了分析。其中42例为意外，3例为自杀。42例意外高坠中，38例发生在工作时。高坠死亡者的年龄从18岁到50岁，21～40岁占77．7％。性别以男性居多，占93．3％。着地部位最常见的是头部。由于高坠后引起机械性损伤所致死亡有43例，其中包括脑损伤（60％），肺损伤（44．4％），脾破裂（33．3％），肝破裂（26．7％），脊柱损伤（26．7％），大血管破裂或断裂（20％），心脏破裂（15．6％）。另2例则是因机械性窒息而死亡。随着坠落高度的增加，胸腹部致命性损伤数目随之增多。坠落的高度较低时，最常见的死亡原因是颅脑损伤。     

364例头皮下组织挫碎的法医学分析

头部与钝性物体相互作用时,可造成头皮下组织挫碎,表现为头皮内囊腔形成和帽状腱膜破裂,但皮肤层完整或只有轻微损伤的现象.本文通过对364例打击、摔跌、高坠和交通事故伤死者进行统计分析,发现这种损伤在摔跌、高坠和交通事故中的发生率明显高于打击伤.这种差异可能与头皮、颅骨的力学特性和致伤物的大小、形态、质量、速度、作用方向和...     

昆明市五华区124例自杀案例分析

目的研究自杀者的性别、年龄、学历、自杀原因与自杀方式之间的关系,为自杀的法医学鉴定提供依据。方法通过现场勘验、尸表检验、尸体解剖、调查走访来确定自杀案件,收集昆明市五华区近三年来的124例自杀案例,然后采用SPSS 22.0进行卡方检验、描述性统计等分析。结果自杀者男女性比例为1.53∶1;自杀方式多选择高坠、自缢和溺死;自杀者昆明户籍与非昆明户籍的比例约为1∶1;小学和初中文化程度者自杀最多;10~50岁年龄段的人群多选择高坠自杀,60岁以上的老年人选择自缢自杀的较多;不同学历层次的人群均以高坠自杀为主;因精神疾病、自身疾病和经济问题自杀者多选择高坠、自缢,而因感情问题自杀者多选择高坠、服毒。结论自杀是一类十分复杂的案件,对于疑似自杀的案件要多方面勘查、全方位思考,综合各方面因素来确定案件的性质。     

Pathologic features of fatal falls from height

Deaths due to falls from height are common in urban settings. At the time the body is found, it is often unclear whether the mode of death is accident, suicide, or homicide. To assess the injury pattern in fatal falls from height with special regard to criteria that might be helpful in discrimination between accident, suicide, and homicide, respectively, we reviewed 68 medicolegal autopsy cases (22 females, 46 males, age range 13-89 years) of fatal falls from height regarding demographic data, findings at the death scene, results of the postmortem examination, psychiatric history, and toxicologic findings. Among the 68 cases, there were 34 suicides, 23 accidents, and 11 unclarified cases, in 3 of which homicide was suspected. In general, suicides were from greater heights than accidents (mean height 22.7 m for suicides and 10.8 m for accidents, respectively; 79% of suicides from more than 16 m). Strikingly, severe head injuries predominantly occurred in falls from heights below 10 m (84%) and above 25 m (90%), whereas in the group of falls from 10 to 25 m, these lesions were seen less frequently (28%). Neck injuries like muscle bleeds and fractures of the hyoid bone were found in 33% of falls from more than 10 m and did not occur from less than 10 m. Our data stress that the evaluation of pathologic features alone is not sufficient to assess the mode of death in fatal falls from height. Instead, postmortem findings have to be considered within the framework of the subject's social, medical, and psychiatric history in conjunction with findings at the death scene and toxicology results to obtain the clearest possible picture of the circumstances of death.     

Fatal Falls from Height in Taiwan

This study conducts an investigation of fatal falls from height, examines gender differences, and compares our findings with those of Western countries. We review deaths in Taiwan caused by falls from height that underwent forensic autopsy from 1994 to 2010. Among the examined cases, 182 were suicide, 156 were accidents, and 18 were homicides. Men who fell from greater heights had a lower probability of fatal head trauma (p = 0.045), and women exhibited a lower fatal head trauma rate when falling from heights of between 10 and 25 m in accident group (p = 0.003). There was no significant difference between cases of falling from greater and lower heights within the suicide group (p = 0.834). Psychiatric illness was only reported in 20.3% and 28.8% cases in suicide and accident groups. Only in male cases was the use of psychotropic substances higher in the suicide groups than in the accident groups (p = 0.047).     

Fatal falls from heights in and around Diyarbakir, Turkey

Falls from high places, such as from a building, are frequently encountered in suicides, in some accidents, and sometimes in homicides. In this study, we evaluated the demographic data, mortality rates, fall causes, and post-mortem findings of individuals who fell from heights. Our cases were collected retrospectively from the files of the Branch of the Council of Forensic Medicine in Diyarbakir between 1996 and 2001. There were 431 accidental and 53 suicidal deaths due to blunt injury resulting from falls. Of the victims, 188 were female and 296 were male. The average age of the 484 victims was 27.05 years (range: 4 months-100 years). For buildings, the height ranged from 3 to 8 stories for suicides and from 1 to 8 stories for accidents. We proceeded to analyse the characteristics of accidental falls as follows. The majority of falls were from balconies or rooftops due to the tendency of people to sit and sleep on these places during the hotter months of the year. Some 54.5% of all falls occurred in May-August. The 53 suicidal jumps all occurred off buildings. The victims ranged in age from 15 to 70 years, and comprised 29 women and 24 men. One of the deceased jumped from the roof of a school in which he was boarding, and another from the seventh story of a hospital in which he was receiving treatment. The remaining 51 jumped from heights ranging from 3 to 8 stories. Psychiatric illness was reported in 18 (33.9%) of the suicide deaths, while 10 (18.8%) of the 53 suicides were single women. The results of this study were at variance with literature data with respect to the following: falls from heights were most common in the 0-5 year age group, females had a higher suicide rate than males, and the majority of accidental falls occurred at home rather than in the workplace.     

Pathologic features of childhood pedestrian fatalities

A retrospective analysis of 68 cases of fatal childhood pedestrian accidents in South Australia that occurred over a 20-year period from January 1977 to December 1996 was undertaken. The age range was 12 months to 16 years (average, 7.6 years), with a male to female ratio of 41:27. The most common site of significant injury was the head (91.2%), followed by the abdomen (50%), chest (47.1%), and neck (38.2%). The most frequently encountered significant injury combinations involved the head, chest, and abdomen (14.7%); the head and chest (11.8%); and the head, neck, and abdomen (11.8%). Injuries were severe, consisting of extensive compound and comminuted skull fractures, neck fractures, and massive intraparenchymal brain and internal organ damage with avulsions and fragmentation. Non-life-threatening limb injuries occurred in 88% of cases. A distinct subgroup involved infants and younger children playing in driveways at home who were hit by reversing vehicles. The injuries were often of such a severe nature that death was instantaneous and with no possibility of successful medical intervention. More deaths occurred during the winter than summer months.     

Fatal pediatric head injuries caused by short-distance falls.

Physicians disagree on several issues regarding head injury in infants and children, including the potential lethality of a short-distance fall, a lucid interval in an ultimately fatal head injury, and the specificity of retinal hemorrhage for inflicted trauma. There is scant objective evidence to resolve these questions, and more information is needed. The objective of this study was to determine whether there are witnessed or investigated fatal short-distance falls that were concluded to be accidental. The author reviewed the January 1, 1988 through June 30, 1999 United States Consumer Product Safety Commission database for head injury associated with the use of playground equipment. The author obtained and reviewed the primary source data (hospital and emergency medical services' records, law enforcement reports, and coroner or medical examiner records) for all fatalities involving a fall. The results revealed 18 fall-related head injury fatalities in the database. The youngest child was 12 months old, the oldest 13 years. The falls were from 0.6 to 3 meters (2-10 feet). A noncaretaker witnessed 12 of the 18, and 12 had a lucid interval. Four of the six children in whom funduscopic examination was documented in the medical record had bilateral retinal hemorrhage. The author concludes that an infant or child may suffer a fatal head injury from a fall of less than 3 meters (10 feet). The injury may be associated with a lucid interval and bilateral retinal hemorrhage.     

Diffuse axonal injury by simple fall.

Diffuse axonal injury (DAI) is the second most common lethal head trauma after subdural hematoma and probably the most frequent cause of traumatic coma in the absence of an expanding intracranial mass lesion. Though it occurs most often in traffic accidents, it may occasionally result from falls from a height. Previously, it has not been associated with a simple fall or a fall of a distance not more than the victim's own height. We report herein a case of DAI from a simple fall.     

Fatal acute intracranial injury, subdural hematoma, and retinal hemorrhages caused by stairway fall

We describe an infant with an acute subdural hematoma, a fatal head injury, and severe hemorrhagic retinopathy caused by a stairway fall. His cerebral and ocular findings are considered diagnostic of abusive head trauma by many authors. Our literature search of serious injuries or fatalities from stairway or low-height falls involving young children yielded 19 articles of primary data. These articles are discrepant, making the classification of a young child's death following a reported short fall problematic. This case report contradicts the prevalent belief of many physicians dealing with suspected child abuse that low-height falls by young children are without exception benign occurrences and cannot cause fatal intracranial injuries and severe retinal hemorrhages. The irreparable harm to a caregiver facing an erroneous allegation of child abuse requires physicians to thoroughly investigate and correctly classify pediatric accidental head injuries.     

Death caused by projectile guns--a retrospective analysis of 34 cases in Berlin and Hamburg

The autopsy material of the institutes for forensic medicine in Berlin/GDR and Hamburg was analyzed retrospectively (period from 1961 till 1987; 70,000 autopsies) for fatalities caused by "humane killers" (n = 22) and stud guns (n = 12).-Epidemiological, criminological and morphological findings: The decreased were all men aged between 18 and 75 years (mean 48 years) except one 61 year-old paraplegic women who was killed by her husband with a humane killer. The great majority of cases consisted of suicides; two accidents at work were caused by stud guns. These unusual weapons are normally used by skilled people (i.e. butchers or constructional workers respectively). The fatal wounds were situated at the head, especially the forehead, seldom at the nape of the neck or in the mouth, or sometimes in the chest when using stud guns. Combined suicides (especially together with hanging) are not unusual. Survival periods (with or without acting capacity) can range between minutes or even months (after neurosurgical intervention).-The frequency of such unusual and overall rare cases did not raise during the investigation period.     

Skeletal Trauma Resulting From Fatal Low (≤3 m) Free Falls: An Analysis of Fracture Patterns and Morphologies

The skeletal trauma resulting from fatal low (≤3 m) free falls is poorly researched and understood by forensic practitioners. The aim of this study was to identify the types of skeletal trauma resulting from low falls through investigating fracture patterns and morphologies. Skeletal trauma was analyzed using full‐body postmortem computed tomography scans of 145 individuals who died from a low free fall. Trauma was then contextualized to the variables that influence how a person falls using multiple logistic regression. Results showed fracture patterning primarily involved the axial skeleton and that there were a number of patterns significantly associated with the height fallen, pre‐existing health conditions, and age. Analysis of fracture morphologies showed 108 possible fracture types, six of which were significantly associated with the height fallen. Understanding the skeletal trauma characteristic of low free falls will further inform anthropological interpretations of trauma in cases where a fall may be considered the possible mechanism.     

Characteristic Features of Pediatric Firearm Fatalities—Comparisons Between Australia and the United States

Abstract:  Gunshot deaths in children less than 17 years of age from Adelaide, SA, Australia (1969–2005) and from San Diego County, CA, United States (1988–2005) were compared. Forty-two pediatric gunshot fatalities occurred in South Australia (1.1 cases/year; M:F = 30:12). There were 6 accidents (14%), 14 suicides (33%), and 22 homicides (52%). In San Diego there were 185 cases ( c. 10 cases/year; M:F = 148:37). There were 6 accidents (3%), 42 suicides (23%), 130 homicides (70%), and 7 undetermined cases (4%). The incidence of homicide was significantly higher in San Diego County compared to Adelaide ( p  < 0.001), with a higher proportion of murder–suicides occurring in Adelaide. There were markedly more accidents and suicides involving males in Adelaide and a far higher number of male homicide victims in San Diego County compared to females. Rifles of 0.22-caliber were preferred weapons in South Australia, compared to handguns in San Diego County.