A Comparative Study of the Injury Patterns and Inflammatory Response Between Suicidal and Unintentional Falls from Height (in Germany)

Background Patients following falls from great height with suicidal intent present unique challenges including delayed medical attention, different often masked injury patterns, severe hypothermia and difficulties obtaining informed consent due to the patient's mental state. Legal and logistical hurdles, such as coordinating with legal guardians or family members, can further delay treatment. These co-factors contribute to reported overall high complication rates in these cases, reaching up to 50%. The aim of this study is to analyze injury patterns, inflammatory responses and complication rates in suicidal jumpers compared to unintentional falls. The purpose of this study is also to investigate correlations between jump height and injury severity. Methods In this retrospective monocentric study patient data such as age, gender, injuries, treatments, and the duration of hospitalization were analysed. Over the last decade it was possible to include 68 suicidal falls. Subsequently, 68 work related falls from >3m were included as a control group to analyse against the suicidal ones. Statistical analysis was performed with SPSS 28 (SPSS Inc.) on the included patients (total n=136; male=86, female=48) with parametric analysis using t-tests, chi-squared tests and correlation analyses. The classification of injury outcomes was based on German polytrauma guidelines. The significance level was set at 5% and an exploratory data analysis with one-sided testing was carried out. Results In the analysis of the subgroup of unintentional falls, a predominance of male patients was observed (76.5%, p = 0.002). In contrast, the group of suicidal jumps exhibited a balanced gender distribution, with 50% male (n=34) and 50% female (n=34) patients. Overall, suicidal falls presented with a significantly more severe injury pattern. The average reported fall height was 9.61 m (± 6.42 m) in the suicidal group compared to 6.14 m (± 4.08 m) in the unintentional group. Regarding the assessment of injury severity based on the Injury Severity Score (ISS), higher values were observed in the suicide group, with an ISS of 32.04 (± 23.43) compared to 17.37 (± 14.01). In accordance with this we observed higher complication rates for the suicidal cases (52.5% vs. 29.9%, p = 0.011), and a greater number of total surgeries required in the suicidal group (3.21 (± 4.27) vs. 1.69 (± 2.81), p = 0.016). The measurable coagulation status (prothrombin time) of patients upon admission was significantly worse in the suicidal group (74.95 (± 21.89) vs. 89.09 (± 21.66), p < 0.001), which resulted in a significantly higher transfusion requirement for erythrocyte concentrates (4.07 (± 9.39) vs. 0.97 (± 2.29), p < 0.001). Conclusion Patients with suicidal jumps suffered from more severe injury patterns with an ISS of 32.04 (± 23.43) compared to 17.37 (± 14.01) in the unintentional group (p< 0.001). The suicidal patients exhibited a higher complication rate (p=0.011), an increased overall transfusion requirement, and a greater number of (re-)operations compared to the cohort of unintentional falls. Our data suggests that these patients require more resources and are more challenging to treat. In these patients, particular attention should be given to the frequent occurrence of complications (e.g., wound healing disorders and infections), the elevated transfusion demand, and the significantly impaired coagulation status upon hospital admission.