A retrospective study of the injury patterns seen in fatal falls downstairs

Introduction

Fatal falls involving stairs are often associated with advanced age, intoxication, acute natural pathology and less commonly – the involvement of a third-party. The injury patterns seen in these cases are often complex and from a medico-legal standpoint, determining third-party involvement based on pathology alone can prove a significant challenge. Classifying the manner of death in such cases, can become particularly complex when the injury pattern appears inconsistent with a simple fall downstairs, or there is an absence of eye-witness testimony.

Aim

To explore the circumstances and injury patterns seen in cases of fatal falls downstairs which were classified as accidental vs. undetermined by the coroners.

Study design

This retrospective study explored the injury patterns present in all cases of fatal falls downstairs referred to the Office of the State Pathologist (OSP) over a 10-year-period (2012–2022) (n = 51).

Results

Fatal falls downstairs which were classified as undetermined were found to have a greater number of craniofacial fractures, spinal fractures and intracranial injuries when compared to accidental falls. Undetermined staircase deaths also displayed more significant fracturing involving the facial skeleton.

Conclusion

Ultimately, where there is a question of third-party involvement, the Post-Mortem Examination (PME) findings alone cannot determine the manner of death. The pathologist's examination may identify injuries that are inconsistent with a simple fall downstairs, but it is the coroner who must conduct a thorough investigation into the circumstances of the fatal fall and ultimately determine the classification of the death.