Fatal falls from great height in Sousse (Tunisia): Study of 141 medicolegal autopsy cases


Souhir Chelly
Abir Mtira
Sarra Gharesellaoui
Majed Hassine
Maher Jedidi
Mohamed Mahjoub
Tasnim Masmoudi


Introduction: Falls from great heights constitute a violent trauma that can lead to death. This represents a suspicious death, leading to initiate legal proceedings with in particular the practice of an autopsy.

Aims: to determine the features of victims of falls from height and relations between medico-legal form of the death, the height of the fall and the nature of traumatic injuries

Methods: A retrospective study about 141 cases of death after fall from great height. Data were collected at the Legal Medicine Department of the Farhat Hached University Hospital in Sousse (Tunisia) over a period of 14 years from 2007 to 2020.

Results: The average age of the victims was 37±12.8 years with a sex ratio of 6.05. Half of them were day laborers. The majority had no history of psychiatric illness (91.5%). The majority of victims (41.8%) fell from a height of 3 to 6 meters. Regarding injuries, rib fractures (52.4) were predominant, especially on the right side followed by skull fractures (31.2%). A significant difference in the prevalence of rib cage lesions in the groups over 9 meters in height (p<0.05) was found. The lesions of the lower limbs were proportional to the increase in the height of the fall. Deaths were accidental in 80.8% and suicides in 13.5%.

Conclusion: In cases of high falls, a forensic autopsy is essential to make a complete evaluation of the injuries, to search a correlation between severity of injuries and height of the fall .....(abstract truncated at 250 words).


fall from height, trauma, autopsy, death, forensic form



  1. ANIL KOHLI, K.K. BANERJEE. Pattern of Injuries in Fatal Falls from Buildings.Med Sci Law2006;46 (4):335-41.
  2. Nguyen-Thanh Q, Trésallet C, Langeron O, Riou B, Menegaux F. Les polytraumatismes sont plus graves après chute d’une grande hauteur qu’après accident de la voie publique. Ann Chir. 2003;128 (8):526‑9.
  3. Lapostolle F, Borron SW, Gere C, Dallemagne F, Beruben A, Lapandry C, et al. Patients victimes de chutes de grande hauteur. Étude d’une cohorte de 287 patients et détermination des facteurs pronostiques cliniques. Ann Fr Anesth Réanimation. 2004;23 (7):689‑93.
  4. Lau G, Ooi PL, Phoon B. Fatal falls from a height: The use of mathematical models to estimate the height of fall from the injuries sustained. Forensic Sci Int. 1998;93 (1):33‑44.
  5. Atanasijevic TC, Popovic VM, Nikolic SD. Characteristics of chest injury in falls from heights. Leg Med. 2009;11:S315‑7.
  6. Demetriades D, Murray J, Brown C, Velmahos G, Salim A, Alo K, Rhee P. High-level falls: type and severity of injuries and survival outcome according to age. J Trauma. 2005 Feb;58 (2):342-5. doi: 10.1097/01.ta.0000135161.44100.d8. PMID: 15706198.
  7. Mosenthal AC, Livingston DH, Elcavage J, Merritt S, Stucker S. Falls: epidemiology and strategies for prevention. J Trauma. 1995 May;38 (5):753-6. doi: 10.1097/00005373-199505000-00013. PMID: 7760404.
  8. Liu CC, Wang CY, Shih HC, Wen YS, Wu JJK, Huang CI, et al. Prognostic factors for mortality following falls from height. Injury. 2009;40 (6):595‑7.
  9. Risser D, Bönsch A, Schneider B, Bauer G. Risk of dying after a free fall from height. Forensic Sci Int. 1996;78 (3):187‑91.
  10. Zatzick DF, Kang SM, Kim SY, Leigh P, Kravitz R, Drake C, et al. Patients with Recognized Psychiatric Disorders in Trauma Surgery: Incidence, Inpatient Length of Stay, and Cost. J Trauma Acute Care Surg. 2000;49 (3):487‑95.
  11. Demetriades D, Gkiokas G, Velmahos GC, Brown C, Murray J, Noguchi T. Alcohol and illicit drugs in traumatic deaths: Prevalence and association with type and severity of injuries. J Am Coll Surg. 2004;199 (5):687‑92.
  12. Fang JF, Shih LY, Lin BC, Hsu YP. Pelvic fractures due to falls from a height in people with mental disorders. Injury. 2008;39 (8):881‑8.
  13. Pérez-Suárez E, Jiménez-García R, Iglesias-Bouzas M, Serrano A, Porto-Abad R, Casado-Flores J. Caídas desde grandes alturas en Pediatría. Epidemiología y evolución de 54 pacientes [Falls from heights in Pediatrics. Epidemiology and evolution of 54 patients]. Med Intensiva. 2012;36 (2):89-94.
  14. Goren S, Subasi M, Týrasci Y, Gurkan F. Fatal falls from heights in and around Diyarbakir, Turkey. Forensic Sci Int. 2003;137 (1):37-40.
  15. Atanasijević T, Nikolić S, Djokić V. Stepen tezine ukupne traume kao mogući parametar za procenu visine sa koje ja ostvaren smrtonosni pad [Level of total injury severity as a possible parameter for evaluation of height in fatal falls]. Srp Arh Celok Lek. 2004;132 (3-4):96-8.
  16. Deemer E, Bertocci G, Pierce MC, Aguel F, Janosky J, Vogeley E. Influence of wet surfaces and fall height on pediatric injury risk in feet-first freefalls as predicted using a test dummy. Med Eng Phys. 2005;27 (1):31-9.
  17. Christensen AM. The influence of behavior on freefall injury patterns: possible implications for forensic anthropological investigations. J Forensic Sci. 2004;49 (1):5‑10.
  18. Steedman DJ. Severity of free-fall injury. Injury. 1989;20 (5):259‑61.
  19. Wedel VL, Galloway A. BROKEN BONES: Anthropological Analysis of Blunt Force Trauma (2nd Ed.). Charles C Thomas Publisher; 2013. 505 p.
  20. Petaros A, Slaus M, Coklo M, Sosa I, Cengija M, Bosnar A. Retrospective analysis of free-fall fractures with regard to height and cause of fall. Forensic Sci Int. 2013;226 (1):290‑5.
  21. Venkatesh VT, Kumar MV, Jagannatha SR, Radhika RH, Pushpalatha K. Pattern of skeletal injuries in cases of falls from a height. Med Sci Law. 2007;47 (4):330-4.
  22. Li L, Smialek JE. The investigation of fatal falls and jumps from heights in Maryland (1987-1992). Am J Forensic Med Pathol. 1994;15 (4):295‑9.
  23. Türk EE, Tsokos M. Pathologic features of fatal falls from height. Am J Forensic Med Pathol. 2004 Sep;25 (3):194-9.
  24. Atanasijevic TC, Savic SN, Nikolic SD, Djoki VM. Frequency and severity of injuries in correlation with the height of fall. J Forensic Sci. 2005 May;50 (3):608-12.
  25. Thierauf A, Preuss J, Lignitz E, Madea B. Retrospective analysis of fatal falls. Forensic Sci Int. 2010 May 20;198 (1-3):92-6.
  26. Casali MB, Battistini A, Blandino A, Cattaneo C. The injury pattern in fatal suicidal falls from a height: an examination of 307 cases. Forensic Sci Int. 2014;244:57-62.
  27. Peng TA, Lee CC, Lin JCC, Shun CT, Shaw KP, Weng TI. Fatal Falls from Height in Taiwan. J Forensic Sci. 2014;59 (4):978‑82.
  28. Papadopoulos IN, Bonovas S, Kanakaris NK, Nikolopoulos G, Kotsilianou O, Konstantoudakis G, Leukidis C. Alcohol and psychoactive drugs increased the pre-hospital mortality in 655 fall-related fatalities in Greece: a call for management protocols. Injury. 2012;43 (9):1522-6.
  29. Behera C, Rautji R, Dogra TD. Fatal accidental fall from height in infants and children: a study from South Delhi. Med Sci Law. 2010 Jan;50 (1):22-4.
  30. Osifo OD, Iribhogbe P, Idiodi-Thomas H. Falls from heights: epidemiology and pattern of injury at the accident and emergency centre of the University of Benin Teaching Hospital. Injury. 2010;41 (5):544-7.
  31. Jannadi MO, Assaf S. Safety assessment in the built environment of Saudi Arabia. Saf Sci. 1998;29 (1):15‑24.
  32. Suraji A, Duff AR, Peckitt SJ. Development of causal model of construction accident causation. J Constr Eng Manag. 2001;127 (4):337‑44.
  33. Kimura R, Ikeda S, Kumazaki H, Yanagida M, Matsunaga H. Comparison of the clinical features of suicide attempters by jumping from a height and those by self-stabbing in Japan. J Affect Disord. 2013;150 (2):695‑8.
  34. Ung EK. Youth suicide and parasuicide in Singapore. Ann Acad Med Singapore. 2003;32 (1):12‑8.
  35. Cetin G, Günay Y, Fincanci SK, Ozdemir Kolusayin R. Suicides by jumping from Bosphorus Bridge in Istanbul. Forensic Sci Int. 2001;116 (2-3):157-62.
  36. Reisch T, Schuster U, Michel K. Suicide by jumping from bridges and other heights: social and diagnostic factors. Psychiatry Res. 2008;161 (1):97-104.
  37. Gunnell, D., & Nowers, M. Suicide by jumping. Acta Psychiatrica Scandinavica. 1997;96 (1), 1–6.
  38. Cross R. Fatal falls from a height: two case studies. J Forensic Sci. 2006 Jan;51 (1):93-9.
  39. Shaw KP, Hsu SY. Horizontal distance and height determining falling pattern. J Forensic Sci. 1998;43 (4):765-71.