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Fatal head trauma (FHT) represents one of the most frequent causes of death diagnosed in forensic pathology. However, profound statistic autopsy data on FHT is still sparse. Therefore, the purpose of this study was to investigate the circumstances and injury patterns of FHT with particular focus on age and sex, and additionally, to describe a recent risk profile of FHT. To this end, the forensic autopsy records of each FHT case at a large German university hospital during a 10-year period (2006-2015) were analyzed retrospectively (n = 372). The male-female ratio was 2.6:1. Regarding median age, females were 12.5 years older than males. Traffic-associated FHT represents the major mechanism of death, followed by fall-associated FHT. While accident was the major manner of death and presented a similar distribution of age and sex, homicides were the only subgroup with a significantly lower ratio between males and females. Skull fractures occurred in 78.2% and intracranial hemorrhages in 80.6% of all cases. In summary and partly in contrast to clinical data on head trauma, FHT still occurs predominantly in male individuals under the age of 45 years, in the context of traffic accidents and affected by alcohol intake. Improvements in traffic security as well as continuing surveillance of the incidence of FHT by forensic autopsies are necessary to further reduce the incidence of FHT.

Fatal falls are frequent and seem to be an increasing problem in the elderly. Especially ground level falls (GLFs) and falls on or from stairs and steps (stairs falls) are worth examining for forensic classification and in order to improve the development of preventive measures. We retrospectively analyzed 261 fatal falls of elderly age 65 + years, which were autopsied at the Institute of Legal Medicine in Munich between 2008 and 2014. After careful screening, the sub-set of all 77 GLFs and 39 stairs falls were analyzed towards socio-demographic characteristics, fall circumstances, injuries, and circumstances of death. A subsequent analysis of GLF cases regarding the presence of proximal femur fractures (PFF) was performed. The injury pattern of the GLFs and the stairs falls clearly differ with a higher share of injuries to the lower extremities in the GLFs. However, the most severely injured body region was the head in both groups (62% of the stairs cases, 49% of the GLF cases). Alcohol as contributing to the fall was seen more frequently in the stairs falls. PFF were not seen in the stairs falls, but then in 18 GLF cases. Yet, for 17 among them (22% of 77), their hip fracture was the only serious injury leading to hospitalization and death. Only one GLF case was already found dead. This finding indicates a potential of avoiding up to 22% of the GLF fatalities by preventing hip fractures by optimized hip protectors or other measures, especially for the elderly aged 75 + years.

The radiology literature describing the injuries of child abuse is very extensive. Articles on the distribution of injuries and the way in which a diagnosis was reached are less frequent. This article represents the detailed analysis of a cohort of patients, suspected of being victims of abuse, referred to the authors. It necessarily reflects personal experience and is not a population study. The distribution of the injuries in a cohort of 467 patients is reviewed.

Reducing mortality among accident and trauma patients requires careful attention to monitoring those regarded as being at low risk. We hospitalized almost 1600 head-injured patients in the period between 1979 and 1992 at the Neurosurgery Department of Gazi University Medical School, Ankara, Turkey. These patients were selected from among the numerous patients admitted to our emergency unit and treated with the same protocol in the same department. Among the hospitalized children, there were three patients defined as having a mild head injury on the basis of Glasgow Coma Scale scores of 15 who later had unfavorable outcomes. Clinical signs that might identify potentially endangered patients with mild injury were gathered; these included the presence of post-traumatic amnesia, somnolence, irritability, anisocoria, local evidence of trauma to the head, associated injuries, history of altered consciousness, and skull fracture. The study was designed to identify features by which patients who are in real danger can be distinguished among the many with trivial trauma that we face every day. We did not find any identifying clinical features and concluded that computed tomographic scanning is the only reliable answer. This will reduce avoidable mortality and morbidity by identifying the patients who are at higher risk than is at first evident.