Factors influencing the incidence of cervical spine/cord injury and severe injury caused by falls.

Falls are major causes of trauma in older people, often resulting in cervical spine/cord injury, and may even be fatal. We aimed to identify factors associated with cervical spine/cord injury and severe injury caused by falls to aid forensic evaluation. We retrospectively analyzed data for 83 individuals who fell between 2011 and 2023 at Shiga University of Medical Science. The characteristics of the victim, cause of death, presence of cervical spine/cord injury, injury severity, part of the body making contact with the impact surface, properties of the impact surface, and fall height were evaluated. Injury severity was assessed using the Abbreviated Injury Severity score and Injury Severity Score (ISS). Severe injury with ISS ≥ 16 occurred in 39.8% of victims and cervical spine/cord injury in 21.7%. Logistic regression analyses revealed that body mass (odds ratio [OR] 1.063, 95% confidence interval [CI] 1.003-1.126) and the part of the body making contact with the impact surface (chest/abdomen vs. head/face, OR 0.074, CI 0.007-0.723) significantly influenced the incidence of cervical spine/cord injury, and fall height >3 m was significantly associated with severe injury (OR 11.473, CI 2.163-60.868). These findings demonstrate that the severity of injury depends on the fall height, whereas cervical spine/cord injury is influenced by body mass and the part of the body making contact with the impact surface. Therefore, the collection of scene information, including the fall height, and body mass and posture are critical for postmortem examinations. Autopsy should be considered when cervical spine/cord injury is suspected.