Forensic distinction between victims of fall from a height and struck pedestrian : the cardiovascular injury pattern

Major blunt traumas are the main cause of violent death in Milan city area and in its province, and are, in the Authors’experience, the most frequent issue which forensic pathologists have to deal with. It is therefore surprising that contusive injuries are still a neglected issue in the forensic literature and specifically in the forensic one, especially as far as a careful and precise characterization of injurie pattern is concerned and of its main determinants (modality of accident). Among major blunt traumas, those caused by traffic accidents and those by fall from high are traditionally compared in current forensic literature. In Authors’ experience it seem more appropriate to classify major blunt traumas as those caused by fall from high and, among traffic accidents, those due to pedestrian struck. It is well known how difficult is for forensic pathologist a precise forensic distinction between pedestrian struck and fall from a height, especially in those cases in which historical and circumstantial data, which could indicate the modalities the accident has occurred, are lacking. It is therefore rather common for forensic pathologist starting from a polytraumatized corpse (frequently found by an edge of a road and near to a building) and then reconstruct the dynamic of the event based only on the injuries found during autopsy. In this case is frequent that pathologist’s reasoning takes into consideration the distinction between fall from a height and struck pedestrian. Authors’ attention specifically focused on injuries involving the cardiovascular system. These injuries, in fact, are commonly found in current practice, are peculiar and are frequently cause of death among other not fatal injuries found and occurred after the traumatic episode. The exact characterization of lesions which may be specific of a definite cause of death is therefore important in order to exactly classify the two different events therefore performing a correct differential diagnosis. The authors carried out a retrospective study on cases studied at the Institute of Legal Medicine of the University of Milan from January 2005 to January 2009, by performing an analysis on available circumstantial data (dynamic of the event, place, time and date), other data including age, sex and concomitant diseases of the victims and the results of autopsy (lesions found, cause of death and pathological findings). Finally, morphologic features of the injuries involving the cardiovascular system (heart and large vessels) were carefully analyzed in order to define a specific pattern typical of the fall from a height subject or of struck pedestrian which might help pathologist to perform a precise and often difficult differential diagnosis.