The role of epidemiology in determining if a simple short fall can cause fatal head injury in an infant: a subject review and reflection.

ABSTRACT

This article is a subject review summarizing and interpreting the existing knowledge on the question "Can a simple short fall cause fatal head injury in an infant?" It also reflects on the challenges of undertaking a review in the contentious area of pediatric forensic pathology. The authors identified and considered 1055 publications for inclusion. Using explicit selection criteria 27 publications were included in the subject review. The literature suggests that it is rare, but possible, for fatal head injury to occur from a simple short fall. Large population studies of childhood injuries indicate that severe head injury from a short fall is extremely rare. This is counter pointed by a single documented case report that demonstrates it can happen. The question of whether it is a credible claim in a particular case is inextricable from the circumstances of that case.To strengthen the evidence based on fatal potential of simple short falls in infants, future studies addressing this question would ideally be prospective in design and include the key elements of (1) a large sample size, (2) clearly defined comparison groups, (3) clear and verifiable criteria for causation, (4) specified fall height, (5) specified fall type vertical free fall or the presence of additional forces, (6) composition of contact surface, and (7) nature of contact point concentrated to one point or onto a flat surface.We believe subject reviews for forensic pathology require a specific approach because the application of information differs between clinical and courtroom settings.