Discrimination of falls and blows in blunt head trauma: a multi-criteria approach.
In the discrimination of falls versus blows, the hat brim line (HBL) rule is mentioned in several textbooks as the most useful single criterion. Recent studies, however, have found that the HBL rule is only moderately valid and that its use on its own is not recommended. The purpose of this 6-year retrospective study was to find additional individually useful criteria in the distinction of falls from blows. Overall, the following criteria were found to point toward blows: more than three lacerations, laceration length of 7 cm or more, comminuted or depressed calvarial fractures, lacerations or fractures located above the HBL, left-side lateralization of lacerations or fractures, more than four facial contusions or lacerations, presence of ear lacerations, presence of facial fractures, and presence of postcranial osseous and/or visceral trauma. Based on the most discriminating criteria, a decision tree was constructed to be potentially applicable to future cases.
Guyomarc'h
Pierre
P
Laboratoire de Sciences Judiciaires et de Médecine Légale, Edifice Wilfrid-Derome, 1701, Parthenais Street, 12th Floor, Montreal, Quebec, Canada, H2K 3S7.
Campagna-Vaillancourt
Maude
M
Kremer
Célia
C
Sauvageau
Anny
A
D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002492:Central Nervous System Depressants / Q000097:blood; D002648:Child; D003288:Contusions / Q000473:pathology; D003657:Decision Making; D003663:Decision Trees; D004431:Ear, External / Q000293:injuries; D000431:Ethanol / Q000097:blood; D005147:Facial Bones / Q000293:injuries; D005151:Facial Injuries / Q000473:pathology; D005260:Female; D049429:Forensic Pathology; D018460:Fractures, Comminuted / Q000473:pathology; D016489:Head Injuries, Closed / Q000473:pathology*; D006708:Homicide; D006801:Humans; D022125:Lacerations / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000473:pathology; D012189:Retrospective Studies; D012535:Scalp / Q000293:injuries / Q000473:pathology; D012887:Skull Fractures / Q000473:pathology; D055815:Young Adult
D002492:Central Nervous System Depressants; D000431:Ethanol