回溯台灣(2010~2012)高處墜落自殺死亡之創傷型態分析

Abstract

台灣高處墜落自殺死亡案件有逐年攀升現象， 並造成了高死亡率和多重嚴重創傷結果。本研究為探討高處墜落自殺死亡之相關因素和創傷型態。研究個案資料是由法務部法醫研究所提供，以2010至2012年區間為高處墜落死亡者，研究變項包含：人口學資料、就醫及過往病史、高處墜落相關資料、司法解剖相關資料、毒藥學相關資料。統計資料類別變數採用卡方檢定(Chi-squared test)，樣本數低於5則使用費雪精確檢定(Fisher's Exact Test)，連續變數採用獨立樣本t檢定(independent t test)和皮爾森相關係數分析(Pearson correlation coefficient)。 本研究結果高處墜落死亡的個案共計119名，其中75名男性，44名女性，年齡範圍為16~84歲，死亡方式：77名為自殺，33名為意外，7名無法確認和2名他殺。在此研究中，在本研究結果顯示高處墜落創傷以頭部和胸腔創傷最為常見，而顱腦損傷為主要致命原因。高度更是重要影響創傷型態之因素，四肢骨折、心臟、肺臟、肝臟、脾臟、胸主動脈和下腔靜脈創傷顯著受到墜落高度影響。自殺和意外二組比較之結果顯示意外組以有職業之男性居多，而自殺組男性與女性之分佈呈現較平均，自殺組比意外組在生前有較高比例有精神疾病、使用抗憂鬱藥物及墜落高度較高(自殺墜落平均高度：20.64公尺，意外墜落平均高度：12.23 公尺) (p<0.05)。創傷結果顯示自殺組較意外組較高比例發生胸椎、下肢骨折(p<0.001)，在減速傷的比較，則顯示二組無顯著差異。

Fall from height is a common cause of suicidal death in Taiwan. The aim of this study was to assess the relationship between the injury patterns and age, gender, height of the fall and stopping of the fall in suicidal high falls. The forensic autopsy files from 2010 to 2012 were reviewed at the Institute of Forensic Medicine, Ministry of Justice, Taiwan. We collected 119 forensic autopsy cases (75 males, 44 females, age range 16-84 years) of fatal falls from height regarding demographic data, findings at the death scene, results of the postmortem examination, psychiatric history, and toxicologic findings. Statistical analysis was performed using Chi-squared test, Fisher's Exact Test, Independent t test and Pearson correlation. Among the 119 cases, there were 77 suicides, 33 accidents, 7 unclarified cases, and 2 suspected homicide. Head injuries were responsible for the majority of deaths. Height was found to be the major factor influencing injury patterns in fatal falls. In our sample, the incidence of the extremities, heart, lungs, liver, spleen, thoracic aorta, and inferior vena cava injuries increased with height. In accident, there were almost exclusively male victims (84.8%). In contrast, gender was nearly equally distributed in suicides (51.9% males, 48.1% females). A history of psychiatric illness, especially depression was present in the suicide more than accident. Suicides had greater falling heights than accidents (mean height 20.64 m for suicides and 12.23 m for accidents). The meaningful statistical difference existed in thoracic vertebra and bilateral extremity fractures between accident and suicide; suicidal victims showed a significantly higher incidence of bilateral extremity fracture when compared to accident. No statistical difference was found in the incidence of vertical deceleration injuries between accident and suicide.