J O U R N A L O F

CLINICAL
FORENSIC
MEDICINE
Journal of Clinical Forensic Medicine 13 (2006) 129–134
www.elsevier.com/locate/jcfm

Original communication

Jumping and falling death in children, adolescents, and young adults

a,*
}
Klára Töro , Nóra Szlávik a, Árpád Mészáros b, György Dunay a,
Margit Soós a, Éva Keller a
a
Department of Forensic Medicine, Semmelweis University Budapest, Üll}oi út 93, 1091 Budapest, Hungary
b
Population, Health and Welfare Statistics Department, Vital Statistics Section, Hungarian Central Statistical Office, Hungary

Received 5 September 2005; received in revised form 11 October 2005; accepted 20 October 2005
Available online 13 December 2005

Abstract

Introduction: Evaluation of fatal jumps and falls from height in children, adolescents and young adults needs careful medico-legal inves-
tigation. The aim of this study was to examine the distribution of undetermined falling from height, accidental falling, and suicidal jump-
ing cases between 1990–2003.
Methods: Copies of death certificates relating to falling from height and jumping deaths in Hungarian youths from the ages of 0–24 years
of those resident in Hungary were obtained.
Results: 215 (34.1%) accidental falls, 394 (62.6%) suicidal jumping, and 21 (3.3%) undetermined intent were investigated. A significant
increase was detected in suicidal jumping death in the age group of 15–19 years (OR = 0.7, CI = 0.49–0.98, p = 0.039), and in the age
group of 20–24 years (OR = 0.72, CI = 0.54–0.96, p = 0.025) in the most recent 5 year study period.
Conclusion: Data concerning the scene investigation, detailed forensic autopsy, and family history have important role in the differen-
tiation of fatal jumping or falling cases. Further investigation about the characteristics injuries may help the final determination of vio-
lent death causes at youth, and more effort should be directed to an effective prevention strategy for jumping or falling death cases.
Ó 2005 Elsevier Ltd and AFP. All rights reserved.

Keywords: Jumping from height; Homicide; Accident; Suicide; Youth

1. Introduction method in providing for the differentiation between fatal

When evaluating falling from height or jumping death
cases in youths the investigator needs to be aware of the
common scenarios, the risk factors, as well as the cause
and manner of death in these fatalities. Jumping from
height is a frequently chosen method of suicide among ado-
lescents and young adults,1–3 however, the final confirma-
tion of suicide, accident or murder requires careful and
systematic medico-legal investigation. There is a great
human investment in deterring accidents or suicides,4 and
protecting the young is important in every society. A factor
in these efforts is the development of forensic medicine that
determines liability for failing to employ reasonable
*
Corresponding author. Tel.: +36 12157300; fax: +36 12162676.
E-mail address: torok@igaz.sote.hu (K. Tör}
o).
death cases.
The aim of this study was to examine the distribution of
undetermined falling from height, accidental falling, and
suicidal jumping cases among children, adolescents and
young adults in Hungary. We use 3 cases to demonstrate
the difficulties during the investigation of accidental falling,
intentional pushing, and suicidal jumping cases.
2. Material and methods
Copies of death certificates relating to falling from high
and jumping deaths up to 24 years of age of those resident
in Budapest and in Hungary were obtained from the Hun-
garian Central Statistical Office. Data were collected from
the 4-year period 1990–2003. Rate of falling or jumping
death was calculated for the number of all death cases in

1353-1131/$ - see front matter Ó 2005 Elsevier Ltd and AFP. All rights reserved.
doi:10.1016/j.jcfm.2005.10.002
130 K. Tör}o et al. / Journal of Clinical Forensic Medicine 13 (2006) 129–134

1 (0.06)
9 (0.54)

27 (1.61)
different age groups (0–4, 5–9, 10–14, 15–19, and 20–24

No. (%)
years). The population died under the age of 24 years in

2003

37
the investigated period amounted to 5.168 in Budapest,
and 36.605 in Hungary. Details of all jumping and falling

3 (0.17)
18 (1.00)

29 (1.60)
No. (%)
deaths were examined by forensic pathologists or hospital

2002
pathologists. Scene investigation was made by the police.

50
We recorded whether a suicide note was left. Previous sui-
cide attempts and psychiatric history data were also col-

3 (0.16)
11 (0.59)

32 (1.80)
No. (%)
lected. The rate of the levels of alcohol intoxication was

2001
recorded. The blood alcohol concentrations (BACs) were

46
used only, if death occurred on the same day as the injury.
Influence of alcohol was categorized as slight (BAC: 51–

0 (0.00)
17 (0.92)

22 (1.04)
No. (%)
80 mg/100 ml), mild (BAC: 81–150 mg/100 ml), moderate

2000
(BAC: 151–250 mg/100 ml), severe (BAC: 251–350 mg/

39
Number and rates of fatal accidental, suicidal, and not determined falls among all death cases in children, adolescents, and young adults in Hungary
100 ml) and very severe (BAC: above 351 mg/100 ml).

3 (0.14)
17 (0.82)

28 (1.35)
Alcohol-involved deaths were defined as those with detect-

No. (%)
able BAC of more than 50 mg/100 ml.

1999

48
Death cases were collected in three groups: (1) Acciden-
tal falls from high (ICD 9th 881-884, 888 and ICD 10th

1 (0.04)
19 (0.82)

29 (1.25)
No. (%)
W11-W17, W19), (2) intentional self-harm by jumping

1998
from a high place (ICD 9th 987 and ICD 10th X80), (3)

49
falling, jumping or pushed from a high place, undetermined
intent (ICD 9th 957 and ICD 10th Y30). Data include

3 (0.13)
6 (0.26)

34 (1.47)
No. (%)
deaths in each year, using the 9th and 10th revisions of

1997
the international classification of diseases (ICD). The

43
ICD 9th version was used in Hungary between years of
1978 and 1995, and the ICD 10th version with detailed

2 (0.08)
12 (0.47)

30 (1.19)
No. (%)
codes was introduced after 1995.
1996

44
The post-mortem medico-legal examination of the pre-
sented accidental falling, intentional pushing and suicidal
0 (0.00)
14 (0.51)

35 (1.29)
jumping death cases was performed at Semmelweis Univer-
No. (%)

sity Department of Forensic Medicine, Budapest. In every

1995

49
case scene investigation was done by the police. The chi
square test with Yates correction factor was used to com-
0 (0.00)
15 (0.51)

37 (1.25)
No. (%)

pare the numbers of total death and jumping death cases.

1994

52

3. Results
2 (0.06)
16 (0.52)

18 (0.58)
No. (%)

215 (34.1%) accidental falling, 394 (62.6%) suicidal

1993

jumping, and 21 (3.3%) undetermined intent cases were

36

identified. The number and the proportion of jumps and

falls for all death cases among children, adolescents and
1 (0.03)
26 (0.73)

28 (0.79)
No. (%)

young adults in Hungary are presented in Table 1. The pro-

1992

55

portion of accidental falls for all death cases was high in

the age group of 15–19 years (0.23–1.8%), and in the age
1 (0.03)
16 (0.42)

22 (0.58)

group of 20–24 years (0.37–2.04%). The rate of suicidal

No. (%)

jumping shows an increasing rate in the age group of 15–

1991

39

19 years (1.72–4.62%), and in the age of 20–24 years

(1.3–4.4%) from the middle of 1990s.
1 (0.03)
19 (0.50)

23 (0.59)
No. (%)

Table 2 shows the age distribution of suicidal, accidental

1990

and undetermined intent cases. The suicidal jumping was

43

the highest at the age group of 15–19 years, while acciden-

tal falling occurred in high number under the age of 4
Undetermined
Type of death

years, and in age group of 20–24 years.

Accident

Among the 394 suicidal jumps psychiatric treatment was

Table 1

Suicide

identified in medical records of 38 investigated cases

All

(9.6%): 36 in outpatient units and two in inpatient unit.

 K. Tör}o et al. / Journal of Clinical Forensic Medicine 13 (2006) 129–134 131

They received psychotropic medication. Thirty patients
were treated for depression by antidepressants, dysthymia
and behavior problems. Antipsychotics were prescribed
for six children to treat anxiety. Two patients received ben-
zodiazepines for schizophrenia. Prior suicides attempted
were detected only in 28 males (7%). Prior suicide attempts
were not observed among females in our study. Suicide let-
ters on the scene were found in 31 suicidal jumping cases
(7.8%).
Fig. 1 demonstrates the rate of undetermined intent
cases comparing the proportions of accidental and suicidal
death cases. In Budapest there were 0-1-2 (2.2%) cases, and
in Hungary there were 0-1-2-3 cases (3.3%) per years in the
undetermined intent death group. Only in two cases were
collected data as evidences for homicide. There was no dya-
dic death reported in these cases. The number of fatal acci-
dental falling (Fig. 2), and the suicidal jumping death cases
(Fig. 3) has been increased for the last years at young
adults.
Scene investigations showed that all suicides and most
of the accidents in the age group of 10–14 years happened
at home or at school. In the age group of 15–19 and 20–24
years other scenes were evident, e.g. high building, forest,
hill, park, prison, barrack, bridge. In age group of 20–24
years there were 33 (36%) accidental falling in connection
with work or sport activities.
However, there was no precise information about the
sites of the primary impacts, traumatic shock with multiple
Table 2
Jumping and falling death cases in different young age groups (1990–2003)
in Hungary
Age (years) Suicidal jumping Undetermined intent Accidental falling
organ damages (suicidal jumping: 92 cases, 23.3%; acciden-
tal jumping: 35 cases, 16.2%), skull fracture, subdural hem-
orrhage, brain contusion (suicidal jumping: 249 cases, 63%;
accidental jumping: 98 cases, 45.5%), severe chest or abdo-
men injuries by blunt trauma (suicidal jumping: 53 cases,
13.4%; accidental jumping: 82 cases, 38%) were reported
as cause of death. In accidental falls the children under
the age of 10 years had higher rate of thoracic and abdom-
inal blunt injuries (56%) such as traumatic rupture of the
aorta, laceration of the liver, while victims in older age
groups suffered in higher percentage brain damages and
skull fractures.
Blood alcohol concentrations were evaluated such as
slight in 21 (3.3%), mild in 63 (10%), moderate in 120
(19%), and severe in 29 (4.6%). In the age group of 20–24
there were four cases positive for amphetamine and one
case positive for cannabis.
In the last five investigated years (1999–2003) a signifi-
cant increase has been detected in suicidal jumping death
at the age group of 15–19 years (OR = 0.7, CI = 0.49–
0.98, p = 0.039), and at the age group of 20–24 years
(OR = 0.72, CI = 0.54–0.96, p = 0.025). There were no
changes detected in the proportion of accidental falling in
the investigated period.
We present three fatal cases of young adults who died by
accidental falling (case 1), suicidal jumping (case 2) and
14
0-4 years
5-9 years
12
10-14 years
15-19 years
20-24years
10
8
No.

No. (%) No. (%) No. (%)

6
0–4 0 0 42 (100)
5–9 0 0 15 (100) 4
10–14 17 (44.7) 1 (2.6) 20 (52.6)
2
15–19 166 (74.7) 9 (4) 47 (21.3)
20–24 211 (67.4) 11 (3.5) 91 (29)
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
years

suicide Fig. 2. Accidental jumping in different age groups.

not defined
accident
100%

25
80% 10-14 years
15-19 years
20 20-24 years
60%
rates

15
No.

40%
10
20%
5
0%
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 0
years 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
years
Fig. 1. Distribution of suicidal, accidental, and not-defined jumping death
cases among the youths in Hungary. Fig. 3. Suicidal jumping in different age groups.
132 K. Tör}o et al. / Journal of Clinical Forensic Medicine 13 (2006) 129–134
undetermined intent (case 3). In every case the post-mor-
tem medico-legal examination was hardly supported by
the results of police investigation to conclude the final deci-
sion of the cause of death.
3.1. Case 1
A 23-year-old young man was drinking two bottles of
wine with his friends on the side of a hill in Budapest.
He jumped over the barrier of a road traffic tunnel situ-
ated in the hillside; he slipped on the rocks, and fell from
8 m high. He died at the scene. At external examination
several bruises and abrasions on the right arm and on
the neck were found. Laceration of the skin of the head
was seen, with blood leaking from the right ear. Lacera-
tion of the right upper arm has been detected, and in the
base of humerus was broken. The autopsy report indi-
cated right humerus fracture, bilateral multiple rib frac-
tures, skull cup and base fracture, pubic joint fracture;
thoracic haemorrhage, contusion of the right lung, sub-
arachnoidal haemorrhage, brain contusion, rupture of
the liver. Natural pathological diseases have not found
during the autopsy. Moderate alcohol intoxication was
measured. The blood alcohol concentration (BAC) was
196 mg/100 ml, and the urine alcohol concentration
was 232 mg/100 ml. No other drugs or chemical agents
were detected by toxicological testing. Based on the
information collected at the scene, and the results of
autopsy and laboratory tests accidental death was
concluded.
3.2. Case 2
A 22-year-old young man was found dead at the side
of a rocky hill of Budapest. At the scene investigation
empty beer can and box of clonazepam were found by
the body. Information collected from the parents sug-
gested any social-economic disadvantage in the family,
or any psychiatric disorders or treatment. At external
examination numerous bruises on the head, chest, bot-
tom, back, laceration of the lower limbs, and fracture
of the left upper limb were found. During the autopsy
linear fracture of the skull, subarachnoidal haemorrhage,
multiple contusion of the brain, multiple rib fractures of
the left side, contusions of the lungs and anaemic organs
were found. Cause of death was defined as traumatic
shock. Any pathological diseases or any natural changes
could not be seen during the post mortem investigation.
However, data from the scene might have suggested pre-
vious alcohol or drug consumption; the detailed toxicol-
ogy test could not detect any drugs or alcohol. Suicidal
notes were found at home of the young man. Interview
with parents suggested suicide attempts, however, there
was not any psychological, or psychiatric treatment in
the past history. Based on the results of scene investiga-
tion, and autopsy findings the final conclusion was sui-
cidal jumping death.
3.3. Case 3
A young woman was hiking in the hills with her hus-
band. In unspecified circumstances she fell in an approx-
imately 9843 feet (30 m) deep cleft. She died at the scene.
The scene investigation did not show any evidence for sui-
cidal jumping or accidental falling. During the medico-
legal autopsy bruises on the face, a laceration above the
eyebrow and on the chin could be seen by external exam-
ination. Multiple fractures of the maxilla and mandible
were found. Several lacerations on the bottom, on the
outer side of the right tight, on the left hand and on
the inner side of the right ankle could be seen. The
autopsy reported multiple fragmentation of the skull base
and skull cap; fracture of the right collarbone, bilateral
multiple fractures of the ribs and fracture of the breast-
bone. Compression of the VI–VII vertebras, contusion
of the spinal marrow, multiple fragmentation of the hip
bones, open fractures of the elbows, right tight bone were
also detected. Rupture of the right lung and liver had
been seen. The autopsy revealed that the woman was
about 11 weeks old pregnant. Cause of death was defined
as traumatic shock caused by severe blunt injury. Careful
forensic post-mortem examination has not detected any
defensive injuries, abrasions on the neck or wrist. Stran-
gulation, grabbing, or signs of physical abuse could be
excluded. Pathomorphological changes of any acute or
chronic natural disease or organ default could not be
observed by the post-mortem investigation. No alcoholic
or drug related intoxication was detected by toxicology
testing. The forensic medical investigation failed to deter-
mine the exact method of the injuries caused fatal compli-
cation, further investigation was suggested to characterize
the partner relationship or potential previous domestic
violence in the family. During the following police inter-
rogation the husband confessed that he had pushed his
wife from the rocks. The relationship between them was
not without trouble. The investigation revealed that he
would have been the inheritor of a flat and the beneficiary
of three valuable life assurances taken out before the
death occurred.
4. Discussion
Evaluation of fatal jumps and falls from height in chil-
dren, adolescents and young adults needs a careful med-
ico-legal investigation. The present study demonstrates
that among the youth 1.7% of all death cases was jumping
or falling from height in Hungary during the period of
1990–2003 years. However, scene investigation was per-
formed, and detailed medico-legal investigation was done
in every case, 3.3% of death remained undetermined intent
without any evidence or characteristics for suicidal, acci-
dental, or intentional death. In the investigated period
there were two homicide cases among children, adolescents
and young adults died by pushing from height and hitting
the ground.
 K. Tör}o et al. / Journal of Clinical Forensic Medicine 13 (2006) 129–134
Until recently, in Hungary coding of cause of death was
performed by the death-certifying doctors, whereas in Wes-
tern Europe this was done by trained persons at the statis-
tical office.5 However, this fact was not expected to affect
our results in the comparison between the two investigated
periods. As a consequence, the distribution of diagnostic
groups within the ICD category of falling or jumping
was defined by the similar trained forensic medical doctors
in the period 1990–1994 with ICD version 9th, and in the
period 1995–2003 with ICD version 10th. In the presented
cases examination and investigation were made by forensic
medical doctors to determine the cause and manner of
death.
Jumping from height, as well as hanging and running
over by a train are so-called ‘‘hard’’ suicidal methods,
usually with a high degree of auto-aggressive, self-
destructive behaviour.6 Suicidal jumping rate was
reported as an incidence of five cases per 100.000 inhab-
itants per year, or one fourth of all suicides.7 In our
material the proportion of suicidal jumps shows an
increasing tendency (from 0.58% to 1.8%) for all death
cases in the youth. Jumping from the height is one of
the most common suicidal methods among the youth,2
especially in urban areas compared to the rural popula-
tion.8,9 Räsänen et al.9 found seasonal distribution in sui-
cidal jumping with the predominance of summer and
autumn in Finland. Suicide safety barriers in metropoli-
tan area provide an effective prevention,10 and following
the removal of the barriers from the bridge the rate of
suicide by jumping in question did not change but the
pattern of suicides changes significantly with more sui-
cides from the bridge in question and fewer at other
sites. The age distribution suggests that the prevalence
of suicidal jumping was sharply increasing in adolescents
and young adults, counted in our material there was a
good agreement with data reported in former forensic
studies.2,6 In our material jumping was a common
method of suicide at age group 15–19, and the most fre-
quent suicidal method at age 20–24. In our material
there was no suicidal jumping under the age 10. Bridges,
high buildings are popular places of suicide attempts.
The distribution of jumping comparing to total death
rates demonstrates that there is a significant increase in
the last years in the proportion of suicidal jumping at
age 20–24.
The investigation of injuries caused by jumping or fall-
ing represents a challenge for forensic pathologists, because
the characteristics of injuries are very similar independently
from the pathomechanisms of falling. Only the careful
scene investigation, evaluation of previous data, collection
all the information from family circle can provide evidences
for the exact final decision. Despite of the different methods
of falling, our cases showed similar injury patterns and lab-
oratory tests results had moderate level of BAC and the
toxicology did not detect anything. Without the results of
the police investigation (provided anamnestic data, interro-
133
gation of family members, and reports of scene examina-
tion) the final conclusion on cause of death would not
have been declared.
Jumping is reported as a frequent suicidal method
among males,11–14 however, some of the studies did not
find any significant gender difference in fatal jumping cases
in the youth2,15 and some studies16,17 reported more jump-
ing suicidal rates amid females. Jumping was found as the
most frequent suicidal method amid psychiatric patients,18
people with schizophrenia the rate of jumping was detected
about 40%.19 Suicides letter play an important role in
determination of the manner of the death. Only one of
our presented cases was left a hand-writing suicidal note,
which was used to characterize the type of jumping. If a
suicide note or evidence showing that the subject has inten-
tionally harmed him/herself can be found, then determina-
tion of the intent is not very difficult.20 Based on the
information collected from the family, victims have not
been sending alarming or understandable signals. In our
suicidal jumping case the suicidal letter and the informa-
tion collected from the parents were important evidences
in the characterization of death cause. Characteristic inju-
ries of recreational sport climbers were reported20,21 as dig-
ital fibro-osseous sheath ruptures and PIP joint collateral
ligament strains. Evaluation of these injuries may help in
the final differentiation of suicidal jumping and accidental
falling in fatal cases. Goren et al.16 stated that the age range
of accidental and suicidal jumping were not similar,
because accidental death were the highest at age 0–5, and
the suicidal death was the most frequent in age group of
16–20. In our material data both suicidal and accidental
jumping cases were the most common at age 15–24 years.
In the last investigated years there was a significant rise
in the proportion of suicidal jumps in the age group of
10–14 years. Scene investigation in every jumping or falling
case seems to be essential in the determination of suicide,
accidents or as an act of homicide. The point of trajectory,
the horizontal distance and the impact point are closely
related to the initial velocity, angle, and height. Shaw
et al.22 investigated the horizontal distance and height is
legitimate measures to use in speculating on the falling pat-
tern and the manner of death.
In the presented homicide case the death happened on
hills, the bodies were found with skull fractures and brain
damages. No signs of homicide were discovered during
the investigation, however, moderate alcohol level was
detected in one case, and toxicology was negative in all
cases. About 37% of all women were murdered by their
current or former intimate partner compared to 6% of
men in the UK,23 and among females approximately 1 in
3 homicides are intimate partner homicides.24 In intimate
partner homicide 80% of women were killed in homes,25
and firearms were used as the method of killing most
often.26 However, high percentage of female victims was
killed by husband or partner, little research has examined
the rate among pregnant women. Martin et al.27 showed
134 K. Tör}o et al. / Journal of Clinical Forensic Medicine 13 (2006) 129–134
that before pregnancy, women who were physically
assaulted by their partners were more likely to drink alco-
hol and use illicit drugs compared with women who did not
experience such violence.
Whereas most of the murder cases are fairly well recog-
nised by the police and medico-legal investigations, the lit-
erature contains little information regarding cases by
intentional pushing from height. Shaw et al.28 reported that
intentional pushing as a method was found among young
male perpetrators, who kill stranger victims. Wyatt et al.29
emphasised there is little potential to reduce the death rate
from suicidal falls by improving hospital treatment, it is
worth considering whether some of the falls might have
been prevented. Legal and health care professionals should
be aware that women are vulnerable to both intimate part-
ner violence and homicide from partners. The forensic med-
ical investigation and the co-operation between the medical
experts and the local authorities or the police seem to be
essential to discover all data for differentiation suicidal
jumping, accidental falling, or intentional pushing. Data
of the scene investigation, detailed forensic autopsy, results
of the laboratory tests, previous data, and family history
have important role in the examination of fatal jumping
and falling cases. Further investigation about the character-
istics injuries may help the final determination of violent
death causes at youth, and more effort should be directed
to the effective prevention strategy of jumping or falling
death cases. The statistical data and the presented cases
emphasised the importance of careful investigation in jump-
ing, pushing or falling cases. The scene investigation and the
detailed medico-legal autopsy can be failed in the final
determination without the evaluation of previous data
and the family history, family circumstances.
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