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Fatal Pediatric Head Injuries Caused by Short-Distance Falls
John Plunkett, MD

I recently attended a lecture given by a District Attorney that discussed the investigation of child abuse cases. These are notes taken from his powerpoint regarding the report by Dr. Plunkett referenced above: 

  1. Claims to prove that kids can die from “short falls” (up to 10 feet)
  2. Found 18 cases out of more than 75,000 playground injuries where he alleges a “short fall” caused death
  3. Involved only 8 cases where the victim was under age 4 – some were as old as 13
  4. Claims that four of the kids had “bilateral retinal hemorrhage”, but admits none were given a formal ophthalmologic evaluation
  5. None had injuries exactly like those seen in shaking cases (he’s admitted that)
  6. Most had either skull fracture, epidural hematoma, subgaleal hematoma (impact)
  7. Admits that the fall was not witnessed in most of the cases – may have been something else done to the child
  8. Youngest child in the series is 12 months old. If these were the only cases that could be found in such a huge database – it is actually evidence that the majority of medical experts are right – Shaking produces a unique pattern of injuries
There is a certain amount of truth in his statements, however, here are the points I would like to make:

  • (Ref #1, and 7) This is a study on playground falls. The risk of abuse in these cases is low, making them ideal for the purposes of studying injuries similar to AHT that are not caused by AHT.
  • (Ref #1) For the 18 cases, the falls ranged from 2-10 feet, with subdural hemorrhages occurring at all heights and retinal hemorrhages occurring between 2-6 feet.
  • (Ref #2) The study population was drawn from over 75,000 but only the fatalities were included in the case studies. There were 114 fatalities from falls and only 18 of which were due to head injury.
  • (Ref #3 and 8) Not many kids under the age of 2 play at playgrounds without strict supervision, so the majority of the injuries were older children.
    • The report does include 5 cases of children between 12-24 months and one of those was a witnessed fall. That child had bilateral retinal hemorrhages, subdural hemorrhage, she was lucid for 10 minutes, and she died from her injuries.
  • (Ref #4) Retinal Hemorrhages were noted in the autopsy reports. It was a retrospective review so formal exams could not be performed.
  • (Ref #5) The point is not that shaking cases don’t exist, it’s that you can see these injuries in other types of trauma, not just AHT.
  • (Ref #6) Two-thirds of the cases had skull fractures. Six cases did not – of those six, four had a lucid interval (all 10 minutes except one that was 48 hours); two had RH and only one was assessed and found not to have RH; and all but one had Subdural Hemorrhages.
  • (other) Lucid intervals ranged from none to 48 hours.
The Summary Table of the 18 cases included in the report can be seen here.

NOTE: I chose to review this study for this month’s Materia Medica because it is so highly controversial. The format is a little different but I felt it was the best way to supply the information in regards to this report.

Full text is available here.

Works Cited
Plunkett, J. (2001). Fatal Pediatric Head Injuries Caused by Short-Distance Falls. American Journal of Forensic Medicine and Pathology, 1-12. 

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