Fatal staircase fall or an assault?
Falls of all kinds are a leading cause of accidental death in the United States. But a staircase fall death investigation is in a category of its own, especially when there’s a “person of interest” at the scene. Was that fatal fall really an accident? Or something more sinister?
Scene investigation of deaths involving stairs
The coroner or medical examiner at a scene involving stairs must first determine whether the decedent actually sustained a fall.
The investigator needs to document the number of steps and landings, carpeting, and condition of the railings and treads.
When examining the body, the investigator should pay particular attention to the head. In deadly staircase falls, traumatic brain injury is the most common type of injury. In a case reported in 2007, a lack of head injuries raised suspicion for homicide. After a lengthy trial, the victim’s husband admitted to killing his wife and staging the staircase fall.
The medicolegal death investigator needs to explore all possible reasons for a staircase fall. Was the cause of death a medical condition with the fall a secondary consequence? Did the person use a walking aid like a cane or walker? Were they incapacitated by drugs or alcohol? Were there trip hazards on the stairs?
Alcohol and stairway fall injuries
Multiple studies in those over 65 report that alcohol use can double the risk of intracranial hemorrhage with a fall. Why? No one knows. Perhaps intoxicated people are less likely to protect their head and face when falling. Perhaps alcohol-related liver disease increases bleeding risk.
Alcohol use also increases the risk for falls (fatal and nonfatal) among young and middle-aged adults.
A ten-year study of fatal falls down stairs in Germany found that twenty-three victims (53.5%) had been under the influence of alcohol.
Suspected perpetrators or defense attorneys may point to alcohol and/or drug use by the victim to deflect blame. But the use of alcohol does not, of course, rule out foul play in a fatal fall down stairs.
The forensic science of fall injuries
We lack forensic tools that can differentiate between accidental and assault injuries in falls from any height, including stairs.
According to a classic forensic pathology textbook (4th Ed), “Autopsy findings in a victim of an accidental or suicidal fall from a height may be indistinguishable from a homicidal fall.”
Injury Patterns in Staircase Deaths
According to a 2023 Canadian study, fatal falls down stairs primarily led to head injuries. Common types of injuries included fractured temporal bones, subarachnoid hemorrhages, and brain contusions. Pelvic and leg fractures, on the other hand, were uncommon. But physical assault can also cause head injuries. In any case, this study did not address different manners of death.
Cranio-cerebral trauma was also a common finding in a 2004 German study of 166 cases of deaths due to falls down stairs. About eleven percent of the fatal falls were due to pre-existing disease or intoxication, but the pattern of injuries did not differ from that seen in accidental or homicidal falls. In other words, falls produce similar physical trauma regardless of the cause/manner of the fall.
Forensic neuropathology in falls: traumatic axonal injury
A neuropathologist should be consulted in any case involving brain injury and possible assault. What will they look for?
Traumatic axonal injury (TAI) involves microscopic damage to the white matter of the brain. It’s often considered a marker of traumatic vs other kinds of brain injury. “TAI is thought to be caused by a variety of traumatic mechanisms involving fast acceleration and/or deceleration, including motor vehicle accidents, falls from height, and blunt assault,” states a comprehensive 2020 review.
A diagnosis of TAI requires special immunochemical stains looking for beta-amyloid precursor protein (β-APP) in brain tissue. As shown in the image, the protein stains black (arrows).
Unfortunately, the presence or absence of β-APP is not a sure way to determine whether a fall down stairs was an accident or a homicide. Here are some reasons why:
- β-APP appears after distinct times post-trauma and depends on the survival times of the individual affected
- “Amyloid precursor protein (APP) immunohistochemistry is helpful for identifying damaged axons, but patterns of damage cannot unambiguously distinguish traumatic brain injury from hypoxic-ischemic injury.” (from a 2018 comprehensive review article)
- In a postmortem study of 57 fatal traumatic brain injury cases, researchers concluded that a positive β-APP stain “is not particularly common in homicide cases even when the fatal impacts are directed to the head.”
Coroners determining the cause of death in a fall involving a head injury must consider the scene, the history, and the medical evidence; even then it may not be possible to distinguish a traumatic brain injury from hypoxic-ischemic injury from artifact.
Forensic reconstruction of a staircase fall
A 2025 case report describes the reconstruction of a staircase fall using postmortem computer tomography (PMCT) and a 3-dimensional model of a staircase associated with the fall of a 70-year-old man. This technique is intriguing, but not accessible by most coroner or medical examiner offices. In cases where resources are available, perhaps high-profile cases or cases involving litigation, coroners may want to consider this approach.
Staircase fall death investigations in the news
Chicago, 2024: Thirty-six-year-old Caitlin Tracey was “found in a stairwell” after falling an estimated twenty stories. The manner of death was undetermined.
New York, 2022: The NYC Office of Chief Medical Examiner confirmed that blunt force injuries to her torso killed Ivana Trump. It deemed the death an accident.
North Carolina, 2001: The Staircase (true crime video series): Michael Peterson, an American novelist, was accused of murdering his wife Kathleen after she was found dead at the bottom of a staircase in their home.
Pennsylvania, 2018: Warning before you click: this is a child abuse case. The Halloween murder of Amy McLaughlin involved a fall down basement stairs. A confession by the perpetrator and documentation of chronic abuse clinched the manner as homicide.
Preventing accidental staircase falls
You can reduce the risk of taking a tumble down your stairs. There is plenty of detailed advice on this topic elsewhere, including this blog.
Here are a few additional tips based on real death scenes.
- Have a soft landing at the bottom of stairs, especially basement stairs with concrete floors
- Do not walk backwards down stairs carrying heavy objects like furniture
- Do not position items like a mousetrap at the top of stairs
- Always hold on to that railing
Christina, thanks for writing this content. Pushes my sphere of thinking outward, as these topics are not something I contemplate usually. A bit morbid, but thought provoking — and some good info for the everyday person just trying not to die from falling down stairs!! … I am probably guilty of several of the things not to do… should be more careful.