Coroner's Finding: TS de-identified

47y · Female·Traumatic closed head injury likely sustained in a fall from standing

TS, a 47-year-old woman with a 18-year history of anorexia nervosa, bulimia, and severe alcoholism, died from a traumatic closed head injury sustained in a fall from standing. At autopsy, blood alcohol concentration was 0.23% (4.5 times the legal driving limit), causing significant impairment of balance, coordination, and judgment. She had alcohol-induced cirrhosis, previous head injuries with subdural haematomas, and multiple documented falls. Clinical lessons include: recognition that chronic malnutrition and alcoholism cause osteoporosis and increased fall risk; importance of assessing fall risk in patients with eating disorders and alcohol use disorder; need for stronger intervention when patients understate alcohol consumption and have deranged liver function; and consideration of capacity assessment and safeguarding in patients with recurrent hospitalizations related to substance abuse and self-harm.