Autopsy findings in drivers and passengers from fatal motor vehicle collisions: limited differences in injury patterns and toxicological test results

We performed a retrospective study of the injuries and characteristics of occupant fatalities in motor vehicle collisions in southeast Norway. The goal was to provide updated knowledge of injuries sustained in modern vehicles and detect possible differences in injury pattern between drivers and passengers. Forensic autopsy reports, police, and collision investigation reports from 2000 to 2014 were studied, data extracted and analyzed. A total of 284 drivers, 80 front-seat passengers, and 37 rear-seat passengers were included, of which 67.3% died in front collisions, 13.7% in near-side impacts, 13.5% in rollovers and 5.5% in other/combined collisions. Overall, 80.5% died within one hour after the crash. The presence of fatal injuries to the head, neck, thorax and abdomen were observed in 63.6%, 10.7%, 61.6% and 27.4% respectively. All occupants with severe injuries to the head or neck had signs of direct impact with contact point injuries to the skin or skull. Injuries to the heart and spleen were less common in front-seat passengers compared to drivers. Seat belt abrasions were more common and lower extremity fractures less common in both front-seat and rear-seat passengers compared to drivers. Blood alcohol and/or drug concentrations suggestive of impairment were present in 30% of all occupants, with alcohol more often detected among front-seat passengers compared to drivers. Few driver-specific and passenger-specific patterns of injury could be identified. When attempting to assess an occupant’s seating position within a vehicle, autopsy findings should be interpreted with caution and only in conjunction with documentation from the crash scene.