Forensic Science, Medicine and Pathology

, Volume 14, Issue 1, pp 4–17 | Cite as

The significance of preexisting medical conditions, alcohol/drug use and suicidal behavior for drivers in fatal motor vehicle crashes: a retrospective autopsy study

  • Jan Mario BreenEmail author
  • Paal Aksel Naess
  • Hallvard Gjerde
  • Christine Gaarder
  • Arne Stray-Pedersen
Original Article


Driver fatalities in motor vehicle collisions (MVCs) encompass accidents, suicides, and natural deaths when driving. The objective of this study was to determine the significance of pathology and other autopsy findings for drivers in fatal MVCs. Forensic autopsy records of driver fatalities in southeast Norway between 2000 and 2014 were studied retrospectively. Data from individual police and collision investigation reports were also collected and analyzed. In 406 driver fatalities, the male/female ratio was 340/66; 9% died from natural causes, 9% were suicides, 65% were culpable accidental deaths, 14% were nonculpable deaths, and 3% were undetermined deaths. Head injuries and thoracic injuries were the most common causes of death. A seatbelt had been worn in 50% of the fatalities, and its prevalence did not differ between accidental deaths and suicides. Blood levels of alcohol and/or drugs that indicated impairment at the time of the collision were found in 40% (105/262) of all culpable accidental deaths but in 50% (64/127) of drivers aged up to 35 years. Pathology (most often cardiovascular disease) suggestive of sudden incapacitation before the collision was present in 24% (62/264) of drivers who were culpable in the accident and in 70% (46/66) of culpable drivers older than 55 years. A substantial proportion of drivers are killed in accidental collisions that may have occurred as a result of either alcohol/drug impairment or preexisting disease. Suicides and natural deaths both constitute significant proportions of MVC fatalities and may be misclassified unless a full inquest including an autopsy is performed.


Motor vehicle collisions Driver-related deaths Medical incapacitation when driving Toxicology Autopsy Forensic pathology 


Funding information

The authors acknowledge financial support from the Gjensidige Foundation (grant number 1022396) and the Norwegian Ministry of Transport and Communication (grant number 11/1950). These funders had no role in the design and conduct of the study, the collection, analysis, and interpretation of the data, or in the preparation, review, and approval of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

Ethical approval

Thisretrospective study of cases was approved by the Regional Committee for Medical and Health Research Ethics, the Data Protection Official for Research, and the Higher Prosecution Authority of Norway.


  1. 1.
    National Highway Traffic Safety Administration (NHTSA). Critical reasons for crashes investigated in the National Motor Vehicle Crash Causation Survey. Report no. DOT HS 812 115. National Highway Traffic Safety Administration. 2015. Accessed 21 June 2017.
  2. 2.
    Norwegian Public Roads Administration (NPRA). In-Depth analyses of Fatal Road Accidents in the year 2014.Report no. 396. Norwegian Public Roads Administration. 2015. Accessed 21 June 2017.
  3. 3.
    Christophersen AS, Morland J, Stewart K, Gjerde H. International trends in alcohol and drug use among vehicle drivers. Forensic Sci Rev. 2016;28:37–66.PubMedGoogle Scholar
  4. 4.
    Brevig T, Arnestad M, Morland J, Skullerud K, Rognum TO. What is thesignificance of disease, intoxication and suicide among driver fatalities? Tidsskr Nor Laegeforen. 2004;124:916–9.PubMedGoogle Scholar
  5. 5.
    Christophersen AS, Gjerde H. Prevalence of alcohol and drugs among car and van drivers killed in road accidents in Norway: an overview from 2001 to 2010. Traffic Inj Prev. 2014;15:523–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Tervo TM, Neira W, Kivioja A, Sulander P, Parkkari K, Holopainen JM. Observational failures/distraction and disease attack/incapacity as cause(s) of fatal road crashes in Finland. Traffic Inj Prev. 2008;9:211–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Antecol DH, Roberts WC. Sudden death behind the wheel from natural disease in drivers of four-wheeled motorized vehicles. Am J Cardiol. 1990;66:1329–35.CrossRefPubMedGoogle Scholar
  8. 8.
    Youngquist ST, Liao M, Hartsell S, Walker M, Kartchner NJ, Nirula R. Acute medical impairment among elderly patients involved in motor vehicle collisions. Injury. 2015;46:1497–502.CrossRefPubMedGoogle Scholar
  9. 9.
    McGwin G Jr, Sims RV, Pulley L, Roseman JM. Relations among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case-control study. Am J Epidemiol. 2000;152:424–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Connor J, Whitlock G, Norton R, Jackson R. The role of driver sleepiness in car crashes: a systematic review of epidemiological studies. Accid Anal Prev. 2001;33:31–41.CrossRefPubMedGoogle Scholar
  11. 11.
    Sagberg F. Driver health and crash involvement: a case-control study. Accid Anal Prev. 2006;38:28–34.CrossRefPubMedGoogle Scholar
  12. 12.
    Charlton J, Koppel S, Odell M, et al. Influence of chronic illness on crash involvement of motor vehicle drivers. Report No. 213. Monash University Accident Research Center. 2004. Accessed 21 June 2017.
  13. 13.
    Sjogren H, Eriksson A, Ostrom M. Role of disease in initiating the crashes of fatally injured drivers. Accid Anal Prev. 1996;28:307–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Buttner A, Heimpel M, Eisenmenger W. Sudden natural death 'at the wheel': a retrospective study over a 15-year time period (1982-1996). Forensic Sci Int. 1999;103:101–12.CrossRefPubMedGoogle Scholar
  15. 15.
    Halinen MO, Jaussi A. Fatal road accidents caused by sudden death of the driver in Finland and Vaud, Switzerland. Eur Heart J. 1994;15:888–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Tervo T, Raty E, Sulander P, Holopainen JM, Jaakkola T, Parkkari K. Sudden death at the wheel due to a disease attack. Traffic Inj Prev. 2013;14:138–44.CrossRefPubMedGoogle Scholar
  17. 17.
    Suzman R, Beard J, Boerma T, Chatterji S. Health in an ageing world – what do we know? Lancet. 2015;385:484–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Routley V, Staines C, Brennan C. Haworth N, Ozanne-Smith J. Suicide and natural deaths in road traffic - Review. Report no. 216. Monash University Accident Research Center. 2003. Accessed 21 June 2017.
  19. 19.
    Morild I. Traffic deaths in western Norway. A study from the county of Hordaland 1986-1990. Forensic Sci Int. 1994;64:9–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Ohberg A, Penttila A, Lonnqvist J. Driver suicides. Br J Psychiatr. 1997;171:468–72.CrossRefGoogle Scholar
  21. 21.
    Ahlm K, Eriksson A, Lekander T, Björnstig U. All traffic related deaths are not "fatalities" - analysis of the offical Swedish statistics of traffic accident fatalities in 1999. Lakartidningen. 2001;98:2016–22.PubMedGoogle Scholar
  22. 22.
    Hernetkoski KM, Keskinen EO, Parkkari IK. Driver suicides in Finland-are they different in northern and southern Finland? Int J Circumpolar Health. 2009;68:249–60.CrossRefPubMedGoogle Scholar
  23. 23.
    Wyatt JP, Squires T, Collis S, Broadley R. Road traffic suicides. J Forensic Legal Med. 2009;16:212–4.CrossRefGoogle Scholar
  24. 24.
    Nelson WD. Intentional acts of violence in motor vehicles: Suicide and murder. SAE Technical Paper 940725. 1994.
  25. 25.
    Mohler B, Earls F. Trends in adolescent suicide: misclassification bias? Am J Public Health. 2001;91:150–3.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Vindenes V, Jordbru D, Knapskog AB, Kvan E, Mathisrud G, Slordal L, et al. Impairment based legislative limits for driving under the influence of non-alcohol drugs in Norway. Forensic Sci Int. 2012;219:1–11.CrossRefPubMedGoogle Scholar
  27. 27.
    Bogstrand ST, Larsson M, Holtan A, Staff T, Vindenes V, Gjerde H. Associations between driving under the influence of alcohol or drugs, speeding and seatbelt use among fatally injured car drivers in Norway. Accid Anal Prev. 2015;78:14–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Svensson K, Andersson AL. Suicide and accident classification methodology. In: Proceedings of the 17th International Conference “Road Safety On Five Continents” (RS5C 2016), Rio de Janeiro, Brazil. 2016. Accessed 21 June 2017.
  29. 29.
    Swedish Transport Administration. Which fatalities in road traffic are suicides? Swedish Transport Administration Report no. 2014:113. 2014. Accessed 21 June 2017.
  30. 30.
    Statistics Norway. Injured occupants of road traffic accidents. Statistics Norway. 2017. Accessed 21 June 2017.
  31. 31.
    Peck DL, Warner K. Accident or suicide? Single-vehicle car accidents and the intent hypothesis. Adolescence. 1995;30:463–72.PubMedGoogle Scholar
  32. 32.
    Austin AE, van den Heuvel C, Byard R. Suicide and fatal single occupant motor vehicle collisions. Aust J Forensic Sci. 2013;45:43–8.CrossRefGoogle Scholar
  33. 33.
    Llerena LE, Aronow KV, Macleod J, Bard M, Salzman S, Greene W, et al. An evidence-based review: distracted driver. J Trauma Acute Care Surg. 2015;78:147–52.CrossRefPubMedGoogle Scholar
  34. 34.
    Romer D, Lee YC, McDonald CC, Winston FK. Adolescence, attention allocation, and driving safety. J Adolesc Health. 2014;54:S6–15.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Williams AF. Teenage drivers: patterns of risk. J Saf Res. 2003;34:5–15.CrossRefGoogle Scholar
  36. 36.
    Marshall SC. The role of reduced fitness to drive due to medical impairments in explaining crashes involving older drivers. Traffic Inj Prev. 2008;9:291–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Skyving M, Berg HY, Laflamme LA. Pattern analysis of traffic crashes fatal to older drivers. Accid Anal Prev. 2009;41:253–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Rainio J, Sulander P, Hantula L, Nuutinen J, Karkola K. Diseases and motor vehicle fatalities in Finland in 2001 and 2002. Traffic Inj Prev. 2007;8:321–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Kerwin AJ. Sudden death while driving. Can Med Assoc J. 1984;131:312–4.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Lindqvist P, Gustafsson L. Suicide classification-clues and their use. A study of 122 cases of suicide and undetermined manner of death. Forensic Sci Int. 2002;128:136–40.CrossRefPubMedGoogle Scholar
  41. 41.
    Byard RW, Austin A. The role of forensic pathology in suicide. Forensic Sci Med Pathol. 2011;7:1–2.CrossRefPubMedGoogle Scholar
  42. 42.
    Henderson AF, Joseph AP. Motor vehicle accident or driver suicide? Identifying cases of failed driver suicide in the trauma setting. Injury. 2012;43:18–21.CrossRefPubMedGoogle Scholar
  43. 43.
    Milner A, De Leo D. Suicide by motor vehicle "accident" in Queensland. Traffic Inj Prev. 2012;13:342–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Brubacher J, Chan H, Asbridge M. Development and validation of a crash culpability scoring tool. Traffic Inj Prev. 2012;13:219–29.CrossRefPubMedGoogle Scholar
  45. 45.
    af Wahlberg AE, Dorn L. Culpable versus non-culpable traffic accidents; what is wrong with this picture? J Saf Res. 2007;38:453–9.CrossRefGoogle Scholar
  46. 46.
    Høye A. How would increasing seat belt use affect the number of killed or seriously injured light vehicle occupants? Accid Anal Prev. 2016;88:175–86.CrossRefPubMedGoogle Scholar
  47. 47.
    Le Blanc-Louvry I, Thureau S, Duval C, Papin-Lefebvre F, Thiebot J, Dacher JN, et al. Post-mortem computed tomography compared to forensic autopsy findings: a French experience. Eur Radiol. 2013;23:1829–35.CrossRefPubMedGoogle Scholar
  48. 48.
    Jalalzadeh H, Giannakopoulos GF, Berger FH, Fronczek J, van de Goot FR, Reijnders UJ, et al. Post-mortem imaging compared with autopsy in trauma victims -a systematic review. Forensic Sci Int. 2015;257:29–48.CrossRefPubMedGoogle Scholar
  49. 49.
    Moskała A, Woźniak K, Kluza P, Romaszko K, Lopatin O. The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents. Leg Med (Tokyo). 2016;18:25–30.CrossRefGoogle Scholar
  50. 50.
    Igeltjorn M, Nordrum IS. Frequency of forensic autopsies after deaths in road traffic accidents. Tidsskr Nor Laegeforen. 2009;129:1850–2.CrossRefPubMedGoogle Scholar
  51. 51.
    Skopp G. Postmortem toxicology. Forensic Sci Med Pathol. 2010;6:314–25.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Jan Mario Breen
    • 1
    • 2
    Email author
  • Paal Aksel Naess
    • 2
    • 3
  • Hallvard Gjerde
    • 4
  • Christine Gaarder
    • 3
  • Arne Stray-Pedersen
    • 1
    • 2
  1. 1.Department of Forensic Sciences, Section of Pediatric Forensic MedicineOslo University HospitalOsloNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Department of TraumatologyOslo University HospitalOsloNorway
  4. 4.Department of Forensic Sciences, Section of Drug Abuse ResearchOslo University HospitalOsloNorway

Personalised recommendations