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
This is a preview of subscription content, log in to check access.
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.
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.
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
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
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
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
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
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
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
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
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
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
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
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
Brubacher J, Chan H, Asbridge M. Development and validation of a crash culpability scoring tool. Traffic Inj Prev. 2012;13:219–29.CrossRefPubMedGoogle Scholar
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
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
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
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
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
Igeltjorn M, Nordrum IS. Frequency of forensic autopsies after deaths in road traffic accidents. Tidsskr Nor Laegeforen. 2009;129:1850–2.CrossRefPubMedGoogle Scholar