Road Fatalities in Children Aged 0-17: Epidemiological Data and Forensic Aspects on a Series of Cases in a Single-Centre in Romania

Abstract

Introduction: Road Traffic Accidents (RTAs) are the leading cause of premature death in young people aged 5-29. Globally, 186,300 children aged 9 years and under die from RTAs each year. Romania had the highest mortality rate in children aged 0 to 14 for 2018-2020. This study aimed to assess the involvement of children aged 0-17 years in fatal RTAs by analyzing medico-legal autopsy records in a 5-year period at Timisoara Institute of Legal Medicine (TILM), Romania.

Materials and methods: A retrospective analysis of medico-legal autopsy records of road fatalities in children aged 0-17 years, from TILM in a 5-year period (2017-2021), was conducted.

Results: Of all medico-legal autopsies in the 5-year period, 23 cases (5.8%) involved road fatalities in children aged 17 and under. Preschoolers accounted for 10 cases, followed by the age group 15-17 years (n = 9). Most children sustained fatal injuries as passengers (n = 13), followed by child pedestrians (n = 7). This research follows four representative cases, each being a different type of child road fatality regarding the type of road user, the age of the victim, and the involvement of other risk factors.

Conclusions: Our findings emphasize the tragedy of road fatalities in children and the need to determine risk factors and prevention strategies to reduce the enormous global crisis involving these vulnerable victims.

Keywords: children; medico-legal autopsy; preventive measures; risk factors; road traffic accidents.

Figure 1

The number of road fatalities in children aged between 0 and 14 per million inhabitants per country in the EU for 2018–2020: light green represents the EU mean (EU27). Source: European Commission (2022) [8].

Figure 2

External examination of the body during the medico-legal autopsy: (a) Left thigh with excoriations and sutured laceration (white arrow); left inguinal region with sutured laceration and drain tube (black arrow); (b,c) Right lower extremity with excoriations, sutured lacerations (white arrows), postoperative sutured wound (black arrow) and drain tube (white circle).

Figure 3

Internal examination of the body during the medico-legal autopsy: (a) Hemorrhage in the pericranium (white arrows); (b) Cerebral edema; (c) Hemoperitoneum (white arrow) and hemorrhage in the pelvic tissues (white star).

Figure 4

Internal examination of the body during the medico-legal autopsy: (a) Hepatic contusions and lacerations (white arrows); (b) Pulmonary contusions (white arrows).

Figure 5

External examination of the body during the medico-legal autopsy: (a) Left eat bleeding (white arrow); (b) Bruises (black arrow) and excoriations (white arrows) located on the victim’s face.

Figure 6

Internal examination of the body during the medico-legal autopsy: (a) Fractured skull base (white arrows); (b) Fractured skull cap (black arrow), hemorrhage in the pericranium (white arrow); (c) Cerebellar hemorrhage (white arrow); (d) Subarachnoid hemorrhage (white arrow), cerebral edema.

Figure 7

Internal examination of the body during the medico-legal autopsy: (a) Skull base with remains of the subdural hematoma (black arrow); (b) Cerebral edema; (c) Subarachnoid hemorrhage (black arrow); (d) Hemorrhage in the pericranium (black arrow); (e) Craniectomy orifice in the skull base (white circle).

Figure 8

An example of interventions targeted at reducing RTAs by combining public awareness with enforcement and legislation, targeted at all road users. Our adaptation of the model presented by Fisa et al. [2].