Injuries in the vulnerable road user fatalities; a study from Sri Lanka

Vulnerable Road Users defined as people at risk in traffic due to absence of an outside protective shield to absorb energy during a collision are mainly pedestrians, bicycle riders and motor cyclists. In low income countries, deaths of VRUs outnumber vehicular drivers and occupants. A forensic pathologist not only reports the cause of death but also forms opinions on type of road user. We attempted to find whether pedestrians could be differentiated from other types of VRUs. A retrospective descriptive study, based on case records of VRUs fatalities from 2005 to 2012 referred to a tertiary care unit for post-mortem examination, was conducted. A pro-forma was developed to extract data from the post-mortem reports and toxicology reports. Data was analysed using SPSS version16. Out of the 328 cases 48% (n = 157) were pedestrians while 45% (n = 147) were riders/pillion riders of two wheeled vehicles and 5% (n = 16) were drivers/occupants of three-wheelers. The majority (87%) was males and 43% of pedestrians were elderly. 59% had 10-25 injuries and 87% had external injuries in the head, face and neck. The majority of skeletal injuries were in the skull followed by ribs. Analysis of different variables of pedestrians to other types of VRUs showed that the variables of, elderly male, road crosser, skull injuries, brain injuries, cause of death being head injuries and multiple injuries were significantly greater among pedestrian group (p: <0.001). The traffic hours (peak and off peak), number of injuries, rib injuries, limb injuries, crushed/run over injuries or lung and liver injuries had no significant association. Although some features helped in determining a pedestrian, many other factors were not associated to differentiate a pedestrian from other VRUs. Therefore, a forensic pathologist has to be cautious in expressing opinions when other corroborative evidence is lacking.