The role of alcohol intoxication in fatal road traffic accidents in Moscow

Background: The World Health Organization states that approximately 1.19 million people worldwide die annually as a result of road traffic accidents. Driving under the alcohol influence significantly increases the risk of traffic accidents and associated fatalities, which may be attributed to the severity of injuries sustained or the masked progression of traumatic disease during acute alcohol intoxication.

Aim: To evaluate the impact of acute alcohol intoxication on the severity of injuries sustained in road traffic accidents in Moscow and their outcomes based on forensic medical data.

Materials and methods: The study included two stages. At the first stage, data on all fatalities resulting from road traffic accidents in Moscow in 2023 (329 cases) were analyzed. At the second stage, cases with available ethanol testing results (247 cases) were studied. The study objects were forensic medical examination and autopsy reports. Demographic profiles of the deceased, involvement in traffic, time of death, injury patterns, and blood ethanol levels were analyzed. For the first time in Russian practice, injury severity was evaluated using the Forensic Injury Severity Score Template (FISST) scale (an objective and quantitative injury severity assessment system based on autopsy findings).

Results: In 2023, over half of the fatalities from road traffic accidents in Moscow occurred at the time of receiving medical assistance. Most victims were men (239/329; 72.6%; mean age 43.9 years [41.8–46]). Ethanol was detected in 32.4% of cases (80/247) among the victims tested for ethanol (247/329; 75%). Pedestrians and drivers were the most frequent victims of alcohol-related fatalities. The most severe injuries were observed in victims with blood ethanol levels exceeding 3‰; however, no direct correlation between injury severity and blood ethanol level was established in this study. The most severe injuries were found in victims who died during the pre-hospital phase, with chest injuries being the primary contributors to the severity of their condition. Victims who died during the pre-hospital phase also had the highest mean blood ethanol levels.

Conclusion: Ethanol was detected in one-third of road traffic accident fatalities in Moscow. One-quarter of drivers and pedestrians in Moscow died with blood ethanol levels above 0.3‰. All intoxicated drivers died within the first 24 hours following the accident. The most severe injuries were observed in individuals with blood ethanol levels exceeding 3‰. However, the frequency of ethanol detection and blood ethanol levels did not directly influence injury severity or hospitalization duration in this study.