Abstract
A 28-year-old driver was found dead in his car after impact with a truck. At the scene he was seated in the driver’s seat partially hanging out of the vehicle with the sash component of the seatbelt tightly pressed into his neck. At autopsy there was evidence of neck compression with bilateral conjunctival petechial hemorrhages and fracture of the right superior horn of the thyroid cartilage. Limb fractures and internal injuries were not associated with significant hemorrhage. There was no evidence of brain trauma. Death was, therefore due to neck compression from the seatbelt demonstrating an additional rare lethal mechanism that may be encountered in vehicle crashes. External bruises and abrasions may not be present around the neck due to padding from clothing, however conjunctival petechiae and neck injuries are supportive of the diagnosis.
Similar content being viewed by others
References
World Health Organization (WHO). Global status report on road safety 2013 https://www.who.int/violence_injury_prevention/road_safety_status/2013/en/. Accessed 15 Aug 2020.
Herath M, Bautz P, Parker D, Dobbins C. The importance of wearing a seatbelt correctly – a case report of blunt trauma causing complete shearing transection of the gastroduodenal junction. Int J Surg Case Rep. 2020;72:197–201.
Alghnam S, Alkelya M, Al-Bedah K, Al-Enazi S. Burden of traumatic injuries in Saudi Arabia: lessons from a major trauma registry in Riyadh. Saudi Arab Ann Saudi Med. 2014;34:291–6.
Turk E, Tsang YW, Champenari A, Pueschel K, Byard RW. Cardiac injuries in car occupants in fatal motor vehicle collisions – an autopsy based study. J Forensic Legal Med. 2010;17:339–43.
Benomran F, Masoud S. Injury, transportation: motor vehicle injury. In: Payne-James J, Byard RW, editors. Encyclopedia of forensic and legal medicine. 2nd ed. Oxford: Academic Press; 2016. pp278–81.
Byard RW. A forensic evaluation of impalement injuries. Med Sci Law. 2018;58:85–92.
Conroy C, Stanley C, Eastman AB, et al. Asphyxia. A rare cause of death for motor vehicle crash occupants. Am J Forensic Med Pathol. 2008;29:14–8.
Marine WM, Kerwin EM, Moore EE, Lezotte DC, Baron AE, Grosso MA. Mandatory seatbelts: epidemiologic, financial, and medical rational from the Colorado matched pairs study. J Trauma. 1994;36:96–100.
Newman RJ. A prospective evaluation of the protective effects of car seatbelts. J Trauma. 1986;26:561–4.
Veenema KR. Strangulation associated with a passive restraint shoulder harness: case report. J Emerg Med. 1994;12:317–20.
Anderson PA, Rivera FP, Maier RV, Drake C. The epidemiology of seatbelt-associated injuries. J Trauma. 1991;31:60–7.
Dell’Erba A, Di Vella G, Giardino N. Seatbelt injury to the common iliac artery: case report. J Forensic Sci. 1998;43:215–7.
Byard RW. Shoulder-lap seatbelts and thoracic transection. J Clin Forensic Med. 2002;9:92–5.
Riches KJ, James RA, Gilbert JD, Byard RW. Fatal childhood vascular injuries associated with seat belt usage. Am J Forensic Med Pathol. 2002;23:45–7.
Jammeh ML, Ohman JW, Reed NR, English SJ, Jim J, Geraghty PJ. Management of seatbelt-type blunt abdominal aortic trauma and associated injuries in pediatric patients. Ann Vasc Surg. 2020. https://doi.org/10.1016/j.avsg.2020.07.024.
Hitosugi M, Takatsu A. A case of strangulation by a vehicle seat belt. Legal Med. 2000;2:46–8.
James RA, Byard RW. Asphyxiation from shoulder seat belts. An unusual motor vehicle injury. Am J Forensic Med Pathol. 2001;22:193–5.
Gilbert J, Jensen L, Byard RW. Further observations on the speed of death in hanging. J Forensic Sci. 2008;53:1204–5.
Najari F, Alimohammadi AM. An immediate death by seat belt compression; a forensic medicine report. Emergency. 2015;3:165–7.
Byard RW. The relationship between positional asphyxia and increasing body mass index. Legal Med. 2020;43:101678.
Byard RW. The complex spectrum of forensic issues arising from obesity. Forensic Sci Med Pathol. 2012;8:402–13.
Muzumdar H, Rao M. Pulmonary dysfunction and sleep apnea in morbid obesity. Pediatr Endocrinol Rev. 2006;3(Suppl 4):579–83.
Inselman LS, Chander A, Spitzer AR. Diminished lung compliance and elevate surfactant lipids and proteins in nutritionally obese young rats. Lung. 2004;182:101–17.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Byard, R.W., O’Donovan, S. & Gilbert, J.D. Seat belt asphyxia as a lethal mechanism in motor vehicle crashes. Forensic Sci Med Pathol 17, 343–345 (2021). https://doi.org/10.1007/s12024-020-00306-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12024-020-00306-4