Vulnerable Road Users in Romania: Forensic Autopsy-Based Analysis of Child and Elderly Fatalities

Background: Vulnerable road users (VRUs), including children and older adults, face a high risk of fatal road traffic accidents (RTAs) due to limited protection and greater injury susceptibility. Romania reports some of the highest child and elderly RTA mortality rates in the European Union. This study analyzed medico-legal autopsies from the Timisoara Institute of Legal Medicine (TILM) between 2017 and 2021 to compare fatalities in these two groups and identify key risk factors. Methods: A retrospective analysis was conducted on autopsy records of children (0–17 years) and older adults (>70 years) who died in RTAs during the study period. Data on demographics, type of road user, traumatic injuries, cause of death, and accident circumstances were extracted and supplemented by police reports. Comparative statistical analyses were performed for categorical and continuous variables. Results: Among 395 RTA autopsies, 23 (5.8%) involved children and 51 (12.9%) older adults. Most child victims were passengers (56.5%), whereas elderly fatalities occurred mainly among pedestrians (33.3%) and cyclists (25.5%), with statistically significant differences between age groups. Polytrauma was the leading cause of death in both categories, though isolated cranio-cerebral trauma was proportionally more frequent in children. Crash circumstances also showed age-related patterns, with children more involved in high-energy collisions and older adults more frequently struck as pedestrians. Survival intervals showed a similar distribution across groups. Conclusions: Child and elderly RTA fatalities in Romania share common determinants, primarily driver-related behaviors and insufficient safety measures, while also exhibiting distinct age-related vulnerabilities. Autopsy-based data highlights these patterns and can guide targeted interventions such as stricter law enforcement, public education, and infrastructure improvements.