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.

Road traffic accidents (RTAs) represent the key sign of the level of road safety. Romania once held the record for road deaths among European Union (EU) countries and as of 2023, it came second place. It is of utmost importance to assess whether measures that restricted human mobility during the coronavirus disease 2019 (COVID-19) pandemic led to a significant reduction in road fatalities. This study assesses the impact of the COVID-19 pandemic on victims of fatal RTAs by analyzing medicolegal autopsies from the Timisoara Institute of Legal Medicine (TILM), Timis County, Romania. Materials and methods: Medicolegal autopsy records of RTA victims from TILM in a 5-year period (2017–2021) were analyzed. Results: 395 cases (10.5%) were represented by victims of fatal RTAs. The reduction in the number of cases in the pandemic period was not statistically significant (p = 0.061) compared to the pre-pandemic period, but the number of victims of RTAs decreased by 17.6%. This highlights the importance of understanding the role of other risk factors in fatal RTAs, since a lesser volume of traffic did not cause a significant decrease in road fatalities. Male victims were predominant, with 18–50 years being the most affected age group. In the pandemic period, the most affected age groups were 31–40 (18.5%), followed closely by 41–50 (17.6%) and 18–30 (16.7%). In the pre-pandemic period, the first place was held by people in the age interval of 61–70 (20.5%), followed by 18–30 (19.2%). Drivers were the most involved type of road user, and a slight increase in the proportion of cyclists (13.9% from 10.5%) and motorcyclists (6.5% from 5.9%) was noted. Conclusions: Our findings show that measures implemented to control the COVID-19 pandemic may have had a positive effect on the reduction of RTAs, as shown by the information based on medicolegal autopsies in Timis County, Romania, but more attention needs to be focused on other risk factors. Further studies need to identify reasons for the small reduction in fatal injuries when the volume of traffic was reduced during mandated national lockdown.

Background: Patients with traumatic injuries often represent the best hosts for healthcare-associated infections, especially pneumonia or bronchopneumonia. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic raised serious problems in the diagnosis and treatment of patients that had a SARS-CoV-2 infection and associated nosocomial bacterial bronchopneumonia. In forensic medicine, these aspects need to be considered when establishing the cause of death and the distinction between the two types of bronchopneumonia is of particular importance. Methods: We present nine cases that were autopsied at the Institute of Forensic Medicine Timisoara between 1 June 2020 and 31 December 2021, that presented traumatic injuries, a SARS-CoV-2 infection, and bronchopneumonia. Results: We focused on the main findings of the macroscopic and microscopic aspects of lung tissues. Conclusions: We consider that the aspects we highlighted in this study, can be very useful in forensic practice in cases with a pluri-factorial pathology.

Background/Objectives: When a patient dies and a complex pathology is identified, it can be difficult to ascertain the cause of death and the contribution of each ailment to the dying process. Patients with traumatic brain injuries often represent the best hosts for healthcare-associated infections, especially pneumonia or bronchopneumonia. Additionally, some of these ones also have pre-existing chronic diseases, which can influence their medical evolution. Therefore, many factors need to be carefully analyzed by the forensic doctor when establishing the cause of death. The purpose of this study is to demonstrate the crucial role a forensic autopsy plays in accurately identifying the cause of death and diagnosing all of a patient's ailments, particularly in cases involving nosocomial infections, while emphasizing the significant number of cases where healthcare-associated infections can lead to mortality. Methods: We conducted a retrospective analysis that included cases with cranial-cerebral traumas, pre-existing chronic diseases, and hospital-acquired infections that were autopsied at the Forensic Medicine Institute in Timișoara between January 1, 2018, and December 31, 2021. We studied the autopsy reports and the medical documentation of the patients. Results: Our research indicates that patients with traumatic brain injuries and non-traumatic conditions face a considerable risk of acquiring healthcare-associated infections, especially pneumonia or bronchopneumonia, even with adequate medical treatment. A significant part of these infectious issues remains unrecognized while hospitalization; however, autopsy can elucidate them. Conclusions: This study demonstrates a high prevalence of healthcare-associated infections in patients with brain injuries, as well as how these infections can alter the progression of traumatic disorders and their mortality rate.

Nosocomial bronchopneumonia is a severe lung infection that develops more than 48 h after hospital admission and is frequently caused by antibiotic-resistant bacteria. It is often identified postmortem in forensic practice, particularly in patients with severe traumatic injuries requiring prolonged hospitalization and immobilization. Diagnosis is typically based on macroscopic findings and histopathological examination of lung tissue. This study aimed to evaluate the diagnostic value of postmortem microbiological testing by comparison with antemortem microbiological data. Ten patients with a clinical diagnosis of nosocomial bronchopneumonia were selected from forensic cases. During autopsy, tracheal swabs and lung tissue samples were collected and subjected to culture-based and molecular analyses. The results were compared with those obtained from antemortem microbiological investigations. Pathogens characteristic of nosocomial infections were identified; however, concordance with in-hospital microbiological data was highest when using next-generation sequencing (NGS) metagenomic analysis. Tracheal swab culture appears to have limited reliability for postmortem identification of bacterial agents in healthcare-associated bronchopneumonia. In contrast, metagenomic next-generation sequencing (mNGS) of lung tissue obtained at autopsy showed the highest concordance with antemortem microbiological findings and may provide valuable complementary diagnostic information, particularly in polymicrobial infections.

Healthcare-associated infections (HAIs) represent a major challenge in trauma patients, particularly in those requiring prolonged hospitalization, invasive procedures, surgery, or intensive care management. In forensic practice, these infections raise complex diagnostic and causal questions, especially when death occurs in patients with traumatic injuries, pre-existing chronic diseases, and post-traumatic complications. This chapter examines HAIs in trauma patients from a forensic and medico-legal perspective, with particular emphasis on traumatic brain injury, nosocomial bronchopneumonia, sepsis, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated pulmonary pathology. By integrating clinical data, imaging findings, microbiological results, autopsy observations, and histopathological examination, the chapter highlights the importance of postmortem investigation in clarifying the cause of death and the role of infection in the thanatogenic chain. Attention is given to the distinction between direct traumatic death, indirect death mediated by infectious complications, and multifactorial death involving trauma, infection, and chronic disease. The chapter also discusses the medico-legal implications of underdiagnosed HAIs and emphasizes the role of forensic autopsy in identifying overlooked complications, reconstructing causal relationships, and supporting objective expert conclusions.