Evaluation of pedestrian–train fatalities in the State of Maryland: A 5-year retrospective study

Few studies have been done on the incidences of train-related pedestrian fatalities throughout the United States, with no previous studies reported in the State of Maryland. A retrospective study was conducted at the statewide medical examiner's office in Maryland to evaluate the characteristics of train-related pedestrian fatalities from 2014 to 2018. The aim of the study was to analyze circumstances of deaths through the medicolegal death investigation and postmortem examination findings, including toxicological study, to help identify epidemiological characteristics of pedestrian–train-related fatalities. A total of 48 pedestrian-train deaths were identified. Of the 48 cases identified, 21 deaths (43.75%) were determined to be accident, 20 deaths (41.67%) were suicide, and 7 deaths (14.58%) whose manner of death could not be determined. Of the 21 accidental victims, 17 were male and 4 were female (M:F ratio = 4.3:1), 11 (52.38%) were white, 6 (28.57%) African American, and 4 Hispanic (19.05%), with age ranging from 16 to 58 years (mean age = 35). Of the 20 suicide victims, 17 were males and 3 females (M:F ratio = 5.7:1), 16 (80%) were white, 2 (10%) African American, and 2 (10%) Hispanic, with age ranging from 22 to 60 years (mean age = 40). The majority of accidents occurred during weekday evening rush hours between 4:00 pm and 7:00 pm, while the suicides showed no specific time frames. No specific peak for seasons of year was found in suicides or accidents. Postmortem toxicological studies showed that 52.38% (11/21 cases) of accidental victims were positive for alcohol and 30% (6/20 cases) of suicide victims were positive for alcohol. Manner of death could not be determined in 7 cases because of unclear circumstances of death. Thorough death scene investigation and complete postmortem examination, including comprehensive toxicological testing, is very important in all train-related pedestrian fatalities. Determining the manner of death can directly affect the outcome of civil ligation and dispersal of insurance benefits. The characteristic profiles of train-related pedestrian fatalities can also assist effective preventive measures on railway suicides and accidents.