Department of Pathology

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Browsing Department of Pathology by browse.metadata.advisor "Afonso, Estevao"

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    A retrospective review of railway-associated deaths in the Cape Town Metro East region over a two-year period.
    (Stellenbosch : Stellenbosch University, 2021-03) Okkers, Heidi Lee; Afonso, Estevao; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology: Forensic Medicine.
    Background: Railway travel is an integral part of the daily transport of people and cargo worldwide, and no less so in South Africa. Generally considered safer than road transport, rail travel is still associated with risk and railway-related deaths attract significant media attention. There is limited local research into the epidemiology and pathology of these deaths. An improved understanding of these cases will assist in preventative strategies to minimise fatalities. Objectives: The aim of this study was to investigate railway-associated fatalities in the Cape Town Metro East region over two years, from 2016 to 2017. The objectives were to obtain a demographic profile of victims, characterise injury patterns, identify the temporal and geographical distribution of deaths and, where possible, the causes of death. Methods: A retrospective descriptive review of all railway-associated fatalities admitted to the Tygerberg Forensic Pathology Laboratory between 1 January 2016 and 31 December 2017 was performed. Data were collected from autopsy reports and available contemporaneous notes for each case, including South African Police documents and hospital notes, where relevant. Results: There were 104 cases of railway-associated deaths during the two-year period under study. Males accounted for 87 cases, while there were only 17 female victims. The mean age of all cases was 34.8 years. Most incidents occurred between the morning hours of 8 am and 10 am and in the evening from 7 pm to 10 pm, and a midweek peak of 62.5% of cases were reported as pedestrians who were struck whilst crossing the railway tracks. Khayelitsha was the suburb where the highest number of cases were recorded. Multiple blunt force injuries as the terminal cause of death accounted for 81.7% of cases. One case of electrocution and one of downing were reported. Two cases of alleged assault were recorded. Head injuries accounted for 91 cases with only five decapitations. Transection of the thorax occurred in eight cases and multiple rib fractures were also recorded. Multiple organs were disrupted and the upper limbs on the right were predominantly injured. 17 victims had blood alcohol levels above the legal limit of 0.05 g/100ml. Conclusion: More than half of the cases died as a result of multiple traumatic injuries after crossing the railway tracks as pedestrians. This study emphasizes the importance of adequate contemporaneous documentation of the cases. The background information and scene investigation play a significant role in determining factors assisting in the determination of the cause and manner of death. Optimal security can aid in the decline of unnecessary railway incidents and death. It is recommended that the investigation of railway-associated fatalities become a priority to prevent circumstances in which these cases occur.