Limitations

This study has several limitations. First, as a retrospective analysis from a single forensic institute, it is subject to selection and information bias, as not all fatalities from motor vehicle accidents undergo forensic autopsy at our institution. The single center study design also limits the generalizability of the findings. Second, the reliance on police and medical reports for crucial data like seatbelt usage resulted in a substantial amount of missing information, limiting the statistical power of our seatbelt analysis. Third, the diagnosis on non-enhanced postmortem CT scans did not allow for the detailed grading of hernias according to classifications like [11], as Grade III injuries involving muscular disruption without herniation of content can be difficult to distinguish from hematomas. Fourth, the study design only used a single reader for the positive diagnosis of lesions, thus preventing the calculation of inter-observer variability. Finally, the relatively small number of TAWH cases (n = 14) within the MVO subgroup restricts the generalizability of the findings regarding seating position and specific injury patterns.