Causes of death and types of injuries of avalanche fatalities based on forensic data: a scoping review.

Background: The main causes of death in avalanche victims are asphyxia, trauma, and hypothermia. However, most evidence is based on epidemiological studies with inconsistent forensic data. We aimed to integrate current evidence on causes of death and types of injuries in avalanche victims undergoing postmortem examination. Methods: We conducted a scoping review of studies reporting forensic data on avalanche-related deaths. Eligible studies included victims who underwent postmortem examination, excluding those buried in buildings or vehicles. Extracted data included study and population characteristics, postmortem investigation (external examination, autopsy, histopathology, toxicology, and imaging), and results (causes of death, types of injuries). Results: We included 38 studies, of which 31 reported original data involving 1543 fatalities. Of these, 862 (56 %) underwent postmortem examination, with 442 (51 %) receiving autopsies. Among 387 autopsied cases with reported causes of death, asphyxia accounted for 72 %, trauma 18 %, hypothermia 2 %, and combined causes 8 %. Asphyxia-related findings included pulmonary edema, organ congestion, and petechiae. Trauma-related deaths involved head, neck, and thoracic injuries. Hypothermia findings included Wischnewski spots and frostbite. Histopathology (n = 48) revealed asphyxia-related lesions in all victims, while hypothermia findings were infrequent. Postmortem imaging (n = 12) showed pulmonary edema. Toxicology detected ethanol in 4 %, cannabinoids in 11 % and cocaine in 1 % of cases tested. Conclusion: Our review aligns with previous studies, confirming asphyxia as the leading cause of death, followed by trauma and hypothermia. Gaps in knowledge remain on autopsy-confirmed causes of death and related injuries. Standardized forensic protocols could improve death classification accuracy, particularly in cases with combined causes.