Original ArticleA 20-Year Review of Recumbent Pedestrian Fatalities (2001–2020)Tiemensma, Marianne MB, ChB, MMedForPath, FRCPA∗,†; Byard, Roger W. PhD, MD, DSc‡,§ Author Information From the ∗Forensic Pathology Unit, Royal Darwin Hospital, Darwin, Northern Territory †College of Medicine and Public Health, Flinders University ‡Department of Pathology, The University of Adelaide §Forensic Science SA, Adelaide, Australia. Manuscript received September 21, 2022; accepted November 1, 2022. Marianne Tiemensma: 0000-0002-8437-6683 Roger W. Byard: 0000-0002-0524-5942 The authors report no conflict of interest. Ethical approval: Obtained from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (ref. no. HREC 21-3950). Reprints: Marianne Tiemensma, MB, ChB, MMedForPath, FRCPA, Forensic Pathology Unit, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, Northern Territory, Australia, 0810. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology ():10.1097/PAF.0000000000000807, December 14, 2022. | DOI: 10.1097/PAF.0000000000000807 Buy PAP Metrics Abstract A retrospective study was performed in the Northern Territory of Australia of all cases of pedestrian fatalities where the decedents had been sitting, crouching, sleeping, or lying on or next to a road, over a 20-year period (January 1, 2001 to December 31, 2020). Of the 865 road traffic fatalities, 161 (19%) were pedestrians, and 42 of these were recumbent at the time of the incident (26% of all pedestrians). The most common age range was 30 to 39 years with a male to female ratio of 25:17. No individuals younger than 15 years were involved. Acute alcohol intoxication played a role in death in all of the cases with medium to high range blood alcohol concentrations. In addition, cannabis or its metabolites were detected in 6 cases, and methylamphetamine in 1 case. A history of chronic alcohol use or dependence was known in 6 (14%) of cases. In no case was an underlying medical condition contributory to death. The majority of incidents occurred at night. This study has shown a very high incidence of recumbent pedestrian deaths in an Australian subpopulation related to acute alcohol intoxication, decreased visibility, and vulnerability because of their position on or proximate to a road. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.