Autopsy data from individual aviation crashes have long been used in aviation safety research in the form of case reports and case series studies. Injuries sustained from aviation crashes, however, have not been well documented at a national level. This study examines the injury patterns for persons who died in aviation crashes in the United States and the implications for preventive strategies. Death certificate data for all aviation-related fatalities for the years 1980 (n = 1,543) and 1990 (n = 1.011) were obtained from the National Center for Health Statistics. The immediate cause of death and all injury diagnoses recorded on the death certificates were analyzed in relation to year of injury, crash category, and type of victim. Despite a 34% reduction in the number of aviation-related fatalities between 1980 and 1990, injury patterns were fairly stable. Multiple injuries were listed as the immediate cause of death in 42% of the fatalities, followed by head injury (22%); internal injury of thorax, abdomen, or pelvis (12%); burns (4%); and drowning (3%). Head injuries were most common among children. The majority (86%) died at the scene or were dead on arrival at the hospital. Eighteen percent of the victims were reported to have sustained a single injury, with head injury being the cause of death in nearly a third of these fatalities. Blunt injuries resulting from deceleration forces, in particular head injury, are still the most important hazard threatening occupants' survival in aviation crashes. To further reduce aviation-related fatalities requires more effective restraint systems and other improvements in aircraft design.