Introduction: Cities are locations having a high level of accumulation and concentration of economic activities and are complex spatial structures that are supported by transport systems. The evolution of mass rapid transport system in the form of suburban railway network has increased railway casualties in the cities as the railroads pass through residential and commercial zones. Hence, the aim of the present study was to assess the analysis of death due to railway accidents in a tertiary care hospital. Material and Methods: During the study period, total 5240 autopsies were conducted in Osmania General Hospital Mortuary, out of which 474 were due to railway accidents. All the findings of autopsy report were noted and relevant photos at the time of autopsy were taken. In relevant cases, wherever necessary the organ were collected and was sent for histopathological examination. Autopsy on all cases of deaths due to railway accidents conducted at Mortuary, Osmania General Hospital in 2015 were included in the present study. Results: Maximum fatalities were reported among third decade of life i.e. 31-40 years followed by second and fourth decade i.e. 21-30 years. Lowest number of fatalities was reported from eighth and first decade of life i.e. 81-90 years. In accidental cases cause of death in most of the cases is multiple injuries, followed by head injury and head injury associated with other injuries. Conclusion: Highest number of accidents happened while crossing the railway track, followed by people lying on the track or jumping in front of a moving train. In suicidal deaths most of the cases were due to decapitation, followed by crush injuries. About 7 cases of traumatic transection were reported during the period of study.