Pedestrian-motor Vehicle Collisions Research Articles

Motor Vehicle and Pedestrian Collisions: Burden of Severe Injury on Major Versus Neighborhood Roads

Objective: To determine whether the severity of injuries sustained by pedestrians involved in motor vehicle collisions varies by road type and age. Methods: All police-reported pedestrian motor vehicle collisions in the city of Toronto, Canada, between January 1, 2000, and December 31, 2005, were analyzed. Geographic Information Systems software was used to determine whether the collisions occurred on major or neighborhood roads. Age-specific estimates of the burden of pedestrian collisions are presented. Odds ratios and 95 percent confidence intervals were calculated to examine age-specific relationships between injury severity and road type. A second analysis comparing the distribution of severe injury location between age groups was also performed. Results: The majority of collisions involved adults (68%), although elderly pedestrians were overrepresented in fatal collisions (49%). Severe and fatal collisions involving working-age and elderly adult pedestrians were more likely on major roads. Odds of severe injury occurring on a major road were 1.36 (95% CI: 1.17–1.57) times higher for adults ages 18 to 64, and 1.55 (95% CI: 1.22–1.99) times higher for elderly aged 65+. By contrast, severe injuries among children were more common on neighborhood roads, with odds of severe injury on a major road of 0.64 (95% CI: 0.37–1.1) for children aged 5 to 9. Among children under 9, 64–67 percent of hospitalized or fatal injuries occurred on neighborhood roads, a marked difference from the distribution of such injuries in adults or the elderly, for whom only 29–30 percent of hospitalized or fatal injuries occurred on neighborhood roads (chi-square = 52.6, p ≤.001). Conclusions: Targeting interventions toward the adult pedestrian burden on major roads alone will not make child pedestrians safer. Pedestrian interventions specific to children and focused on neighborhood roads must be considered in urban centers like Toronto.

Environmental Characteristics Associated With Pedestrian–Motor Vehicle Collisions in Denver, Colorado

We examined patterns of pedestrian-motor vehicle collisions and associated environmental characteristics in Denver, Colorado. We integrated publicly available data on motor vehicle collisions, liquor licenses, land use, and sociodemographic characteristics to analyze spatial patterns and other characteristics of collisions involving pedestrians. We developed both linear and spatially weighted regression models of these collisions. Spatial analysis revealed global clustering of pedestrian-motor vehicle collisions with concentrations in downtown, in a contiguous neighborhood, and along major arterial streets. Walking to work, population density, and liquor license outlet density all contributed significantly to both linear and spatial models of collisions involving pedestrians and were each significantly associated with these collisions. These models, constructed with data from Denver, identified conditions that likely contribute to patterns of pedestrian-motor vehicle collisions. Should these models be verified elsewhere, they will have implications for future research directions, public policy to enhance pedestrian safety, and public health programs aimed at decreasing unintentional injury from pedestrian-motor vehicle collisions and promoting walking as a routine physical activity.

Back-over Collisions in Child Pedestrians from the Canadian Hospitals Injury Reporting and Prevention Program

Objective: The objective of the current study was to describe the burden of back-over collisions within the context of other child pedestrian collisions as identified through a pediatric emergency room injury surveillance database. Methods: Injury data for child pedestrian motor vehicle collisions from 1994 to 2003 were obtained from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). Back-over collisions involving children under the age of 14 were identified and classified by written narratives. Characteristics of children involved in back-over collisions were described, and for those admitted to hospital, the nature of injury was compared with other types of child pedestrian collisions. Results: There were 4295 child pedestrian motor vehicle collisions reported to CHIRPP during the study time period. Of the 4295 children, 148 (3.4%) were injured in a back-over collision, with 49 (33.1%) of these collisions involving a vehicle backing out of a driveway. Children involved in back-over collisions were significantly younger than those in forward-moving/other collisions; however, almost 50 percent of back-over collisions involved children older than age 4. Children involved in back-over collisions on driveways were significantly younger than those involved in collisions occurring at other locations. Of those admitted to hospital, children in back-over collisions were more likely to sustain injuries to internal organs. Children in back-over collisions were less likely to sustain severe/mild head injuries and hip/leg fractures. Conclusions: Although back-over collisions represent a small proportion of pedestrian motor vehicle collisions, they tend to involve more severe injuries, as indicated by their admission to hospital. It was found that older children are also at risk of back-over collisions and back-over collisions occur in areas other than driveways. In order to lessen the burden of back-over collisions, interventions must address children of different ages and a variety of locations.

Treatment of musculoskeletal injuries of multiple-trauma patients in a Spanish tertiary referral hospital

To analyze the diagnostic and therapeutic protocol used in multiple-trauma patients with musculoskeletal injuries at a Spanish tertiary referral hospital that lacks a specific unit endowed with the functional structure to treat these patients. Retrospective observational study. All patients admitted to the Intensive Care Unit (ICU) between January 2001 and May 2003 with a diagnosis of multiple trauma to the musculoskeletal system were included. There were a total of 135 patients, of which 120 could be evaluated. The patients’ clinical records were analyzed and a record was made of the mechanism of injury, ISS (Injury Severity Score) and NISS (New Injury Severity Score) calculations, treatment administered in each case and time of administration, any ensuing complications and mortality rate. The SPSS 11.0 software was used for data analysis. Mean age was 38 (range: 15-75 years). Ninety-five (80%) were male. The main mechanisms of injury were road accidents and pedestrian-motor vehicle collisions (65%). Mean ICU stay was 13.5 days (range: 1-130). Thirty-three percent were operated on for their musculoskeletal lesions. Main time-to-fracture stabilization was 9.3 days (range: 1-70). Thirty-three patients (28%) developed inflammatory systemic complications and 37 (31%) had serious infections. Twenty-one patients (18%) died 8.5 days (range 1-50 days) after their admission. A comparison with protocols and results published by dedicated multiple-trauma units from other countries reveals the need for a greater degree of protocolization and multidisciplinary coordination to improve the treatment of the bone and joint pathologies of these patients in referral hospitals. Analizar el proceso diagnóstico y tratamiento del paciente politraumatizado con lesiones del aparato locomotor en un hospital español de tercer nivel sin unidad específica estructurada funcionalmente para la atención de estos pacientes. Estudio observacional retrospectivo. Se incluyeron todos los pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) bajo el diagnóstico de politraumatismo con lesiones del aparato locomotor entre enero de 2001 y mayo de 2003, 135 enfermos, de los cuales 120 pudieron ser evaluados. Se procedió al estudio de las historias clínicas, registrándose el mecanismo causal, diagnósticos, cálculo del ISS (Injury Severity Score) y NISS (New Injury Severity Score), tratamientos aplicados y el momento en el que se realizaron, complicaciones desarrolladas y mortalidad. Se utilizó el software SPSS 11.0 para el análisis de los datos. La edad media fue 38 (rango 15-75 años). Noventa y cinco (80%) eran hombres. Los mecanismos causales principales fueron el accidente de tráfico y el atropello (65%). La estancia media en UCI fue 13,5 días (rango 1-130). El 33% fue intervenido de las lesiones del aparato locomotor. La demora media en la estabilización de las fracturas fue 9,3 días (rango 1-70). Treinta y tres pacientes (28%) desarrollaron complicaciones sistémicas inflamatorias, y 37 (31%) presentaron infecciones graves. Veintiún pacientes (18%) fallecieron en una media de 8,5 días (rango 1-50 días) después de ingresar. La comparación con los protocolos y resultados publicados por unidades específicas para politraumatizados en otros países demuestra la conveniencia de una mayor protocolización y coordinación multidisciplinar para mejorar la atención de la patología osteoarticular de estos pacientes en centros de referencia.

Risk of Pedestrian Collision Occurrence

This individual-level case control study analyzed the risk of occurrence of a pedestrian–motor vehicle collision at a given location on a state route in King County, Washington. With the full sample of collisions (1999-2004), binomial logit models estimated the odds of collision occurrence as related to the road and the neighborhood environments and adjusting for exposure. Separate models were run for SR-99, the principal transregional arterial with four-plus lanes ( n = 826), and for all the other state routes ( n = 1,602). The strongest significant correlates of the risk of collision occurrence were the presence of crosswalks with or without traffic signals, the facility's number of lanes, and the presence of nearby retail uses. Also positively significant were the number of traffic signals and the street-block size near the location and being located outside the city of Seattle. Exposure variables including road-level measures such as average daily traffic and posted speed and neighborhood-level measures such as the number of residential units and bus ridership were significant in at least one of the models. Employment density appeared to be an unreliable measure of exposure. Other pedestrian activity generators such as educational facilities were not significantly associated with the risk of collision occurrence. The strong significance of crosswalks, whether signalized or not, indicated that engineering approaches to safety should likely be complemented by education- and enforcement-based measures. Similarly, facilities in areas with concentrations of retail should become the targets of future safety programs.

Atlanto-Occipital Dislocation With Traumatic Pseudomeningocele Formation and Post-Traumatic Syringomyelia

A case report of traumatic atlanto-occipital dislocation complicated by the development of anterior and posterolateral pseudomeningoceles and the late development of syringohydromyelia is presented. To describe a unique post-traumatic and postsurgical course following atlanto-occipital dislocation. Syringomyelia is a significant potential long-term complication in patients recovering from traumatic atlanto-occipital dislocation. Cord enlargement and increased T2 signal can be a marker of abnormal cerebrospinal fluid flow dynamics. This "presyrinx state" can be seen before clinical evidence of neurologic compromise. Pseudomeningocele formation after atlanto-occipital dislocation is rare, with only 3 reported cases. To our knowledge, all reported cases describe retropharyngeal pseudomeningoceles, and posterolateral pseudomeningocele as seen in this case has not previously been described. A single case is reported with an emphasis on the imaging findings related to the patient's subsequent neurologic deterioration. Following a pedestrian-motor vehicle collision, the patient received initial evaluation and treatment at a local foreign medical facility, where his cervical spine was cleared. Several days following stabilizing treatment and surgery, the patient was transferred to a foreign-based United States military medical facility and ultimately to our institution, where magnetic resonance imaging demonstrated occipitocervical dissociation. The patient was taken to the operating room for surgical stabilization. Four months after his index operation, the patient underwent halo removal. Follow-up magnetic resonance imaging revealed thickening of the cervical spinal cord in conjunction with diffuse high cord T2 signal and a small low cervical segment of syringomyelia. The patient was observed with follow-up magnetic resonance imaging obtained after 1 month. At this time, the low cervical syrinx had enlarged slightly, a small thoracic syrinx was observed, and cine imaging of cerebrospinal fluid flow demonstrated obstruction at the level of the foramen magnum. The patient was taken to the operating room fordecompression of the foramen magnum and posterior fossa and duraplasty. One month later, the patient's clinical condition began to deteriorate, and repeat imaging showed continued enlargement of the patient's syrinx and hydrocephalus. He was admitted for an urgent shunt procedure but unfortunately sustained cardiorespiratory arrest while on the ward awaiting surgery. Atlanto-occipital dislocation is rarely survivable, and delayed diagnosis can negatively affect long-term clinical outcome. This case illustrates how, despite early signs of improvement, post-traumatic syringomyelia may occur months or even years after spinal trauma and should always be considered in patients who experience late neurologic deterioration after atlanto-occipital dislocation.

Family characteristics and pedestrian injury risk in Mexican children

Background: Family characteristics have been described as risk factors for child pedestrian and motor vehicle collision. Research results come mainly from developed countries, where family relationships could be different than...

Area-wide traffic calming for preventing traffic related injuries.

It is estimated that by 2020 road traffic crashes will have moved from ninth to third in the world disease burden ranking, as measured in disability adjusted life years, and second in developing countries. The identification of effective strategies for the prevention of traffic related injuries is of global health importance. Area-wide traffic calming schemes that discourage through traffic on residential roads is one such strategy. To evaluate the effectiveness of area-wide traffic calming in preventing traffic related crashes, injuries, and deaths. We searched the following electronic databases: Cochrane Injuries Group's Specialised Register, Cochrane Controlled Trials Register, MEDLINE, EMBASE and TRANSPORT (NTIS, TRIS, TRANSDOC). We searched the web sites of road safety organisations, handsearched conference proceedings, checked reference lists of relevant papers and contacted experts in the area. The search was not restricted by language or publication status. Randomised controlled trials, and controlled before-after studies of area-wide traffic calming schemes. Two reviewers independently extracted data on type of study, characteristics of intervention and control areas, and length of data collection periods. Before and after data were collected on the total number of road traffic crashes, all road user deaths and injuries, pedestrian-motor vehicle collisions and road user deaths. The statistical package STATA was used to calculate rate ratios for each study, which were then pooled to give an overall estimate using a random effects model. We found no randomised controlled trials, but 16 controlled before-after trials met our inclusion criteria. Seven studies were done in Germany, six in the UK, two in Australia and one in the Netherlands. There were no studies in low or middle income countries. Eight trials reported the number of road traffic crashes resulting in deaths. The pooled rate ratio was 0.63 (0.14, 2.59 95% CI). Sixteen studies reported the number of road traffic crashes resulting in injuries (fatal and non fatal). The pooled rate ratio was 0.89 (0.80, 1.00 95% CI). Nine studies reported the total number of road traffic crashes. The pooled rate ratio was 0.95 (0.81, 1.11 95% CI). Thirteen trials reported the number of pedestrian-motor vehicle collisions. The pooled rate ratio was 1.00 (0.84, 1.18). There was significant heterogeneity for the total number of crashes and deaths and injuries. The results from this review suggest that area-wide traffic calming in towns and cities may be a promising intervention for reducing the number of road traffic injuries, and deaths. However, further rigorous evaluations of this intervention are needed.

Crosswalk markings and the risk of pedestrian-motor vehicle collisions in older pedestrians.

Motor vehicles struck and killed 4739 pedestrians in the United States in the year 2000. Older pedestrians are at especially high risk. To determine whether crosswalk markings at urban intersections influence the risk of injury to older pedestrians. Case-control study in which the units of study were crossing locations. Six cities in Washington and California, with case accrual from February 1995 through January 1999. A total of 282 case sites were street-crossing locations at an intersection where a pedestrian aged 65 years or older had been struck by a motor vehicle while crossing the street; 564 control sites were other nearby crossings that were matched to case sites based on street classification. Trained observers recorded environmental characteristics, vehicular traffic flow and speed, and pedestrian use at each site on the same day of the week and time of day as when the case event had occurred. Risk of pedestrian-motor vehicle collision involving an older pedestrian. After adjusting for pedestrian flow, vehicle flow, crossing length, and signalization, risk of a pedestrian-motor vehicle collision was 2.1-fold greater (95% confidence interval, 1.1-4.0) at sites with a marked crosswalk. Almost all of the excess risk was due to 3.6-fold (95% confidence interval, 1.7-7.9) higher risk associated with marked crosswalks at sites with no traffic signal or stop sign. Crosswalk markings appear associated with increased risk of pedestrian-motor vehicle collision to older pedestrians at sites where no signal or stop sign is present to halt traffic.

Exposure to traffic among urban children injured as pedestrians

Objectives: To explore the immediate pre-crash activities and the routine traffic exposure (street crossing and play) in a sample of urban children struck by automobiles. In particular, the traffic exposure...

Safety education of pedestrians for injury prevention: a systematic review of randomised controlled trials

Objectives: To quantify the effectiveness of safety education of pedestrians.Design: Systematic review of randomised controlled trials of safety education programmes for pedestrians of all ages.Main outcome measures: Effect of safety...

Safety education of pedestrians for injury prevention.

Each year about one million people die and about 10 million are seriously injured on the world's roads. Educational measures to teach pedestrians how to cope with the traffic environment are considered to be an essential component of any prevention strategy, and pedestrian education has been recommended in many countries. However, as resources available for road safety are limited, a key question concerns the relative effectiveness of different prevention strategies. To quantify the effectiveness of pedestrian safety education programmes in preventing pedestrian-motor vehicle collisions. We searched the Injuries Group specialised register, Cochrane Controlled Trials Register, TRANSPORT, MEDLINE, EMBASE, ERIC, PSYCHLIT, SPECTR, and the WHO database on the Internet. We checked reference lists of relevant reviews and papers and contacted experts in the field. Most database searching was conducted in 1999. Randomised controlled trials of safety education programmes for pedestrians of all ages. One reviewer screened records. Two reviewers independently extracted data and assessed methodological quality of trials. Because of differences in the types of interventions and outcome measures used in the trials, meta-analyses were not carried out. We found 15 randomised-controlled trials of pedestrian safety education programmes, conducted between 1976 and 1997. Methodological quality of the included trials was generally poor. Allocation concealment was adequate in three trials, outcome assessment was blinded in eight, and in most of the studies large numbers of participants were lost to follow-up. Study participants were children in 14 studies and institutionalised adults in one. Eight studies involved the direct education of participants, seven used parents as educators. No trials were conducted in a developing country and there were none of pedestrian safety training in the elderly. None of the included trials assessed the effect of pedestrian safety education on the occurrence of pedestrian injury but six trials assessed the effect on observed behaviour. Some of these trials showed evidence of behavioural change following pedestrian safety education but it is difficult to predict what effect this might have on pedestrian injury risk. Pedestrian safety education can result in improvement in children's knowledge and can change observed road crossing behaviour but whether this reduces the risk of pedestrian motor vehicle collision and injury occurrence is unknown. There is evidence that changes in safety knowledge and observed behaviour decline with time suggesting that safety education must be repeated at regular intervals.

Traumatic aortic injury: an imaging review.

Traumatic aortic injury (TAI) is a major cause of fatality in high speed deceleration injuries. It accounts for 10-20% of fatalities in blunt chest trauma. These injuries are usually related to high-speed motor vehicle and motorcycle collisions, pedestrian-motor vehicle collisions, and falls. Only 10-20% of patients who suffer TAI survive the initial injury and reach the emergency department. If left untreated, 30% die within 6 h, 40-50% die within 24 h, and 90% die within 4 months. A chronic pseudoaneurysm will develop in 2-5% of patients whose injury is not diagnosed. It is imperative, therefore, that these injuries are detected promptly and accurately. Symptoms and physical examination findings are nonspecific. External evidence of chest wall injury is present in 7-90% of cases, so that in up to 30% of the cases no apparent chest injury is identified on physical examination. Chest radiographs are very sensitive in detecting mediastinal hemorrhage, but have a low positive predictive value for aortic injury. The positive predictive value for chest radiography ranges between 5% and 20% for TAI. Aortography has been considered the gold standard for many years in the evaluation of TAI, but is time-consuming, labor- and resource-intensive, and invasive. Because of the shortcomings of physical examination and these more traditional imaging examinations, computed tomography (CT) has become increasingly utilized as a screening and diagnostic tool. Recent investigations have documented its high sensitivity and specificity in the detection of TAI. This article reviews the recent investigations of imaging evaluation of TAI, with a focus on helical CT.

A geographic analysis of motor vehicle collisions with child pedestrians in Long Beach, California: comparing intersection and midblock incident locations

Objectives—The purpose of this study was to use geographic information system (GIS) software to locate areas of high risk for child pedestrian-motor vehicle collisions in the city of Long Beach...

Tricuspid regurgitation following central line insertion in a patient undergoing haemodialysis.

<h3>Background</h3> Road traffic injury is the leading cause of death for children in Canada. Lower speed roads are correlated with lower pedestrian injury severity. Pedestrians are 8 times more likely...

TRAUMATIC SUBARACHNOID-PLEURAL FISTULA

Subarachnoid-pleural fistula is an unusual complication of spinal cord injury without radiologic abnormality (SCIWORA) and a rare cause of posttraumatic pleural effusion. The clinical presentation and surgical management of a child, the first with this complication seen at our institution, who sustained a T-6 SCIWORA and a cerebrospinal fluid-pleural effusion following a pedestrian-motor vehicle collision is discussed. Magnetic resonance imaging (MRI) proved superior to myelography in demonstrating the fistulous connection and associated cord damage. The fistula was successfully closed via a thoracotomy using a muscle and pleural plug.

Factors contributing to the severity of childhood pedestrian injury in Perth, Western Australia.

Pedestrian-motor vehicle collisions that involved children aged 0 to 14 years in Perth, Western Australia were examined for the period 1980-1989 in order to identify factors which contribute to the severity of injury. Nearly half (49%) of the 1,282 children injured during this period required hospitalization, with a further 46% of the children requiring some form of medical treatment. Multivariate analysis indicated that children aged 0 to four years had a higher risk of sustaining a severe injury compared with children aged five to nine and ten to 14 years, with relative risks of 1.6 and 1.7 respectively. A greater proportion of more severe injuries occurred after 3 pm. Injuries tended to be more severe when the collision occurred on a highway or main road, and when the child was actually on the road at the point of impact. Further research on more comprehensive datasets, which consider the child's behavior at the time of injury as well as driver attributes, will provide greater insight into factors contributing to the severity of injury.

CHILD PEDESTRIAN INJURY

Linked multiple data sources were analyzed to provide a population-based collision and injury severity profile among pedestrians under 20 years of age struck by a motor vehicle during 1986-1987 in Hartford, Connecticut. Data sources included police accident reports, medical examiner records, and hospital charts. There were 234 motor vehicle-pedestrian collisions reported to the police in the study period. Of these, 213 were Hartford residents resulting in an annual age-specific pedestrian collision rate of 22.8 per 10,000 persons. A spot map of collision location reveals several well-defined geographic areas, which includes nearly half (45%) of the motor vehicle-pedestrian collisions. We reviewed 143 of 192 medical charts (75%) and 6 medical examiner records. The case fatality rate was 4.2% and the mean Injury Severity Score was 4.4. These findings will be useful for designing, implementing, and evaluating a targeted child pedestrian safety program.

ENVIRONMENTAL FACTORS AND THE RISK FOR CHILDHOOD PEDESTRIAN-MOTOR VEHICLE COLLISION OCCURRENCE

In King County, Washington, during 1985-1986, 98 children aged less than 15 years involved in pedestrian-motor vehicle collisions resulting in death or injuries severe enough to require hospitalization were identified through the Trauma Registry at the Regional Trauma Center and the Medical Examiner's Office. Two age- and sex-matched controls were selected for each case, one through random digit dialing and the other from children undergoing appendectomy. Various environmental and traffic characteristics were ascertained from visits to the neighborhoods of all subjects. Children living in multifamily dwellings had a risk for injury that was 5.5 times greater than children living in single family homes (95% confidence interval 2.5-12.3). In general, areas with busier streets (greater posted vehicle speeds and/or greater traffic volumes) were associated with increased risk for pedestrian injuries. The lack of pedestrian crossing devices, crosswalks, or sidewalks, however, was not associated with an increased risk. When the analysis was restricted to the 23 cases injured in front of their homes and their controls, risks were not elevated for any of the street or traffic characteristics. The small size of the study and the lack of relevant information for many subjects limited our ability to adjust for the likely confounding influence of other household/environmental factors. Thus, these results should be viewed as suggestions for future investigations of the causes of childhood pedestrian injuries.

Pedestrian post-impact kinematics and injury patterns

In this paper, frontal motor vehicle pedestrian collisions are classified according to post-impact pedestrian kinematics observed in real world vehicle vs. pedestrian accidents. Results from in-depth pedestrian accident investigations provide the medico-engineering basis for this study. It was found that impact-induced pedestrian motion is influenced by the relative configuration of the vehicle and pedestrian at impact as well as the vehicle's impact speed and deceleration rate. Injury patterns were found to be dependent on the trajectory type in addition to impact severity and characteristics of the vehicle and roadway. Five basic kinematic trajectories have been identified for frontal collision cases and are described as: wrap, forward projection, fender vault, roof vault, and somersault. Pedestrian injury patterns are analyzed for each of the trajectory types; an injury risk index is defined; and the associated injury risks are compared. It is hoped that classification of the characteristic injury patterns and trajectories can facilitate vehicle design improvements to reduce pedestrian injury severity.