Pedestrian-motor Vehicle Crashes Research Articles

Behavioral pathway analysis of pedestrian injury severity in pedestrian-motor vehicle crashes

Despite the health and environmental benefits of walking as an active and sustainable mode of transport, the increasing number of road crashes involving pedestrians has become a public health concern. This study investigates the direct and indirect effects of various contributing factors on pedestrian injury severity in pedestrian-motor vehicle crashes. Data on pedestrian-vehicle crashes from North Carolina between 2015 and 2019, including the pedestrian pre-crash actions and injury severity, were used. Path analysis was applied to uncover the inter-relationship between contributing factors, pedestrian pre-crash behaviors, and injury severity using random parameter ordered logit and mixed logit models. The results indicate that pedestrian intoxication, lighting condition, number of lanes, speed limit, and vehicle type contribute directly and indirectly (through pre-crash behaviors) to increasing injury severity. It was also observed that pedestrian position and traffic control directly decreased injury severity but indirectly increased injury severity through pre-crash behaviors. This study provides valuable information about the relationship between various crash factors and pedestrian injury severity. For researchers and agencies interested in pedestrian safety improvements, this study gives valuable insight by uncovering the roles of pedestrians’ pre-crash action on injury severity outcomes. For countermeasures, the study recommends better street lighting and re-evaluation of posted speed limits on roads with high pedestrian traffic. A regular educational campaign should inform pedestrians of the importance of yielding to motorists at locations without crosswalks. Also, drivers’ compliance with existing pedestrian-vehicle interaction laws should be monitored, especially at intersections.

Analysis of Pedestrian–Motor Vehicle Crashes in San Antonio, Texas

Pedestrian safety is becoming a global concern and an understanding of the contributing factors to severe pedestrian crashes is crucial. This study analyzed crash data for San Antonio, TX, over a six-year period to understand the effects of pedestrian–vehicle crash-related variables on pedestrian injury severity based on the party at fault and to identify high-risk locations. Bivariate analysis and logistic regression were used to identify the most significant predictors of severe pedestrian crashes. High-risk locations were identified through heat maps and hotspot analysis. A failure to yield the right of way and driver inattention were the primary contributing factors to pedestrian–vehicle crashes. Fatal and incapacitating injury risk increased substantially when the pedestrian was at fault. The strongest predictors of severe pedestrian injury include the lighting condition, the road class, the speed limit, traffic control, collision type, the age of the pedestrian, and the gender of the pedestrian. The downtown area had the highest crash density, but crash severity hotspots were identified outside of the downtown area. Resource allocation to high-risk locations, a reduction in the speed limit, an upgrade of the lighting facilities in high pedestrian activity areas, educational campaigns for targeted audiences, the implementation of more crosswalks, pedestrian refuge islands, raised medians, and the use of leading pedestrian interval and hybrid beacons are recommended.

Towards activity-based exposure measures in spatial analysis of pedestrian–motor vehicle crashes

BackgroundAlthough numerous efforts have been devoted to exploring the effects of area-wide factors on the frequency of pedestrian crashes in neighborhoods over the past two decades, existing studies have largely failed to provide a full picture of the factors that contribute to the incidence of zonal pedestrian crashes, due to the unavailability of reliable exposure data and use of less sound analytical methods. MethodsBased on a crowdsourced dataset in Hong Kong, we first proposed a procedure to extract pedestrian trajectories from travel-diary survey data. We then aggregated these data to 209 neighborhoods and developed a Bayesian spatially varying coefficients model to investigate the spatially non-stationary relationships between the number of pedestrian–motor vehicle (PMV) crashes and related risk factors. To dissect the role of pedestrian exposure, the estimated coefficients of models with population, walking trips, walking time, and walking distance as the measure of pedestrian exposure were presented and compared. ResultsOur results indicated substantial inconsistencies in the effects of several risk factors between the models of population and activity-based exposure measures. The model using walking trips as the measure of pedestrian exposure had the best goodness-of-fit. We also provided new insights that in addition to the unstructured variability, heterogeneity in the effects of explanatory variables on the frequency of PMV crashes could also arise from the spatially correlated effects. After adjusting for vehicle volume and pedestrian activity, road density, intersection density, bus stop density, and the number of parking lots were found to be positively associated with PMV crash frequency, whereas the percentage of motorways and median monthly income had negative associations with the risk of PMV crashes. ConclusionsThe use of population or population density as a surrogate for pedestrian exposure when modeling the frequency of zonal pedestrian crashes is expected to produce biased estimations and invalid inferences. Spatial heterogeneity should also not be negligible when modeling pedestrian crashes involving contiguous spatial units.

Qualitative Field Observation of Pedestrian Injury Hotspots: A Mixed-Methods Approach for Developing Built- and Socioeconomic-Environmental Risk Signatures

Road traffic injuries constitute a significant global health burden; the World Health Organization estimates that they result in 1.35 million deaths annually. While most pedestrian injury studies rely predominantly on statistical modelling, this paper argues for a mixed-methods approach combining spatial analysis, environmental scans, and local knowledge for assessing environmental risk factors. Using data from the Nova Scotia Trauma Registry, severe pedestrian injury cases and ten corresponding hotspots were mapped across the Halifax Regional Municipality. Using qualitative observation, quantitative environmental scans, and a socioeconomic deprivation index, we assessed hotspots over three years to identify key social- and built-environmental correlates. Injuries occurred in a range of settings; however, clear patterns were not observed based on land use, age, or socio-economic status (SES) alone. Three hotspots revealed an association between elevated pedestrian injury and a pattern of geographic, environmental, and socio-economic factors: low- to middle-SES housing separated from a roadside attraction by several lanes of traffic, and blind hills/bends. An additional generalized scenario was constructed representing common risk factors across all hotspots. This study is unique in that it moves beyond individual measures (e.g., statistical, environmental scans, or geographic information systems (GIS) mapping) to combine all three methods toward identifying environmental features associated with pedestrian motor vehicle crashes (PMVC).

Contingent negative variation during a modified cueing task in simulated driving.

The obscured pedestrian-motor vehicle crash has become a serious danger to driving safety. The present study aims to investigate the contingent negative variation (CNV) during the anticipation of an obscured pedestrian-motor vehicle crash in simulated driving. We adopted two cueing tasks: (i) a traditional cognitive paradigm of cueing task that has been widely used to study anticipatory process, and (ii) a modified cueing task in simulated driving scenes, in which Electroencephalogram (EEG) signals of 32 participants were recorded to detect the CNV. Simulated car following and pedestrian crossing tasks were designed to measure anticipation-related driving behaviors. The results showed that both early and late CNVs were observed in two cueing tasks. The mean amplitude of the late CNV during a modified cueing task in simulated driving was significantly larger than that in a traditional cueing task, which was not the case for the early CNV potentials. In addition, both early and late CNVs elicited in simulated driving were significantly correlated with anticipatory driving behaviors (e.g., the minimum time to collision). These findings show that CNV potentials during the anticipation of an obscured pedestrian-motor vehicle crash might predict anticipation-related risky driving behaviors.

Evaluation of Pedestrian/Bicycle Crash Injury Case Definitions for Use with NC DETECT

ObjectiveTo evaluate four ICD-10-CM based case definitions designed to capture pedestrian and bicycle crash-related emergency department (ED) visits in North Carolina’s statewide syndromic surveillance system, NC DETECT.IntroductionOver the last few decades, the United States has made considerable progress in decreasing the incidence of motor vehicle occupants injured and killed in traffic collisions.1 However, there is still a need for continued motor vehicle crash (MVC) injury surveillance, particularly for vulnerable road users, such as pedestrians and bicyclists. In NC, the average annual number of pedestrian-motor vehicle crashes increased by 13.5 percent during the period 2011-2015, as compared to 2006-2010.2 Therefore, the Carolina Center for Health Informatics (CCHI), as part of a NC Governor’s Highway Safety Program-funded project to improve statewide MVC injury surveillance, developed and evaluated four ICD-10-CM based case definitions for use with NC DETECT, NC’s statewide syndromic surveillance system.MethodsWe created four pedestrian/bicycle crash injury case definitions based on ICD-10-CM transportation codes (“V-codes”): Traffic-Related Pedestrian Crashes, Traffic/Non-Traffic-Related Pedestrian Crashes, Traffic-Related Bicycle Crashes, and Traffic/Non-Traffic-Related Bicycle Crashes. These definitions were based on the Centers for Disease Control and Prevention (CDC) “ICD-10-CM External Cause of Injury Codes”.3 We then applied these pedestrian/bicycle crash case definitions to 2016-2017 NC DETECT ED visit data and data obtained from a single NC Level I Trauma Center. Next, we linked the two data sources using the variables date of visit, time of visit, and medical record number. Since trauma center data are collected and verified by a designated trauma registrar, we considered the data obtained from the Level I Trauma Center to be the “gold standard”.ResultsThe linkage between the two data sources was successful, with 99.5% of all Level I Trauma Center records linking to ED visits in NC DETECT. However, we found discrepancies in the assignment of codes between the ED visit and Trauma Center data. For example, 47.5% of NC DETECT ED visits that linked to a pedestrian/bicycle crash record in the Trauma Center data, were missing an ICD-10-CM injury mechanism code of any category. Historically, the proportion of injury-related ED visits that were missing corresponding injury mechanism codes was low (<15%). However, the transition from ICD-9-CM to ICD-10-CM increased the proportion of injury-related visits missing injury mechanism codes.4 Among the 92 NC DETECT ED visits missing injury mechanism codes, 35.9% contained a pedestrian/bicycle crash-related keyword in the Chief Complaint or Triage Note.Among the 100 linked records with valid ICD-10-CM injury mechanism codes, the percent agreement between the two data sources on whether the ED visit was a “pedestrian” or “bicycle” crash was 54.4% and 71.9%, respectively. Percent agreement decreased for “traffic” and “non-traffic” designations, however. The most common V-code assigned to misclassified pedestrian/bicycle crashes in the NC DETECT ED visit data was “V87.7XXA-Person injured in a collision between other specified motor vehicles (traffic)”.Although the linkage study used data obtained from only a single Level I Trauma Center and primarily a single facility in NC DETECT, we felt that the results of this limited linkage study were generalizable to statewide NC DETECT ED visit data. For example, many facilities in NC DETECT underreport injury mechanism codes. Therefore, we added pedestrian/bicycle crash injury-related keywords to the Traffic/Non-Traffic Pedestrian/Bicycle Crash Injury case definitions (Table 1). After inclusion of these keywords, the number of identified pedestrian and bicycle crash injury-related ED visits identified in NC DETECT increased by 16.9% and 57.9% from January-June 2018, respectively (Figure 1).ConclusionsPedestrian and bicycle crashes represent a major cause of MVC injury morbidity and mortality. Therefore, the development and evaluation of case definitions is key for the successful surveillance of these types of injuries. The inclusion of keywords can help account for some of the injury mechanism data missingness common to ED surveillance systems.

Random parameter probit models to analyze pedestrian red-light violations and injury severity in pedestrian–motor vehicle crashes at signalized crossings

Pedestrian red-light violations at signalized crossings are an important traffic safety concern, particularly in densely populated cities. In this study, the authors quantitatively investigated the factors associated with pedestrian red-light violations and injury severity resulting from pedestrian–motor vehicle crashes at signalized crossings. Random parameter probit models are used to account for individual-specific heterogeneity that arises from a set of unmeasured factors related to traffic conditions and the pedestrians’ physical and mental status. Data for the analysis are based on the historical crash record maintained by the Hong Kong Transport Department. Children younger than age 11 years are not only associated with a higher likelihood of pedestrian red-light violations but also tend to have a higher probability of severe injuries. Factors including summer, dual carriageways with a central traffic island, and pedestrian age of 12 to 25 years are solely related to a higher likelihood of pedestrian red-light violations; meanwhile, variables solely associated with a higher probability of severe injuries include crashes that occur between 22:00 and 06:59, crashes occurring in rainy weather, crashes involving pedestrians older than age 46 years, and bus crashes. Appropriate countermeasures are recommended to curb pedestrian red-light violations and to reduce the injury severity of pedestrian crashes.

An examination of the increases in pedestrian motor-vehicle crash fatalities during 2009–2016

IntroductionPedestrian fatalities increased 46% in the United States during 2009–2016. This study identified circumstances under which the largest increases in deaths occurred during this period. MethodAnnual counts of U.S. pedestrian fatalities and crash involvements were extracted from the Fatality Analysis Reporting System and General Estimates System. Poisson regression examined if pedestrian fatalities by various roadway, environmental, personal, and vehicle factors changed significantly during 2009–2016. Linear regression examined changes over the study period in pedestrian deaths per 100 crash involvements and in horsepower per 1000 pounds of weight among passenger vehicles involved in fatal single-vehicle pedestrian crashes ResultsPedestrian deaths per 100 crash involvements increased 29% from 2010, when they reached their lowest point, to 2015, the most recent year for which crash involvement data were available. The largest increases in pedestrian deaths during 2009–2016 occurred in urban areas (54% increase from 2009 to 2016), on arterials (67% increase), at nonintersections (50% increase), and in dark conditions (56% increase). The rise in the number of SUVs involved in fatal single-vehicle pedestrian crashes (82% increase) was larger than the increases in the number of cars, vans, pickups, or medium/heavy trucks involved in these crashes. The power of passenger vehicles involved in fatal single-vehicle pedestrian crashes increased over the study period, with larger increases in vehicle power among more powerful vehicles. ConclusionsEfforts to turn back the recent increase in pedestrian fatalities should focus on the conditions where the rise has been the greatest. Practical applicationsTransportation agencies can improve urban arterials by investing in proven countermeasures, such as road diets, median crossing islands, pedestrian hybrid beacons, and automated speed enforcement. Better road lighting and vehicle headlights could improve pedestrian visibility at night.

2384 - Risk Factors for Pedestrian Injury on Tribal Lands

Background American Indians have the highest rate of pedestrian death per capita among ethnic groups in the United States. In North Dakota, the incidence rate for pedestrian involvement in crashes 3.9% on tribal lands compared to less than 0.1% among other rural populations in the state. The cultural foundation of the American Indians includes a proclivity toward walking and community-based solutions. Nationally, contributing factors such as limited sight zone, alcohol involvement, no sidewalk facility, and uncontrolled intersections are attributed in these crashes. Methods Descriptive Statistics and Case Study. Information regarding pedestrian motor vehicle crash (MVC) involvement is available nationally for fatal crashes. The fatal crash data will be coupled with all injury-level crashes in North Dakota to look at these crashes from a local perspective as well as the national view. This state database is a census of police-reported traffic crashes in the state. Both data sets include data on incident, vehicle, and occupant crash elements. While these data do not provide a means for predicting pedestrian crash involvement, it can be used to gain a better understanding of the crash events. Results Quantitative Problem Scope and Trend Discussions and Tribal Community Case Study Solutions/Interventions. This analysis will use crash records from the years 2012 to 2016. Descriptive statistical analysis of crash records is used in a diagnostic process to distinguish crash elements associated with tribal lands MVC where pedestrian involvement. The pedestrian-involved MVC crashes on other roads will be compared for statistical similarity. Significant differences in driver, vehicle, environment, and roadway elements will be examined using the chi-square test. Gaining a better understanding of these tribal pedestrian-involved crashes will help decision makers to more effectively select the most appropriate evidence based solutions. Conclusions Investigation into crashes the occurred locally on tribal lands and other rural locations provides insight to aid tribal communities as they prevent future traffic injuries.

Wartime Soft Tissue Coverage Techniques for the Deployed Surgeon.

Since the start of the conflict in the Middle East in 2001, military orthopedic surgeons have faced complex orthopedic injuries including high-energy soft tissue wounds, traumatic amputations, and open fractures. Although orthopedic surgeons are well trained in the management of osseous injuries, the treatment of soft tissue injuries can be technically challenging and unfamiliar. Early washout, debridement of devitalized tissue, external fixation of bony injuries, and antibiotic therapy remain the foundation of early wound management. However, these unique extremity injuries have no standard plan of care, and definitive treatment options continue to evolve. The following report highlights the typical cases seen in the wartime setting and offers possible solutions for the associated soft tissue injuries. A single orthopedic surgeon at a Role 3 combat support hospital performed all cases in this series. This study is a report of the cases that the orthopedic surgeon encountered while deployed and the various techniques that can be used to manage the complex wounds seen in a deployed setting. Twelve patients were included in this report and the data are shown. Of the 12 patients, 6 were injured by an improvised explosive device (IED), 4 were injured by a high-velocity gunshot wound (HVGSW), 1 was injured by a gunshot wound (GSW), and 1 was injured in an auto versus pedestrian motor vehicle crash. The wound sizes ranged from 10 to 300 cm2. All patients required more than one irrigation and debridement before wound closure. There was a successful outcome in 11 of the 12 patients. The only patient without a known successful outcome was lost to follow up. Six patients were treated with split thickness skin graft (STSG) alone. Four patients were treated with STSG plus an additional means of coverage. One patient was treated with a random flap and one patient was treated with a full thickness skin graft. Integra was used in two of the patients. Each of the patients in whom integra was used had exposed bone and had a successful outcome with respect to tissue coverage. This study details different soft tissue coverage techniques that must be learned and possibly employed by the deployed surgeon. Limitations of this study include its retrospective nature and the selected sampling of cases. At initial presentation, the management of war wounds secondary to high-velocity gunshot wounds and improvised explosive devices can be quite daunting. Adhering to firm surgical principles of thorough and meticulous debridement is the foundation of later soft tissue reconstructive options. Once the tissue is deemed clear of infection and contamination, there are myriad treatment options utilizing flaps, synthetic materials, and skin grafting. These are relatively straightforward techniques that the general orthopedic surgeon can utilize while deployed in a combat setting. In the end, it is critical for deployed surgeons to learn multiple techniques to provide definitive soft tissue coverage in a wartime theater.

Race and ethnicity, neighborhood poverty and pediatric firearm hospitalizations in the United States

PurposeTo better understand the effects of race and/or ethnicity and neighborhood poverty on pediatric firearm injuries in the United States, we compared overall and intent-specific firearm hospitalizations (FH) with those of pedestrian motor vehicle crash hospitalizations (PMVH). MethodsWe used Nationwide Inpatient Sample data (1998–2011) among 0–15 year-olds in a 1:1 case-case study; 4725 FH and 4725 PMVH matched by age, year, and region. ResultsRisk of FH versus PMVH was 64% higher among black children, Odds ratio (OR) = 1.64, 95% confidence interval (95% CI) = 1.44–1.87, as compared to white children (P < .0001); this risk did not vary by neighborhood poverty (P interaction = .52). Risk of homicide FH versus PMVH was 842% higher among black (OR = 8.42, 95% CI = 6.27–11.3), 452% higher among Hispanics (OR = 4.52, 95% CI = 3.33–6.13) and 233% higher among other race (OR = 2.33, 95% CI = 1.52–3.59) compared to white children. There was a lower risk for unintentional FH among black OR = 0.73, 95% CI = 0.62–0.87, Hispanics (OR = 0.60, 95% CI = 0.49–0.74), and other (OR = 0.63, 95% CI = 0.47–0.83) compared to whites. These intent-specific risks attributed to race did not vary by neighborhood affluence. ConclusionsBlack children were at greater likelihood of FH compared to white children regardless of neighborhood economic status. Minority children had an increased likelihood of intentional FH and a decreased likelihood of unintentional FH as compared to white children irrespective of neighborhood income.

Pedestrian and bicycle plans and the incidence of crash-related injuries

This study examined the association between the presence of pedestrian and bicycle plans to pedestrian and bicyclist nonfatal and fatal injuries from 1997 to 2009 among 553 North Carolina (NC) municipalities. We considered all municipal plans (n=92; 49 pedestrian; 34 bicycle; and 9 combined plans featuring pedestrian and bicyclist components) published through 2009. Counts of pedestrian and bicyclist nonfatal and fatal injuries came from the NC Department of Transportation crash database, and the estimated number of pedestrian and bicycle trips per municipality in one year were used to calculate pedestrian and bicyclist nonfatal and fatal injury rates. In the 13-year study period, pedestrian/combined municipality plans and bicycle/combined municipality plans were present for 189 (2.6%) and 238 (3.3%) municipality-years, respectively. There were 11,795 nonfatal injuries, 9237 possible nonfatal injuries, and 1075 fatal injuries sustained by pedestrians in pedestrian–motor vehicle crashes. There were 4842 nonfatal injuries, 3666 possible nonfatal injuries, and 134 fatal injuries sustained by bicyclists in bicyclist–motor vehicle crashes. Although not statistically significant, unadjusted nonfatal and fatal injury rates among pedestrians and bicyclists were lower in those municipality-years in which plans had been published that year or in a year prior, compared to municipality-years lacking a plan. Adjusted rate ratios (RR) indicated that pedestrian nonfatal and fatal injury rates decreased in municipality-years with publication of pedestrian/combined plans (nonfatal injury RR: 0.75, 95% confidence interval (CI): 0.68, 0.82; fatal injury RR: 0.63, 95% CI: 0.46, 0.85). However, bicyclist nonfatal and fatal injury rates did not significantly change with publication of bicyclist/combined plans. Our research suggests that plan publication is associated with lower rates of nonfatal and fatal injury in pedestrians; this association was not observed for bicyclists. Further work must determine how the extent of implementation and quality of safety-related content within these plans affects changes in nonfatal and fatal injury rates.

Running the Numbers

This article summarizes statistics regarding pedestrian crash injuries in the state of North Carolina. This authors report characteristics of the pedestrian–motor vehicle crashes that were reported statewide for the 5-year period from 2007-2011, and include age, sex, and race/ethnicity of the people involved in the crashes, temporal and environmental factors, and type of roadway. Data used are from the Division of Motor Vehicles Crash Database, North Carolina Department of Transportation, a database of police crash reports. The authors present data from all crashes classified as reportable pedestrian crashes (those that involve greater than $1,000 in property damage and/or a personal injury), and include all road types (ie, state and local maintained roads). The authors note that pedestrian crashes tend to be especially serious. During this 5-year interval, more than 9% of pedestrians struck by a motor vehicle in North Carolina were killed, whereas the fatality rate for all crash-involved people (mostly drivers and passengers) was only 0.3% over the same time period. The authors conclude with a section of recommendations for improving pedestrian safety, including the use of engineering countermeasures and street redesign, as well as safety-related programs. Readers are referred to a new pedestrian safety campaign called Watch For Me NC (http://www.watchformenc.org).

Explaining reduction of pedestrian–motor vehicle crashes in Arkhangelsk, Russia, in 2005–2010

Objective. To explain a reduction in pedestrian–motor vehicle crashes in Arkhangelsk, Russia, in 2005–2010.Study design. Retrospective ecological study.Methods. For 2005–2010, police data on pedestrian–motor vehicle crashes, traffic violations, and total motor vehicles (MVs) were combined with data on changes in national road traffic legislation and municipal road infrastructure. Negative binomial regression was used to investigate trends in monthly rates of pedestrian–motor vehicle crashes per total MVs and estimate changes in these rates per unit changes in the safety measures.Results. During the 6 years, the police registered 2,565 pedestrian–motor vehicle crashes: 1,597 (62%) outside crosswalks, 766 (30%) on non-signalized crosswalks, and 202 (8%) on signalized crosswalks. Crash rates outside crosswalks and on signalized crosswalks decreased on average by 1.1% per month, whereas the crash rate on non-signalized crosswalks remained unchanged. Numbers of signalized and non-signalized crosswalks increased by 14 and 19%, respectively. Also, 10% of non-signalized crosswalks were combined with speed humps, and 4% with light-reflecting vertical signs. Pedestrian penalties for traffic violations increased 4-fold. Driver penalties for ignoring prohibiting signal and failure to give way to pedestrian on non-signalized crosswalk increased 7- and 8-fold, respectively. The rate of total registered drivers’ traffic violations per total MVs decreased on average by 0.3% per month. All studied infrastructure and legislative measures had inverse associations with the rate of crashes outside crosswalks. The rate of crashes on signalized crosswalks showed inverse associations with related monetary penalties.Conclusions. The introduction of infrastructure and legislative measures is the most probable explanation of the reduction of pedestrian–motor vehicle crashes in Arkhangelsk. The overall reduction is due to decreases in rates of crashes outside crosswalks and on signalized crosswalks. No change was observed in the rate of crashes on non-signalized crosswalks.

Targeting Pediatric Pedestrian Injury Prevention Efforts: Teasing the Information Through Spatial Analysis

Pediatric pedestrian injuries remain a major cause of childhood death, hospitalization, and disability. To target injury prevention efforts, it is imperative to identify those children at risk. Racial disparities have been noted in the rates of pediatric pedestrian injury and death. Children from low-income families living in dense, urban residential neighborhoods have a higher risk of sustaining pedestrian injury. Geographic information systems (GIS) analysis of associated community factors such as child population density and median income may offer insights into prevention. Using trauma registry E-codes for pedestrian motor vehicle crashes, children younger than 16 years were identified, who received acute care and were hospitalized at the University of Chicago Medical Center, a Level I pediatric trauma center, after being struck by a motor vehicle from 2002 to 2009. By retrospective chart review and review of the Emergency Medical Services run sheets, demographic data and details of the crash site were collected. Crash sites were aggregated on a block by block basis. A "hot spot" analysis was performed to localize clusters of injury events. Using Gi* statistical method, spatial clusters were identified at different confidence intervals using a fixed distance band of 400 m (≈ ¼ mile). Maps were generated using GIS with 2000 census data to evaluate race, employment, income, density of public and private schools, and density of children living in the neighborhoods surrounding our medical center where crash sites were identified. Spatial correlation is used to identify statistically significant locations. There were 3,521 children admitted to the University of Chicago Medical Center for traumatic injuries from 2002 to 2009; 27.7% (974) of these children sustained injuries in pedestrian motor vehicle injuries. From 2002 to 2009, there were a total of 106 traumatic deaths, of which 29 (27.4%) were due to pedestrian motor vehicle crashes. Pediatric pedestrian motor vehicle crash sites occurred predominantly within low-income, predominantly African-American neighborhoods. A lower prevalence of crash sites was observed in the predominantly higher income, non-African-American neighborhoods. Spatial analysis using GIS identified associations between pediatric pedestrian motor vehicle crash sites and the neighborhoods served by our pediatric trauma center. Pediatric pedestrian motor vehicle crash sites occurred predominantly within low-income, African-American neighborhoods. The disparity in prevalence of crash sites is somewhat attributable to the lower density of children living in the predominantly higher income, non-African-American neighborhoods, including the community immediately around our hospital. Traffic volume patterns, as a denominator of these injury events, remain to be studied.

Analyzing fault in pedestrian–motor vehicle crashes in North Carolina

Crashes between pedestrians and motor vehicles are an important traffic safety concern. This paper explores the assignment of fault in such crashes, where observed factors are associated with pedestrian at fault, driver at fault, or both at fault. The analysis is based on police reported crash data for 1997 through 2000 in North Carolina, U.S.A. The results show that pedestrians are found at fault in 59% of the crashes, drivers in 32%, and both are found at fault in 9%. The results indicate drivers need to take greater notice of pedestrians when drivers are turning, merging, and backing up as these are some of the prime factors associated with the driver being found at fault in a crash. Pedestrians must apply greater caution when crossing streets, waiting to cross, and when walking along roads, as these are correlated with pedestrians being found at fault. The results suggest a need for campaigns focused on positively affecting pedestrian street-crossing behavior in combination with added jaywalking enforcement. The results also indicate that campaigns to increase the use of pedestrian visibility improvements at night can have a significant positive impact on traffic safety. Intoxication is a concern and the results show that it is not only driver intoxication that is affecting safety, but also pedestrian intoxication. The findings show in combination with other research in the field, that results from traffic safety studies are not necessarily transferable between distant geographic locations, and that location-specific safety research needs to take place. It is also important to further study the specific effects of the design of the pedestrian environment on safety, e.g. crosswalk spacing, signal timings, etc., which together may affect pedestrian safety and pedestrian behavior.

The Identification Of Environmental Factors In Pediatric Pedestrian Motor Vehicle Crashes

The Identification Of Environmental Factors In Pediatric Pedestrian Motor Vehicle Crashes

Pediatric Pelvic Fractures: A Marker for Injury Severity

Pelvic fractures comprise a small number of annual Level I pediatric trauma center admissions. This is a review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures. This is a retrospective review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures during the 12-year period from 1992 to 2004. From 1992 to 2004, there were 2850 pediatric trauma admissions. Thirteen patients were identified with pelvic fractures; seven were boys and six were girls. The average age was 8 years old. The mechanism of injury in all cases was motor vehicle related; 11 patients (87%) sustained pedestrian-motor vehicle crashes. According to the Torode and Zeig classification system, type III fractures occurred in eight patients (62%) and type IV fractures occurred in six patients (31%). Associated injuries occurred in eight patients (62%). Seven of these patients (88%) had associated injuries involving two or more organ systems. Of the associated injuries, additional orthopedic injuries were the most common, occurring in 62 per cent of our patients. Neurological injuries occurred in 54 per cent of patients, vascular injuries in 39 per cent, pulmonary injuries in 31 per cent, and genitourinary injuries in 15 per cent. Five patients (38%) were treated operatively; only two patients underwent operative management directly related to their pelvic fracture. The remaining three patients underwent operative management of associated injuries. The mortality rate was 0 per cent. Although pelvic fractures are an uncommon injury in pediatric trauma patients, the morbidity associated with these injuries can be profound. The majority of pelvic fractures in children are treated nonoperatively, however, more than one-half of these patients have concomitant injuries requiring operative management. When evaluating and treating pediatric pelvic fractures, a systematic multidisciplinary approach must be taken to evaluate and prioritize the pelvic fracture and the associated injuries.

A review of evidence-based traffic engineering measures designed to reduce pedestrian-motor vehicle crashes.

We provide a brief critical review and assessment of engineering modifications to the built environment that can reduce the risk of pedestrian injuries. In our review, we used the Transportation Research Information Services database to conduct a search for studies on engineering countermeasures documented in the scientific literature. We classified countermeasures into 3 categories-speed control, separation of pedestrians from vehicles, and measures that increase the visibility and conspicuity of pedestrians. We determined the measures and settings with the greatest potential for crash prevention. Our review, which emphasized inclusion of studies with adequate methodological designs, showed that modification of the built environment can substantially reduce the risk of pedestrian-vehicle crashes.

Pedestrian crashes in Washington, DC and Baltimore

Police crash reports were obtained for pedestrian-motor vehicle crashes in Washington, DC ( N=852) and Baltimore ( N=1234) for the year 1998. Reports were coded using procedures developed and applied in these two cities during the 1970s, including the determination of pedestrian crash type, primary precipitating factor, and culpability. Results indicated substantial differences between crash patterns observed during the 1970s and those observed during 1998. Midblock dart–dash crashes, which typically involve a precipitating factor or critical error by a child pedestrian, decreased (from 37% to 15% in Washington). Across all crashes in both cities, the number of drivers who made a critical error leading to the crash was nearly equivalent to the number of pedestrians who made a critical error. Overall, pedestrians were slightly more likely to be judged culpable (50% vs. 39%). Turning vehicle crashes, which typically involve a driver's failure to grant a pedestrian the right of way at a signalized intersection, increased (from 9% to 25% in Washington). Countermeasures to reduce the number of pedestrians hit by turning vehicles are discussed.