Pediatric Pedestrian Injuries Research Articles

Integrating selective attention into developmental pedestrian safety research.

Abstract Pedestrian injury affects thousands of Canadian children many of whom die as a result of related accidents. Pedestrian behaviours involve numerous cognitive development factors that influence the interaction between child and environment. One such cognitive factor is selective attention. Guided by a cognitive framework, this paper explores links between the development of selective attention and children's pedestrian behaviours, and suggests future directions for the inclusion of selective attention in pedestrian safety research. Links Between Development and Selective Attention in Pedestrian Injury Risk Thousands of children between the ages of 5 and 9 are killed or injured as pedestrians each year (Canadian Institute of Child Health, 2000; National Center for Injury Prevention and Control, 2005; U.S. Department of Transportation, 2001). In addition to injury or loss of life, pediatric pedestrian injuries cost more than $10 billion annually (National Safety Council, 2001). Although recent work has led to progress in understanding risk factors for pedestrian injury (Schwebel & Barton, 2005), there is still much to be learned. The etiology of pedestrian injuries is complex, involving multiple child risk factors (Schwebel & Barton, 2005) and interactions with environmental variables (Barton & Schwebel, 2006b). Gender, for example, is a risk factor with the rate of pedestrian injury being higher among boys (Assailly, 1997; Durkin, Laraque, Lubman, & Barlow, 1999; Macpherson, Roberts, & Pless, 1998). Another risk factor is temperamental control. Children with a tendency to behave impulsively choose riskier routes through a pedestrian setting (Barton & Schwebel, 2006a). A more commonly cited risk factor for pedestrian injury is age (e.g., Assailly, 1997). Some research indicates children between the ages of 5 and 9 are at highest risk (Assailly, 1997; Durkin et al., 1999), while other evidence suggests pedestrian injuries peak between the ages of 10 and 11 years (National Center for Injury Prevention and Control, 2005). Regardless, middle childhood has been consistendy identified as a time of elevated risk for pedestrian injury (Assailly, 1997; Canadian Institute of Child Health, 1998; Durkin et al., 1999; Malek, Guyer, & Lescohier, 1990; National Center for Injury Prevention and Control, 2005). During this developmental period, children begin to range farther from home, exploring pedestrian environments without adult supervision. In fact, many parents are comfortable allowing their children to cross neighbourhood streets independently by age 6 or 7 (Agran, Winn, & Anderson, 1994; Rivara, Bergman, & Drake, 1989; Wills et al., 1997). However, children's cognitive ability to handle the demands of safely crossing streets is not sufficiently developed during middle childhood. Although a seemingly straightforward and simple task, a street crossing is in fact rather complex. Children must identify safe places to initiate a street crossing. They must then adequately sample the direction and flow of cars so that important information is not missed. Finally, they must identify safe crossing gaps in traffic by attending to the speed and distance of vehicles and to visual occlusions such as parked cars or curves and inclines on the roadway. Such a complex task is usually difficult for children. As examples, young children tend to inefficiendy use the time available for crossing through a safe gap in traffic. Children tend to be overly conservative and often hesitate to begin crossing after selecting a gap in traffic (Demetre et al., 1992; Plumert, Kearney, & Cremer, 2004). As a result of hesitation in initiating a crossing, children waste part of a safe crossing gap and increase their risk for injury. Younger children also attend more to the presence of a vehicle in a pedestrian setting and ignore speed and distance (Connelly, Conaglen, Parsonson, & Isler, 1998). …

Optimal Driving Conditions are the Most Common Injury Conditions for Child Pedestrians

Motor vehicle-pedestrian crashes are one of the leading causes of serious injury in children. Prior studies have focused on child and traffic factors contributing to these crashes. The objective of the current study was to examine the role of driving conditions on the occurrence of motor vehicle crashes involving child pedestrians. Detailed information was abstracted for the period January 1994 to December 1999 from the Philadelphia Police Department accident reports for all pediatric (age <18 years) pedestrian crashes in a single, urban county. Data included pedestrian age, road and weather conditions, illumination, pedestrian location, and intent, time of day, and date of incident. For the 6-year period of review, there were 3823 children under 18 years of age struck by motor vehicles (range 518 to 726 crashes per year), representing an average of 1.7 per day and a rate of 181 crashes per 100,000 children per year. The mean age was 7.9 years +/- 3.9 (range 1 to 17 years). Crashes occurred when the street was dry (>90%), with no adverse weather conditions (>90%), and during daylight hours or under streetlights (>92%). The most frequent day of the week was Friday (18.1%). The most common time of day was 3:00 to 6:00 PM (38.7%). The spring months (39.1%) predominated, with May (14.0%) being the most common month and January the least. When the circumstances were known, children were struck crossing in midblock 87.9% of cases and crossing behind a vehicle 38.8% of the time; only 4.8% were struck while playing in the street. Injuries as reported by the police exceeded minor in 32.3% with an overall fatality rate of 0.7%. Urban pediatric pedestrian crashes are common and occur most frequently during optimal driving conditions (good lighting, a dry road, and good weather). The data also suggest that pedestrian crashes are related to the saturation of the streets with children (optimal play conditions) compounded by poor street-crossing technique. Prevention efforts should reinforce the fact that optimal driving conditions are also likely to represent optimal conditions for child play and may increase the risk for pediatric pedestrian injuries through increased exposure.

Child Pedestrian Injury in an Urban Setting Descriptive Epidemiology

Abstract Objective: To describe the epidemiology of pedestrian injuries to children and adolescents (ages &lt;20 years) in an urban setting, providing analyses of environmental and pedestrian variables. Methods: Anonymous data were obtained for all motor vehicle crashes occurring in New York City over a seven‐year period (1991‐1997). Results: Among 693,283 crashes, 97,245 resulted in injuries to 100,261 pedestrians, of whom 32,578 were under the age of 20. Using census counts for the denominator, the overall incidence of pediatric pedestrian injuries was 246/100,000 per year, and the case fatality rate was 0.6%. Incidence rates peaked in the 6‐14‐year age group, and showed a modest annual decline during the study period. Younger children were more likely to be struck mid‐block and during daylight hours, whereas adolescents were more likely to be struck at intersections and at night. For younger children, there was a sharp peak in incidence during the summer months. Road and weather conditions did not appear to affect injury risk. Conclusions: These results help identify priorities for child pedestrian injury prevention and education, inform public health policy, and direct emergency medical health services resource allocation.

Child pedestrian injury in an urban setting: descriptive epidemiology.

To describe the epidemiology of pedestrian injuries to children and adolescents (ages <20 years) in an urban setting, providing analyses of environmental and pedestrian variables. Anonymous data were obtained for all motor vehicle crashes occurring in New York City over a seven-year period (1991-1997). Among 693,283 crashes, 97,245 resulted in injuries to 100,261 pedestrians, of whom 32,578 were under the age of 20. Using census counts for the denominator, the overall incidence of pediatric pedestrian injuries was 246/100,000 per year, and the case fatality rate was 0.6%. Incidence rates peaked in the 6-14-year age group, and showed a modest annual decline during the study period. Younger children were more likely to be struck mid-block and during daylight hours, whereas adolescents were more likely to be struck at intersections and at night. For younger children, there was a sharp peak in incidence during the summer months. Road and weather conditions did not appear to affect injury risk. These results help identify priorities for child pedestrian injury prevention and education, inform public health policy, and direct emergency medical health services resource allocation.

Driveway crush injuries in young children: A highly lethal, devastating, and potentially preventable event

Background/Purpose: The aim of this study was to investigate driveway-related injuries in children, identify associated risk factors, and evaluate outcome compared with other mechanisms of blunt trauma. Methods: A 6-year review (1991 to 1996) of pediatric (age less than 18 years) pedestrian injuries treated at two urban trauma centers was conducted: one regional pediatric trauma center and one level I trauma center with pediatric commitment. Five hundred twenty-seven children injured in pedestrian accidents were identified from the trauma registry; 51 children (10%) sustained traumatic injuries as a result of being struck in their driveway. Data are reported as mean ± SEM. Results: Children less than 5 years of age (n = 41) had an injury severity score (ISS) of 12.3 ± 2.3, 15 (37%) sustained closed head injury, 13 (37%) had torso trauma, 19 (46%) skeletal trauma, and eight (20%) died. Children ≥ 5 years old (n = 10) had an ISS of 10.7 ± 2.4, three (30%) sustained closed head injury, four (40%) torso trauma, six (60%) skeletal trauma, and none died. In contrast, all other pediatric pedestrian accidents analyzed over the same time period had a mortality rate of only 2% (11 of 476). Conclusions: Pediatric driveway trauma carries a significant risk of head injury and a 10-fold increase in mortality in children under 5 years of age when compared with all other pediatric pedestrian accidents. More emphasis must be placed on injury prevention and public education to prevent this devastating mechanism of injury in these young, vulnerable children.

Pediatric pedestrian injuries: a community assessment using a hospital surveillance system.

To provide a descriptive demographic and environmental account of pedestrian injuries among children aged < or =15 years in Jefferson County, Alabama. This was a retrospective study with a case definition for inclusion of individuals, aged < or =15 years, who suffered a pedestrian injury and sought care at The Children's Hospital of Alabama between 1989 and 1991. Demographic and injury-related information was obtained from the medical record and analyses were performed using t-test and a simple correlation. The majority of the cases were nonwhite, and nearly half had Medicaid or were uninsured. The most common injuries were fractures and closed head trauma. The geographic locations of injury events were not uniformly distributed: a comparison of areas wherein an injury occurred with those that were injury-free revealed a number of significant differences with regard to specific demographic, socioeconomic, and ecological factors. Some of the possible manageable environmental risk factors identified in this study were relatively high posted speed limits; sidewalks that were narrow, absent, or in a state of disrepair; vehicular parking on both sides of the street; and the absence of a divided highway. In this community, the most cost-effective educational intervention may best be targeted to elementary-aged schoolchildren living in areas with low-income families and that have a high density of children.

The Role of the Physical and Traffic Environment in Child Pedestrian Injuries

To identify environmental risk factors on residential streets for pediatric pedestrian injuries. The sample consisted of 39 Latino children 0 to 14 years of age injured as pedestrians on a street in the same block as their home and 62 randomly selected neighborhood control subjects matched to the case by city, age or year of birth, ethnicity, and gender. The cases were identified from a population-based hospital and coroner's office surveillance system established in north-central Orange County, CA. Neighborhood assessments were performed from 3:45 PM to 5 PM, a fairly active time for young pedestrians. The cases were compared with the controls using conditional logistic regressions; in this study design, the odds ratios were interpreted as estimates of the incidence rate ratios. Children living in a multifamily residence had an incidence of injury greater than that of children living in single-family residence on a single lot (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.6). The ORs in the highest category were several times those in the lowest category for both parked vehicles (OR 9.6, 95% CI 2.6-36) and total number of pedestrians observed (OR 4.7, 95% CI 1.4-16). Vehicle parking, total pedestrians, vehicular traffic volume, and speed were examined in a multivariate model. The association of vehicles parked on the street with pedestrian injury risk remained significant. Unlike the crude results, progressively greater vehicular speed was associated with a marked increase in risk. Progressively higher vehicular traffic volume was associated with a progressively lower adjusted OR. The results of this analysis would indicate that residential streets with a high proportion of multifamily residence, over 50% of the curb occupied with parked vehicles, and a large number of pedestrians observed in unenclosed areas should receive high priority for intervention programs to reduce pediatric pedestrian injuries. The analysis suggests that on these streets, measures to reduce the amount of street parking (thus increasing visibility) and reductions in vehicular speed should be considered to decrease pedestrian injuries.

Pedestrian Injuries to Children Younger Than 5 Years of Age

Historically, research on pediatric pedestrian injuries has analyzed children younger than 5 years of age as a single group. However, in this study, these children were divided into two age groups which were reflective of differences in behavior and development. The data demonstrate differences in the circumstances of the pedestrian injury events between toddlers (0 through 2 years and ambulatory) and preschoolers (3- and 4-year-olds). Toddlers were more likely to be injured in nontraffic events whereas preschoolers were more frequently injured in traffic situations. A high proportion of toddler injuries occurred in residential driveways and were caused by vehicles backing up. The majority of preschoolers, often without supervision, were injured while crossing/darting midblock on residential streets near their homes. Reflecting these differences in circumstances and also developmental differences between toddlers and preschool children, there is a need for age-specific interventions to reduce pedestrian injuries in children younger than 5 years of age.