This study examined two-level (road environments and census tracts) built environments related to the probability of severe injury for pedestrians. In total, 1407 pedestrian–vehicle crashes (years 2008–2012) were identified from 140 census tracts in the city of Austin. Two multilevel models were applied to examine pedestrian injury severity by using level-1 factors (individual characteristics, road environments, and area characteristics around the crash location) and level-2 factors (characteristics of census tracts). The results demonstrated the importance of using the multi-level model to avoid the biased results from employing the single-level model. This study showed that the likelihood of being severely injured or killed decreased when vehicles turned left, when crashes occurred at intersections, when there were traffic control devices at the crash location, and when crashes occurred during inclement weather conditions. Areas with higher sidewalk densities and higher percentage of commercial uses were negative correlates, while population density was a positive predictor. Pedestrian injury severity has been and will continue to be an important topic for the fields of public health. Future safety programs should focus on providing connected sidewalks and on populated areas.