The pedestrian problem: a 12-month review of pedestrian accidents

Pedestrian injuries and vehicle type in Maryland, 1995-1999

Pedestrian deaths constitute the second largest category of motor vehicle deaths in the US. The present study examined how pedestrian injury is associated with vehicle type, while controlling for vehicle weight and speed.Police, trauma registry, and autopsy data were linked for injured pedestrians. Logistic regression analyses were performed to control for vehicle weight and speed. Outcomes included pedestrian mortality, injury severity score, and injuries to specific body regions. Compared to conventional cars, pedestrians hit by sport utility vehicles and pick-up trucks were more likely to have higher injury severity scores (odds ratio=1.48; 95% confidence interval: 1.18-1.87) and to die (odds ratio=1.72; 95% confidence interval: 1.31-2.28). These relationships diminished when vehicle weight and speed were controlled for. At lower speeds, pedestrians struck by sport utility vehicles, pick-up trucks, and vans were approximately two times as likely to have traumatic brain, thoracic, and abdominal injuries; at higher speeds, there was no such association. The overall increased danger sport utility vehicles and pick-up trucks present to pedestrians may be explained by larger vehicle masses and faster speeds. At slower speeds being hit by sport utility vehicles, and pick-up trucks, and vans resulted in specific injuries, indicating that vehicle design may contribute to different injury patterns.

Traffic injury data, policy, and public health: lessons from Boston Chinatown

We note that long-standing land use and transportation policy are critical factors in creating traffic conditions and will have to play a role in reducing injuries. We present the historical progression of events that created current traffic conditions in Boston Chinatown and an analysis of traffic-related injuries at the community level for the years 1996-1998. Injuries were found to be as likely on weekends as on weekdays and frequently occurred late at night. Nighttime occupant injuries were found to be more likely on Friday, Saturday, and Sunday nights (relative risk = 2.26; confidence interval = 1.35-3.78, P =.0014). Injuries varied significantly by location for occupant (P = <.001) and for pedestrian injuries (P =.039). There were no peaks of injuries at traditionally defined commuter hours, which have been the standard time for assessing "worst case" traffic impacts by developers and government agencies. There was, however, a strong association between injuries and vehicle volume at 9 intersections with simple configurations for AM and PM commuter hours (R(2) = 0.589, P =.010), resulting in a calculated increase of 3-5 injuries per year for each increase of 1,000 vehicles. There was no such association at 10 intersections with complex configurations (R(2) = 0.104, P =.397). The 24-hour weekend patterns of vehicle volumes showed that traffic abated only between 3 and 7 AM, and the patterns appeared qualitatively to mirror the 24-hour pattern of injuries, suggesting that they were also indicative of injury risk. We suggest that there is a need for both long-term changes in policy and more immediate interventions. We also conclude that researchers should be cautious about assuming that traffic patterns conform to naive expectations such as rush hour peaks.

Can a community inject public health values into transportation questions?

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The epidemiology of fractured femurs and the effect of these factors on outcome

We have analysed 250 cases of fractured shaft of the femur with the objective of highlighting any preventative measures and anticipating morbidity associated with cause and type of injury. The younger patients typically injure themselves as pedestrians, motorcyclists and bicyclists in Summer. The older patients tend to have falls in late Summer and Winter. The outcome varies depending on the cause, type and age of the injured person. The greatest morbidity was found in high-velocity accidents involving motorcyclists, pedestrians and car accidents. Knee flexion is a particular problem with these injuries and we are currently using continuous passive motion in conjunction with a continuous opiate infusion where this is likely to be a problem. The results also suggest that the mechanism of injury and its possible prevention, particularly in motorcycle design, could be as important as the type of treatment. Elderly females following falls also form a distinct group, suggesting that osteoporosis is a major factor with the best outcome associated with treatment by internal fixation. We feel that age alone should not be a reason for exclusion from intramedullary fixation and this merits further study.

Injuries associated with a fractured shaft of the femur

A knowledge of injury patterns, both from the mechanism of injury and from their associations, allows specific injuries to be suspected and actively excluded. We have reviewed fractures of the femoral shaft to highlight the patterns of their associated high morbidity and mortality. Our survey shows that accidents involving motorcyclists, pedestrians and motor cars have the highest incidence of associated injury. Common associations include chest, head, pelvis and ipsilateral leg injuries in pedestrians, and pelvic and ipsilateral leg injuries in motorcyclists. Rarer associations with femoral shaft fractures include ipsilateral tibia and talus/navicular fractures in motorcyclists, knee injuries and contralateral acetabular fractures in pedestrians and contralateral necks of femur in motor car passengers.

Pedestrian accidents on Merseyside: the case for criminalization of jaywalking

During a 12-month review within Merseyside, 85 serious pedestrian accidents (ISS > 15 or death), were identified. Analysis of police accident statistics showed that 17 per cent of these cases had not been recorded. Children and the elderly made up 64 per cent of those injured. Accidents were more common in the afternoon and evening and evenly spread throughout the week. There was a low rate of alcohol testing among casualties who died and involved drivers. The majority of accidents occurred in good visibility and weather; 90 per cent were due to pedestrian behaviour.

Pattern and severity of injury sustained by pedestrians in road traffic accidents with particular reference to the effect of alcohol

The injuries sustained by 102 pedestrians consecutively admitted to the Accident and Emergency Department of the Royal Infirmary of Edinburgh were prospectively recorded. Injuries were categorized by body regions and the severity assessed by the ISS/AIS system. Pedestrian injuries were found to comprise 0.8 per cent of the department workload and 28 per cent of RTA injuries. The commonest sites of injury were the right leg and head. Injuries to the right side of the body were almost three times more frequent than those to the left. Patients considered to be under the influence of alcohol had more severe and widespread injuries, were more likely to have facial injuries, and were more likely to be detained as inpatients. Males were more commonly injured than females and the predominant age group was 20-29 years. The group affected by alcohol was predominantly male and young, whereas the group unaffected by alcohol included a considerable number of elderly people. The possible reasons for the pattern of injuries are discussed and the contribution of alcohol to the morbidity suffered by pedestrians is stressed.

Injuries to pedestrians in road traffic accidents

Although there have been many reports on injuries to occupants of cars in road traffic accidents, there have been few prospective studies of injuries to pedestrians in such accidents. For this reason a two year prospective study of pedestrians in road traffic accidents in the Oxford region was carried out. The incidence of death in pedestrians was significantly higher than in car occupants or motorcyclists. The principal determinant of death was the weight of the vehicle concerned. The most common site of injury was the head because of a high incidence of brief concussion, but the most common site of serious injuries was the leg. Injuries to all regions of the body increased with age and with the weight of the vehicle in the collision. Accidents most often concerned young children or the elderly.