Pedestrian injuries to children and youth

Joint Effect of Heavy Vehicles and Diminished Light Conditions on Paediatric Pedestrian Injuries in Backover Crashes: A UK Population-Based Study

Backover crashes cause considerable injuries especially among young children. Prior research on backover crashes has not assessed the joint effect of heavy vehicles and diminished light conditions on injuries. By analysing the United Kingdom STATS19 crash dataset from 1991 to 2020, this study focused on backover crashes involving paediatric cyclists or pedestrians aged ≤17 years and other motorised vehicles. By estimating the adjusted odds ratio (AOR) of multiple logistic regression models, pedestrians appeared to have 82.3% (95% CI: 1.78-1.85) higher risks of sustaining killed or serious injuries (KSIs) than cyclists. In addition, casualties involved in backover crashes with heavy vehicles were 39.3% (95% CI: 1.35-1.42) more likely to sustain KSIs than those involved in crashes with personal cars. The joint effect of heavy vehicles and diminished light conditions was associated with a 71% increased probability of sustaining KSIs (AOR = 1.71; 95% CI: 1.60-1.83). Other significant joint effects included young children (aged 0 to 5 years) as pedestrian (AOR = 1.92; 95% CI: 1.87-1.97), in diminished light conditions (AOR = 1.23; 95% CI: 1.15-1.31), and with heavy vehicle (AOR = 1.37; 95% CI: 1.28-1.47).

Evaluating pedestrian crashes in areas with high low-income or minority populations

In this paper, we present an analysis of the relationship between pedestrian-vehicle crashes and characteristics of areas with high low-income and minority populations in the Chicago metropolitan area (also called environmental justice or EJ areas in the United States). While related research has indicated that pedestrian crashes occur more frequently in these areas than in non-EJ areas, this paper attempts to relate the incidence to environmental characteristics and behavioral factors through a better understanding of the contributing factors present in crash occurrences in EJ versus non-EJ areas. Specially constructed small-area factors from a Spatial Decision Support System (SDSS) are used to explain pedestrian-vehicle crashes. Using a Poisson model that corrects for underreporting, we find that pedestrian crash incidents in EJ areas are related to variables of exposure (including the suitability of the area for walking and transit accessibility), crime rates, transit availability, and general population demographics such as income and presence of children. Results suggest that it may be necessary to better incorporate a safety perspective or measures of safety improvements in pedestrian and transit improvements and expansion programs within EJ areas.

Street Crossing by Typically Developed Children in Real and Virtual Environments

Independent street crossing is a necessary skill for children to have so they can engage in different occupations and complete tasks such as arriving at school or after-school activities. Without the appropriate opportunities to practice and master street crossing, children's participation will be incomplete and they will not be able to attain their physical, emotional, and intellectual potentials. Training children in safe street crossing is especially important because pedestrian injury is the second leading cause of death and serious injury among children between 5 and 14 years old. The existing methods for teaching children how to cross a street safely are difficult to transfer to real-life situations. The purpose of the current study was to evaluate the effectiveness of a virtual reality environment in teaching children how to cross a street safely. Eighty-six typical children (55 girls and 31 boys) between 7 and 12 years old participated in the study. The children who failed the virtual reality test were randomly assigned to training and control groups. The children were observed while crossing a real street and tested within the virtual environment both before and after the virtual reality training. Results indicate that children in the training group significantly improved their street crossing abilities in both the virtual reality simulation and the real street crossing in comparison to the control group. Street crossing became safer with increasing age, but no differences were found between boys and girls. This low-cost and readily available street crossing simulation had a positive effect on children's street crossing behavior in the real environment and on their self-reported satisfaction. These results provide support for the potential of training in a virtual street crossing simulation to transfer to actual street crossing.

The prevalence of driveway back-over injuries in the era of sports utility vehicles

BACKGROUND

Small children are vulnerable to serious accidents when a motor vehicle is placed in motion in a driveway. We describe a series of such accidents, consider the predisposing factors, and analyze the outcomes.

METHODS

We conducted a retrospective review of the trauma database of a large, level I, freestanding children's hospital with specific attention to driveway auto-pedestrian accidents.

RESULTS

During an 8-year period, 495 children were treated for injuries sustained in auto-pedestrian accidents, with 128 occurring in the driveway. The children's median age was 2.9 years, with 54% of the injuries sustained by boys. These often serious accidents carried an overall mortality rate of 6%. The most common injuries were abrasions, blunt head injury, and fractures. Chest trauma was associated with the highest mortality (11%), and both chest and abdominal trauma had the highest median Injury Severity Score of 13. Orthopedic injuries were the most common reason for operative intervention. Thirty-one percent of the children required intensive care unit monitoring, with their average unit stay being 3.9 days. Cars, trucks, and sports utility vehicles comprised 55%, 25%, and 12% of the accidents, respectively. Truck accidents carried the highest mortality rate (19%). Accidents were more likely to occur between 3:00 and 8:00 pm, between Thursday and Saturday, and between May and October. An increasing number of accidents occurred during the last 4 years of the study.

CONCLUSIONS

Driveway injuries are an underrecognized often severe form of auto-pedestrian accidents. To prevent these family tragedies, drivers of large vehicles with children younger than 12 years old should be extremely attentive and account for children outside the vehicle before moving.

Effectiveness of virtual reality for teaching pedestrian safety

Sixty percent to 70% of pedestrian injuries in children under the age of 10 years are the result of the child either improperly crossing intersections or dashing out in the street between intersections. The purpose of this injury prevention research study was to evaluate a desktop virtual reality (VR) program that was designed to educate and train children to safely cross intersections. Specifically, the objectives were to determine whether children can learn pedestrian safety skills while working in a virtual environment and whether pedestrian safety learning in VR transfers to real world behavior. Following focus groups with a number of key experts, a virtual city with eight interactive intersections was developed. Ninety-five children participated in a community trial from two schools (urban and suburban). Approximately half were assigned to a control group who received an unrelated VR program, and half received the pedestrian safety VR intervention. Children were identified by group and grade by colored tags on their backpacks, and actual street crossing behavior of all children was observed 1 week before and 1 week after the interventions. There was a significant change in performance after three trials with the VR intervention. Children learned safe street crossing within the virtual environment. Learning, identified as improved street-crossing behavior, transferred to real world behavior in the suburban school children but not in the urban school. The results are discussed in relation to possibilities for future VR interventions for injury prevention.

Epidemiology and prevention of traffic injuries to urban children and adolescents

OBJECTIVES

To describe the incidence of severe traffic injuries before and after implementation of a comprehensive, hospital-initiated injury prevention program aimed at the prevention of traffic injuries to school-aged children in an urban community.

MATERIALS AND METHODS

Hospital discharge and death certificate data on severe pediatric injuries (ie, injuries resulting in hospital admission and/or death to persons age <17 years) in northern Manhattan over a 13-year period (1983-1995) were linked to census counts to compute incidence. Rate ratios with 95% CIs, both unadjusted and adjusted for annual trends, were calculated to test for a change in injury incidence after implementation of the Harlem Hospital Injury Prevention Program. This program was initiated in the fall of 1988 and continued throughout the study period. It included 1) school and community based traffic safety education implemented in classroom settings in a simulated traffic environment, Safety City, and via theatrical performances in community settings; 2) construction of new playgrounds as well as improvement of existing playgrounds and parks to provide expanded off-street play areas for children; 3) bicycle safety clinics and helmet distribution; and 4) a range of supervised recreational and artistic activities for children in the community.

PRIMARY RESULTS

Traffic injuries were a leading cause of severe childhood injury in this population, accounting for nearly 16% of the injuries, second only to falls (24%). During the preintervention period (1983-1988), severe traffic injuries occurred at a rate of 147.2/100 000 children <17 years per year. Slightly <2% of these injuries were fatal. Pedestrian injuries accounted for two thirds of all severe traffic injuries in the population. Among school-aged children, average annual rates (per 100 000) of severe injuries before the intervention were 127.2 for pedestrian, 37.4 for bicyclist, and 25.5 for motor vehicle occupant injuries. Peak incidence of pedestrian and bicyclist injuries occurred during the summer months and afternoon hours, whereas motor vehicle occupant injuries showed little seasonal variation and were more common during evening and night-time hours. Age-specific rates showed peak incidence of pedestrian injuries among 6- to 10-year-old children, of bicyclist injuries among 9- to 15-year-old children, and of motor vehicle occupant injuries among adolescents between the ages of 12 and 16 years. The peak age for all traffic injuries combined was 15 years, an age at which nearly 3 of every 1000 children each year in this population sustained a severe traffic injury. Among children hospitalized for traffic injuries during the preintervention period, 6.3% sustained major head trauma (including concussion with loss of consciousness for >/=1 hour, cerebral laceration and/or cerebral hemorrhage), and 36.9% sustained minor head trauma (skull fracture and/or concussion with no loss of consciousness >/=1 hour and no major head injury). The percentage of injured children with major and minor head trauma was higher among those injured in traffic than among those injured by all other means (43.2% vs 14.2%, respectively; chi2 = 336; degrees of freedom = 1). The percentages of children sustaining head trauma were 45.4% of those who were injured as pedestrians, 40.2% of those who were injured as bicyclists, and 38.9% of those who were injured as motor vehicle occupants. During the intervention period, the average incidence of traffic injuries among school aged children declined by 36% relative to the preintervention period (rate ratio:.64; 95% CI:.58,.72). After adjusting for annual trends in incidence, pedestrian injuries declined during the intervention period among school aged children by 45% (adjusted rate ratio:.55; 95% CI:.38,.79). No comparable reduction occurred in nontargeted injuries among school-aged children (adjusted rate ratio:.89; 95% CI:.72, 1.09) or in traffic injuries among younger children who

A review of risk factors for child pedestrian injuries: are they modifiable?

PURPOSE

To identify modifiable risk factors for child pedestrian injuries.

DATA SOURCES

(1) MEDLINE search from 1985 to 1995; search term used was traffic accidents; (2) review of reference lists from retrieved articles and books; (3) review of reference lists from three systematic reviews on childhood injuries and (4) consultation with 'key informants'.

STUDY SELECTION

All studies that examined the risk factors for child pedestrian injuries were targeted for retrieval. Seventy potentially relevant articles were identified using article titles, and, when available, abstracts. Of the 70 retrieved articles, 44 were later assessed as being relevant.

QUALITY ASSESSMENT

Articles were classified on the basis of study design as being either descriptive (hypothesis generating) (26) or analytical (hypothesis testing) (18) studies. Consensus was used for difficult to classify articles.

DATA EXTRACTION

Variables judged to be risk factors for child pedestrian injuries were extracted by one author.

DATA SYNTHESIS

A qualitative summary of the information extracted from relevant articles is presented in tabular form.

RESULTS

Risk factors for child pedestrian injuries were classified as: (1) child, (2) social and cultural, (3) physical environment, and (4) driver. Risk factors within each classification are summarized and discussed.

Paediatric slow-speed non-traffic fatalities: Victoria, Australia, 1985-1995

An important group of fatal incidents are slow-speed pedestrian non-traffic incidents to children, which account for 14% of accidental deaths from all causes in Victorian children under 5 years of age between 1985 and 1995, and 12% of pedestrian deaths of all ages. In Victoria, Australia, the database of the state Consultative Council on Obstetric and Paediatric Morbidity and Mortality was utilised to identify paediatric slow-speed pedestrian non-traffic-accident deaths in the local population. Additional data relating to the car and its driver, the child, and the circumstances of the incident were abstracted from records kept by the State Coroner and the Victorian compulsory third party traffic injury insurance organisation. Twenty eight Victorian children were identified who had died in one of three types of incident (driverless cars, child interacting with the vehicle and driver, and drivers who were unaware of the child's proximity). These incidents were more common in rural areas compared with urban, usually occurring at the child's home. The child was with or near an adult on all occasions. The vehicle was usually being driven by a relative, and was reversing in a higher proportion of 'unaware' incidents compared with the 'interactive' type. The association of 'off-road' family vehicles and trucks with these incidents appears to be increasing, especially in recent years. These findings suggest some countermeasures, including the separation of vehicle driveways from children's play areas, and object vicinity ultrasonic warning devices for vehicles.

Walking to school and traffic exposure in Australian children

Daily patterns of pedestrian activity in young children have important health implications, primarily because of the risk of road traffic injury, but also because they may reflect the commencement of exercise habits with long-term consequences. A cross-sectional survey in two Australian cities, Melbourne and Perth, aimed to collect, by parent self-administered questionnaire, population-based data on modes of travel, numbers of street crossings (both accompanied and unaccompanied by an adult), and sociodemographic factors for six- and nine-year-old children. Results indicate that 35 per cent (95 per cent confidence interval (CI) 31 to 39 per cent) and 31 per cent (CI 28 to 34 per cent) walk to school in Melbourne and Perth respectively, while over 60 per cent are driven to school by car, with very small proportions riding bicycles or taking public transport. A higher level of walking was associated with lower levels of several indicators of socioeconomic status. Logistic regression analysis showed that the strongest predictor of walking activity was school type (government versus independent), and after adjusting for this, lesser car ownership, non-English-speaking background and lower occupational category were associated with walking to school, while a different set of predictors--age, sex and maternal education--was associated with the unaccompanied crossing of streets. There was little difference in overall walking levels between boys and girls, but boys were significantly more likely to cross streets unaccompanied (adjusted odds ratio 1.41, CI 1.14 to 1.72), providing a partial explanation of documented sex differences in injury rates.

An international study of the exposure of children to traffic

OBJECTIVES

To examine the extent of international differences in children's exposure to traffic as pedestrians or bicyclists.

DESIGN

Children's travel patterns were surveyed using a parent-child administered questionnaire. Children were sampled via primary schools, using a probability cluster sampling design.

SETTING

Six cities in five countries: Melbourne and Perth (Australia), Montreal (Canada), Auckland (New Zealand), Umeå (Sweden), and Baltimore (USA).

SUBJECTS

Children aged 6 and 9 years.

MAIN OUTCOME MEASURES

Modes of travel on the school-home journey, total daily time spent walking, and the average daily number of roads crossed.

MAIN FINDINGS

Responses were obtained from the parents of 13423 children. There are distinct patterns of children's travel in the six cities studied. Children's travel in the three Australasian cities, Melbourne, Perth and Auckland, is characterised by high car use, low levels of bicycling, and a steep decline in walking with increasing car ownership. In these cities, over a third of the children sampled spent less than five minutes walking per day. In Montreal, walking and public transport were the most common modes of travel. In Umeå, walking and bicycling predominated, with very low use of motorised transport. In comparison with children in the Australasian and North American cities, children in Umeå spend more time walking, with 87% of children walking for more than five minutes per day.

CONCLUSIONS

There are large international differences in the extent to which children walk and cycle. These findings would suggest that differences in 'exposure to risk' may be an important contributor to international differences in pedestrian injury rates. There are also substantial differences in pedestrian exposure to risk by levels of car ownership-differences that may explain socioeconomic differentials in pedestrian injury rates.

A case-control study of childhood pedestrian injuries in Perth, Western Australia

STUDY OBJECTIVES

To identify the determinants of childhood pedestrian injuries, taking the child's exposure to the road environment into account.

DESIGN

This was a case-control study.

SETTING AND PARTICIPANTS

The study was conducted in Perth, Western Australia between 1991 and 1993. Altogether 100 injured and 400 uninjured child pedestrians aged 1 to 14 years were studied. Aspects of the child's social and physical environments, measures of his or her behaviour, cognitive skills, and "habitual" exposure to the road environment, as well as his or her knowledge of road safety, were recorded.

MAIN RESULTS

The likelihood of injury increased by 12% with each 10,000 vehicles per day increase in the volume of traffic (odds ratio (OR) 1.12, 95% confidence interval (CI) = 1.05, 1.19) on roads most frequently crossed. In addition, the presence of visual obstacles on the verge of the child's street of residence increased the likelihood of injury by more than 2.6 times (OR 2.68, 95% CI = 1.42, 5.02). In contrast, the absence of footpaths was associated with a 52% reduction in the likelihood of injury compared with the presence of footpaths on the child's street of residence (OR 0.48, 95% CI = 0.27, 0.87).

CONCLUSION

The amount of exposure to the road environment and the nature of the road environment to which the child pedestrian was exposed partly influenced the likelihood of injury in children from low socioeconomic areas, male children, and children aged 13 to 14 years. Until now, the excess incidence of childhood pedestrian injuries in these subgroups of the population had not been explained because the child's exposure per se had not been examined.

Pedestrian intoxication and fatal traffic accident injury patterns

INTRODUCTION

Sixteen percent of all motor-vehicle fatalities are pedestrian, and accidents involving pedestrians are associated with the highest morbidity and mortality rates. Classic pedestrian injury patterns have been described. However, it has been suggested that the pattern may differ if the pedestrian is intoxicated. The role of pedestrian intoxication on motor-vehicle accident injury patterns has not been well-delineated.

HYPOTHESIS

Intoxicated pedestrian traffic victims have an injury pattern that is more serious and more rapidly fatal than is the pattern for nondrinking victims.

METHODS

Autopsies of 223 consecutive pedestrian victims were reviewed and grouped according to the presence of alcohol in the blood: Group I, Negative (n = 165); Group II, Positive (n = 58). Gender, age, anatomic injuries, survival time, time of day, and year also were examined.

RESULTS

Results indicated that there were more males in Group II (79%) than in Group I (64%); younger victims, younger than 40 years old, in Group II (70%) than in Group I (34%); fewer victims older than 60 years old in Group II (8%) than in Group I (38%). Group II sustained more frequent and more severe injuries--two times the frequency of the cervical spine, liver, upper and lower extremity, pelvic and rib fractures and thoracolumbar spine injuries; three times more aortic injuries; five times more heart injuries. Death occurred within 24 hours in 95% of those in Group II and in 67% of those in Group I. Accidents occurred from 1500h to 2300h in 67% of Group II and in 53% of Group I victims.

CONCLUSION

Intoxicated pedestrian accident victims are predominantly young men, struck between 1500h and 0700h; they have an injury pattern that is two to five times more serious than is the pattern for the sober victims.

Childhood pedestrian injuries in the Perth metropolitan area

OBJECTIVE

To examine the characteristics of childhood pedestrian injuries in the Perth metropolitan area from 1980 to 1989.

DESIGN

Retrospective descriptive study.

SETTING

Perth metropolitan area, Western Australia.

PARTICIPANTS

Child pedestrians aged 0 to 14 years who were injured during the period 1 January 1980 to 31 December 1989.

MAIN OUTCOME MEASURES

An extensive database which reported fatal and non-fatal motor vehicle collisions was used to obtain details on the child pedestrian, the vehicle involved in the collision, and the environmental factors related to these injuries.

RESULTS

A total of 1282 child pedestrian injuries were reported in the 10 year period. Children aged between 5 and 9 years, and were overrepresented among those injured. This study also demonstrated a similar proportion of injuries involving the 10-14 year age group. Injuries frequently occurred mid block, on local urban roads, between the hours of 3 p.m. and 7 p.m., and a greater than expected proportion of drivers involved in these collisions were in the under-21 age category. To describe the pattern of childhood pedestrian injuries we calculated both age-specific injury rates, and injury rates based on the number of registered motor vehicles. The latter revealed a greater than 20-fold variation between local government areas.

CONCLUSIONS

Further analytical research, incorporating a measure of the child pedestrian's exposure to roads and traffic is required to identify those features in the individual and the environment which have a significant influence on the likelihood of a collision. Such research is required to institute effective preventive measures.

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.

An analysis of pediatric trauma deaths in Indiana

From June 1986 to May 1988, there were 1,931 childhood deaths recorded in Indiana. Eight hundred six children (0 to 18 years old) died as a result of trauma (41.4% of all deaths). Seventy percent of all traumatic deaths occurred in boys. Blunt trauma accounted for 54% of deaths, asphyxia or drowning 26%, penetrating trauma 15%, electrocution 3%, and burns 1%. Sixty percent of deaths occurred in rural areas and 40% occurred in urban centers; however, state-wide demographics define the population as 70% urban. The percentage of deaths due to trauma within a given race was: hispanic 71%, caucasian 42%, black 35%, and others 50%. However, when deaths occurring in infants less than 30 days of age were eliminated, the percentages changed: hispanics 70%, caucasian 45%, black 45%, and others 50%. Traumatic deaths were 1.6 times as likely to occur during the months of June through October (n = 85 deaths/mo) as opposed to November through May (n = 53 deaths/mo) (P less than .05). Mortality from burns was limited to children less than 5 years of age and penetrating trauma mortality was twice as likely to occur in children over 15 years (10% v 20%). Fifty-two percent of all traumatic deaths in children occurred between 15 and 18 years of age. Major burns account for only 1% of traumatic deaths in this state. Asphyxia and drowning were more common in young children, and blunt traumatic deaths more common in older children. In 1988, the first state-wide accident awareness program was instituted.(ABSTRACT TRUNCATED AT 250 WORDS)

A case-control study of pedestrian and bicyclist injuries in childhood

We identified children ages 0 to 14 years injured in traffic as pedestrians or bicyclists in Montreal, Canada. Two hundred children with injuries who received a score of 2 or more on the Maximum Abbreviated Injury Severity scale were considered as cases and compared with 400 uninjured children seen in the same hospitals for non-traumatic reasons. Systematic, blinded interviews and tests were conducted with parents to determine the role of a series of social, familial, personal, and behavioral characteristics. After adjustment for age, gender and socioeconomic area of residence, logistic regression analyses showed higher risks of injury to be related to fewer years of parents' education, a history of accident to a family member, an environment judged as unsafe, and poor parental supervision. Absence of physical health problems, fewer family preventive behaviors and reported lack of cautiousness were also related to a higher risk, whereas neither aggressivity nor behavioral disturbance, whether internalizing or externalizing, showed any such relation. These data suggest that the child's personality and behavior are weaker risk factors for pedestrian and bicyclist injuries than are family and neighborhood characteristics.

Traumatic deaths in children: the importance of prevention

In order to determine the preventable factors in fatal accidents, a retrospective review of paediatric deaths after admission to a suburban teaching hospital was conducted. The medical records and coroners' reports for 64 consecutive cases over a 68-month period were reviewed. The main causes of death were pedestrian injuries (42% of deaths), drowning (20% of deaths) and injuries to vehicular passengers (17% of deaths) and cyclists (13% of deaths). There was a male predominance (64%). Children who were aged less than five years were at greatest risk at home, with death by drowning (46% of deaths) predominating. For children who were over five years of age, accidents on the roadway as pedestrians (58% of deaths) and pedal-cyclists (20% of deaths) were the most-common causes of death. Analysis of the accidents showed that preventive strategies were underutilized. Thirty per cent of deaths could have been avoided by the wearing of restraints in motor vehicles, the wearing of cycle-helmets and the proper use of swimming-pool barrier equipment. Adequate supervision of children who were less than 10 years of age at road crossings could have prevented a further 17% of deaths. In comparison, even the most-optimal postinjury care would have salvaged only 5% of the cases. Therefore, while the ideal organization of services after injury is a logical aim in the management of childhood trauma, if lives are to be saved, the main emphasis must be on prevention.

Fatal pedestrian injuries to young children: a different pattern of injury

All pedestrian vehicle collision fatalities to children less than five years of age in Washington State were evaluated for a five-year period using State death certificates, coroners' reports, and police records. Although the majority of pedestrian fatalities to older children have been shown to be due to "dart-outs" into traffic with the child being struck by an oncoming car, pedestrian fatality incident for children less than five tended to occur when the child was backed over in the home driveway by the family van or light truck driven by a parent. Prevention of pedestrian injuries in this age group requires strategies aimed at safeguarding the driveway and reassessing the safety of light trucks and vans as family vehicles.