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Swedler DI, Ali B, Hoffman R, Leonardo J, Romano E, Miller TR. Injury and fatality risks for child pedestrians and cyclists on public roads. Inj Epidemiol 2024; 11:15. [PMID: 38605370 PMCID: PMC11010370 DOI: 10.1186/s40621-024-00497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Pedestrians and cyclists are often referred to as "vulnerable road users," yet most research is focused on fatal crashes. We used fatal and nonfatal crash data to examine risk factors (i.e., relationship to an intersection, urbanicity, crash circumstances, and vehicle type) for police-reported pedestrian and cyclist injuries on public roads among children aged 0-9 and aged 10-19. We also compared risk factors among these two age groups with adults aged 20-29 and aged 30-39. METHODS Crash data were obtained for 2016-2020 from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System for fatal crash injuries and Crash Report Sampling System for nonfatal crash injuries. We collected data on victim demographics, roadway, and vehicle- and driver-related factors. Descriptive analyses were conducted between and within pedestrian and cyclist victims. RESULTS We analyzed 206,429 pedestrian injuries (36% in children aged 0-19) and 148,828 cyclist injuries (41% in children aged 0-19) from 2016 to 2020. Overall, child pedestrians had lower injury rates than adults, but children aged 10-19 had greater cycling crash rates than adults. Almost half of the pedestrian injuries in children aged 0-9 were "dart-out" injuries (43%). In the majority of the cyclist injuries, children in both age groups failed to yield to vehicles (aged 0-9 = 40% and aged 10-19 = 24%). For children and all ages included in the study, the fatality risk ratio was highest when pedestrians and cyclists were struck by larger vehicles, such as trucks and buses. Further exploration of roadway factors is presented across ages and transportation mode. CONCLUSION Our findings on child, driver, vehicle, and roadway factors related to fatal and nonfatal pedestrian and cyclist injuries may help to tailor prevention efforts for younger and older children.
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Affiliation(s)
- David I Swedler
- UMass Chan Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA
| | - Bina Ali
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, Beltsville, MD, 20705, USA.
| | - Rebecca Hoffman
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, Beltsville, MD, 20705, USA
| | - Jennifer Leonardo
- Education Development Center, 300 Fifth Avenue, Suite 2010, Waltham, MA, 02451, USA
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, Beltsville, MD, 20705, USA
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, Beltsville, MD, 20705, USA
- Curtin University School of Public Health, Kent St, Bentley, WA, 6102, Australia
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Goodman LF, Birnbaum Flyer Z, Schomberg J, Maginas M, Wallace E, Vukcevich O, Awan S, Gibbs D, Nahmias J, Guner YS. Electric bicycles (e-bikes) are an increasingly common pediatric public health problem. Surg Open Sci 2023; 14:46-51. [PMID: 37519328 PMCID: PMC10372360 DOI: 10.1016/j.sopen.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/11/2023] [Accepted: 06/16/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Electric bicycles (e-bikes) achieve higher speeds than pedal bicycles, but few studies have investigated the impact on injury rates specific to the pediatric population. Utilizing the National Electronic Injury Surveillance System (NEISS), we compared rates of pediatric injury for e-bikes, bicycles, and gas-engine bicycles (mopeds) from 2011 to 2020. Methods Descriptive and bivariate inferential analyses were performed upon NEISS estimates of e-bike, bicycle, and moped injuries in children aged 2-18 years. Analyses were stratified by patient age and helmet usage. The Mann-Kendall test of trends was used. Results We identified 3945 e-bike, 23,389 moped, and 2.05 million bicycle injuries. Over time, the incidence of injury increased for e-bikes (Kendall's τ=0.73, p = 0.004), decreased for pedal bicycles (Kendall's τ= - 0.91, p = 0.0003), and did not change for mopeds (Kendall's τ = 0.06, p = 0.85). Males accounted for 82.5 % of e-bike injuries. The age group most commonly affected by e-bike injury (44.3 %) was 10-13 years old. The proportion of injuries requiring hospitalization was significantly higher for e-bikes (11.5 %), compared to moped and bicycle (7.0 and 4.8 %, respectively, p < 0.0001). In cases where helmet use or absence was reported, 97.3 % of e-bike riders were without a helmet at the time of injury, compared to 82.1 % of pedal bicycle riders and 87.2 % of moped riders. Conclusions The rate of pediatric e-bike injuries increased over the study period. Compared to riders on pedal bicycles or mopeds, children on e-bikes had infrequent helmet use and increased rate of hospitalization. These findings suggest that attention to e-bike safety and increasing helmet usage are important to public health among the pediatric population. Level of evidence IV.
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Affiliation(s)
- Laura F. Goodman
- Department of Surgery, University of California Irvine, Irvine, CA, United States
- Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, United States
| | - Zoe Birnbaum Flyer
- Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, United States
| | - John Schomberg
- Department of Nursing, Children's Hospital of Orange County, Orange, CA, United States
- CHOC Research Institute, Children's Hospital of Orange County, Orange, CA, United States
| | - Mary Maginas
- Department of Nursing, Children's Hospital of Orange County, Orange, CA, United States
| | - Elizabeth Wallace
- CHOC Research Institute, Children's Hospital of Orange County, Orange, CA, United States
| | - Olivia Vukcevich
- School of Medicine, University of California Riverside, United States
| | - Saeed Awan
- Department of Surgery, University of California Irvine, Irvine, CA, United States
- Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, United States
| | - David Gibbs
- Department of Surgery, University of California Irvine, Irvine, CA, United States
- Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, United States
| | - Jeffry Nahmias
- Department of Surgery, University of California Irvine, Irvine, CA, United States
- Division of Trauma, Burns, Critical Care, & Acute Care Surgery, University of California Irvine, Orange, CA, United States
| | - Yigit S. Guner
- Department of Surgery, University of California Irvine, Irvine, CA, United States
- Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, United States
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Takagi-Stewart J, Muma A, Umali CV, Nelson M, Bansal I, Patel S, Vavilala MS, Mooney SJ. Microscale pedestrian environment surrounding pedestrian injury sites in Washington state, 2015-2020. TRAFFIC INJURY PREVENTION 2022; 23:440-445. [PMID: 35877997 DOI: 10.1080/15389588.2022.2100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE While microscale pedestrian environment features such as sidewalks and crosswalks can affect pedestrian safety, it is challenging to assess microscale environment associated risk across locations or at scale. Addressing these challenges requires an efficient auditing protocol that can be used to assess frequencies of microscale environment features. For this reason, we developed an eight-item pedestrian environment virtual audit protocol and conducted a descriptive epidemiologic study of pedestrian injury in Washington State, USA. METHODS We used data from police reports at pedestrian-automotive collision sites where the pedestrian was seriously injured or died. At each collision site, high school students participating in an online summer internship program virtually audited Google Street View imagery to assess the presence of microscale pedestrian environment features such as crosswalks and streetlighting. We assessed inter-rater reliability using Cohen's kappa and explored prevalence of eight microscale environment features in relation to injury severity and municipal boundaries. RESULTS There were 2248 motor vehicle crashes eliciting police response and resulting in death or serious injury of a pedestrian in Washington State between January 1, 2015 and May 8, 2020. Of the crashes resulting in serious injury or death, 498 (22%) resulted in fatalities and 1840 (82%) occurred within municipal boundaries. Cohen's kappa scores for the eight pedestrian features that were audited ranged from 0.52 to 0.86. Audit results confirmed that features such as sidewalks and crosswalks were more common at collision sites within city limits. CONCLUSIONS High school student volunteers with minimal training can reliably audit microscale pedestrian environments using limited resources.
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Affiliation(s)
- Julian Takagi-Stewart
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Amy Muma
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Christina V Umali
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
- Department of Health Services, University of Washington, Seattle, Washington
| | - Michaela Nelson
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Ishan Bansal
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Sejal Patel
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Monica S Vavilala
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Stephen J Mooney
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
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Abstract
BACKGROUND Assessing aspects of intersections that may affect the risk of pedestrian injury is critical to developing child pedestrian injury prevention strategies, but visiting intersections to inspect them is costly and time-consuming. Several research teams have validated the use of Google Street View to conduct virtual neighborhood audits that remove the need for field teams to conduct in-person audits. METHODS We developed a 38-item virtual audit instrument to assess intersections for pedestrian injury risk and tested it on intersections within 700 m of 26 schools in New York City using the Computer-assisted Neighborhood Visual Assessment System (CANVAS) with Google Street View imagery. RESULTS Six trained auditors tested this instrument for inter-rater reliability on 111 randomly selected intersections and for test-retest reliability on 264 other intersections. Inter-rater kappa scores ranged from -0.01 to 0.92, with nearly half falling above 0.41, the conventional threshold for moderate agreement. Test-retest kappa scores were slightly higher than but highly correlated with inter-rater scores (Spearman rho = 0.83). Items that were highly reliable included the presence of a pedestrian signal (K = 0.92), presence of an overhead structure such as an elevated train or a highway (K = 0.81), and intersection complexity (K = 0.76). CONCLUSIONS Built environment features of intersections relevant to pedestrian safety can be reliably measured using a virtual audit protocol implemented via CANVAS and Google Street View.
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Wheeler-Martin KC, Curry AE, Metzger KB, DiMaggio CJ. Trends in school-age pedestrian and pedalcyclist crashes in the USA: 26 states, 2000-2014. Inj Prev 2020; 26:448-455. [PMID: 31562195 PMCID: PMC7098840 DOI: 10.1136/injuryprev-2019-043239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite substantial progress, motor vehicle crashes remain a leading killer of US children. Previously, we documented significant positive impacts of Safe Routes to School interventions on school-age pedestrian and pedalcyclist crashes. OBJECTIVE To expand our analysis of US trends in motor vehicle crashes involving school-age pedestrians and pedalcyclists, exploring heterogeneity by age and geography. METHODS We obtained recent police-reported crash data from 26 states, calculating population rates of pedestrian and pedalcyclist crashes, crash fatality rates and pedestrian commuter-adjusted crash rates ('pedestrian danger index') for school-age children as compared with other age groups. We estimated national and statewide trends by age, injury status, day and travel hour using hierarchical linear modeling. RESULTS School-age children accounted for nearly one in three pedestrians and one in two pedalcyclists struck in motor vehicle crashes from 2000 to 2014. Yet, the rates of these crashes declined 40% and 53%, respectively, over that time, on average, even as adult rates rose. Average crash rates varied geographically from 24.4 to 100.8 pedestrians and 15.6 to 56.7 pedalcyclists struck per 100 000 youth. Crash rates and fatality rates were inversely correlated. CONCLUSIONS Despite recent increases in adult pedestrian crashes, school-age and younger pedestrians experienced ongoing declines in motor vehicle crashes through 2014 across the USA. There was no evidence of displacement in crash severity; declines were observed in all outcomes. The growing body of state crash data resources can present analytic challenges but also provides unique insights into national and local pedestrian crash trends for all crash outcomes.
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Affiliation(s)
- Katherine C Wheeler-Martin
- Surgery, NYU Langone Medical Center, New York City, New York, USA
- Population Health, NYU Langone Medical Center, New York City, New York, USA
| | - Allison E Curry
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Charles J DiMaggio
- Surgery, NYU Langone Medical Center, New York City, New York, USA
- Population Health, NYU Langone Medical Center, New York City, New York, USA
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McLaughlin CM, Barry WE, Barin EN, Mert M, Lowery C, Upperman JS, Jensen AR, Arbogast H. Interactive Education is Associated With Lower Incidence of Pedestrian-Related Injury in Children. J Surg Res 2019; 244:57-62. [PMID: 31279264 DOI: 10.1016/j.jss.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/13/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pedestrian-related injuries are a significant contributor to preventable mortality and disability in children. We hypothesized that interactive pedestrian safety education is associated with increased knowledge, safe crosswalk behaviors, and lower incidence of pedestrian-related injuries in elementary school-aged children. METHODS An interactive street-crossing simulation was implemented at target elementary schools in Los Angeles County beginning in 2009. Mixed-methods were used to evaluate the impact of this intervention. Multiple-choice examinations were used to test pedestrian safety knowledge, anonymous observations were used to assess street-crossing behaviors, and statewide traffic records were used to report pedestrian injuries in elementary school-aged (4-11 y) children in participating school districts. Pedestrian injury incidence was compared 1 y before and after the intervention, standardized to the incidence in the entire City of Los Angeles. RESULTS A total of 1424 and 1522 children completed the pretest and post-test, respectively. Correct answers increased for nine of ten questions (all P < 0.01). Children more frequently looked both ways before crossing the street after the intervention (10% versus 41%, P < 0.001). There were 6 reported pedestrian-related injuries in intervention school districts in the year before the intervention and 2 injuries in the year after the intervention, resulting in a significantly lower injury incidence (standardized rate ratio 0.28; 95% CI, 0.11-0.73). CONCLUSION Pedestrian safety education at Los Angeles elementary schools was associated with increased knowledge, safe street-crossing behavior, and lower incidence of pediatric pedestrian-related injury. Formal pedestrian safety education should be considered with injury prevention efforts in similar urban communities.
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Affiliation(s)
- Cory M McLaughlin
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Wesley E Barry
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Erica N Barin
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Melissa Mert
- Southern California Clinical and Translational Science Institute (SC-CTSI), Los Angeles, California
| | - Chantel Lowery
- Injury Prevention Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey S Upperman
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Aaron R Jensen
- Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California.
| | - Helen Arbogast
- Injury Prevention Program, Children's Hospital Los Angeles, Los Angeles, California
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