Validity across four common street-crossing distraction indicators to predict pedestrian safety.

BACKGROUND: Multiple distraction indicators have been applied to measure street-crossing distraction but their validities in predicting pedestrian safety are poorly understood. METHODS: Based on a video-based observational study, we compared the validity of four commonly used distraction indicators (total duration of distraction while crossing a street, proportion of distracted time over total street-crossing time, duration of the longest distraction time, and total number of distractions) in predicting three pedestrian safety outcomes (near-crash incidence, frequency of looking left and right, and speed crossing the street) across three types of distraction (mobile phone use, talking to other pedestrians, eating/drinking/smoking). Change in Harrell's C statistic was calculated to assess the validity of each distraction indicator based on multivariable regression models including only covariates and including both covariates and the distraction indicator. RESULTS: Heterogeneous capacities in predicting the three safety outcomes across the four distraction indicators were observed: 1) duration of the longest distraction time was most predictive for the occurrence of near-crashes and looks left and right among pedestrians with all three types of distraction combined and talking with other pedestrians (Harrell's C statistic changes ranged from 0.0310 to 0.0335, P < 0.05), and for the occurrence of near-crashes for pedestrians involving mobile phone use (Harrell's C statistic change: 0.0053); 2) total duration of distraction was most predictive for speed crossing the street among pedestrians with the combination and each of the three types of distraction (Harrell's C statistic changes ranged from 0.0037 to 0.0111, P < 0.05), frequency of looking left and right among pedestrians distracted by mobile phone use (Harrell's C statistic change: 0.0115), and the occurrence of near-crash among pedestrians eating, drinking, or smoking (Harrell's C statistic change: 0.0119); and 3) the total number of distractions was the most predictive indicator of frequency of looking left and right among pedestrians eating, drinking, or smoking (Harrell's C statistic change: 0.0013). Sensitivity analyses showed the results were robust to change in grouping criteria of the four distraction indicators. CONCLUSIONS: Future research should consider the pedestrian safety outcomes and type of distractions to select the best distraction indicator.

Definition of a maximum threshold of direct solar radiation exposure for pedestrians of diverse walking abilities.

Since pedestrians are impacted by solar radiation differently, urban designers must evaluate solar radiation exposure of pedestrian paths adopting an inclusive approach. This paper proposes a maximum threshold of direct solar radiation exposure for pedestrians based on activity, user profile and environmental conditions, defined as the difference between the energy consumption before feeling exhausted and the energy cost of walking. Two users of diverse walking abilities, a young adult and an elderly person with mobility impairment, were characterised by metabolic activity, walking speed and maximum energy capacity. Based on the theoretical framework, the energy budget of young adults to cope with thermal stress was set as three times higher than for the elderly. This framework was used to quantify the contribution of direct solar radiation to energy balance and then classify walkability during clear-sky summer hours; the term 'walkable' referred to environmental conditions allowing users to walk without feeling exhausted. The methodology was tested on an open area and an urban canyon in Milan; applicability by urban designers was key in developing a simplified way to evaluate shading needs. This approach could be applied to evaluate solar radiation exposure of pedestrian paths adopting diverse user experiences as an evaluation criterion.

Absorbing Material of Button Antenna with Directional Radiation of High Gain for P2V Communication.

Vehicular communication systems can be used to enhance the safety level of road users by exchanging safety/warning messages. In this paper, an absorbing material on a button antenna is proposed for pedestrian-to-vehicle (P2V) communication, which provides safety service to road workers on the highway or in a road environment. The button antenna is small in size and is easy to carry for carriers. This antenna is fabricated and tested in an anechoic chamber; it can achieve a maximum gain of 5.5 dBi and an absorption of 92% at 7.6 GHz. The maximum distance of measurement between the absorbing material of the button antenna and the test antenna is less than 150 m. The advantage of the button antenna is that the absorption surface is used in the radiation layer of the antenna so that the antenna can improve the radiation direction and gain. The absorption unit size is 15 × 15 × 5 mm3.

Pediatric Pedestrian Injuries: Striking Too Close to Home.

BACKGROUND: Pediatric pedestrian injuries (PPI) are a major public health concern. This study utilized geospatial analysis to characterize the risk and injury severity of PPI. METHODS: A retrospective chart review of PPI patients (age < 18) from a level 1 trauma center was performed (2013-2020). A geographic information system geocoded injury location to home and other public landmarks. Incidents were aggregated to zip codes and the Local Indicators of Spatial Association statistic tested for spatial clustering of injury rates per 10,000 children. Predictors for increased injury severity were assessed by logistic regression. RESULTS: PPI encompassed 6% (n = 188) of pediatric traumas. Most patients were black (54%), male (58%), >13 years (56%), and with Medicaid insurance (68%). Nine zip codes comprised a statistically significant cluster of PPI. Nearly half (40%) occurred within a quarter mile of home; 7% occurred at home. Most (65%) PPI occurred within 1 mile of a school, and 45% occurred within a quarter mile of a park. Nearly all (99%) PPI occurred within a quarter mile of a major intersection and/or roadway. Using admission to ICU as a marker for injury severity, farther distance from home (OR 1.060, 95% CI 1.001-1.121, p = 0.045) and age <13 years (3.662, 95% CI 1.854-7.231, p < 0.001) were independent predictors of injury severity. CONCLUSIONS: There are significant sociodemographic disparities in PPI. Most injuries occur near patients' homes and other public landmarks. Multidisciplinary injury prevention collaboration can help inform policymakers, direct local safety programs, and provide a model for PPI prevention at the national level. LEVEL OF EVIDENCE: Level IV.

Higher risk of auto versus pedestrian crashes in school-age children on school days.

BACKGROUND: This study examines the rates of pediatric auto versus pedestrian collision (APCs) and determined ages and periods of greatest risk. We hypothesized that the rate of APC in children would be higher on school days and in the timeframes correlating with travel to and from school. METHODS: Retrospective case-control study of APC on school and nonschool days for patients younger than 18 years at an urban Level II pediatric trauma center from January 2011 to November 2019. Frequency of APC by hour of the day was plotted overall, for school versus nonschool days and for age groups: 0 year to 4 years, 5 years to 9 years, 10 years to 13 years, and 14 years to 17 years. t Test was used with a p value less than 0.05, which was considered significant. RESULTS: There were 441 pediatric APC in the study period. Frequency of all APC was greater on school days (0.174 vs. 0.101; relative risk [RR], 1.72, p < 0.001), and APC with Injury Severity Score greater than 15 (0.039 vs. 0.024; p = 0.014; RR, 1.67; 95% confidence interval, 1.10-2.56). Comparing school day with nonschool day, the 0-year to 4-year group had no significant difference in APC frequency (0.021 vs. 0.014; p = 0.129), APC frequency was higher on school days in all other age groups: 5 years to 9 years (0.036 vs. 0.019; RR, 1.89; p = 0.0134), 10 years to 13 years (0.055 vs. 0.024; RR, 2.29; p < 0.001), and 14 years to 17 years (0.061 vs. 0.044; RR, 1.39; p = 0.045). The greatest increase in APC on school days was in the 10-year to 13-year age group. DISCUSSION: All school age children are at higher risk of APC on school days. The data support our hypothesis that children are at higher risk of APC during transit to and from school. The age 10-year to 13-year group had a 129% increase in APC frequency on school days. This age group should be a focus of injury prevention efforts. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV.

Lateral Vibration Control of Long-Span Small-Radius Curved Steel Box Girder Pedestrian Bridge with Distributed Multiple Tuned Mass Dampers.

Curved pedestrian bridges are important urban infrastructure with the desired adaptability to the landscape constraints and with aesthetic benefits. Pedestrian bridges feature thin cross-sections, which provide sufficient load capacities but lead to low natural frequencies that make the bridges susceptible to vibration under pedestrian excitation. This study investigates the lateral vibration of a curved bridge with a small radius down to 20 m, proposes an approach to mitigate the lateral vibration of bridges with large curvatures using distributed multiple tuned mass dampers (MTMD), and conducts in-situ bridge tests to evaluate the vibration mitigation performance. The lateral vibration was investigated through in-situ tests and finite element analysis as well as the code requirements. The key parameters of the distributed MTMD system were improved by strategically selecting the mass ratio, bandwidth, center frequency ratio, and damper number. The results showed that the curved bridge was subjected to significant lateral vibration due to the coupling of torque and moment, and the recommended design parameters for the studied bridge were derived, i.e., the total mass ratio is 0.02, bandwidth is 0.15, center frequency ratio is 1.0, and damper number is 3. The proposed approach effectively improves the deployment of MTMD for lateral vibration control of the curved bridge. The field tests showed that the vibration was reduced by up to 82% by using the proposed approach.

Integrating traffic safety data with area deprivation index: A method to better understand the causes of pediatric pedestrian versus automobile collisions.

BACKGROUND: The purpose of this study was to identify clinical and traffic factors that influence pediatric pedestrian versus automobile collisions (P-ACs) with an emphasis on health care disparities. METHODS: A retrospective review was performed of pediatric (18 years or younger) P-ACs treated at a Level I pediatric trauma center from 2008 to 2018. Demographic, clinical, and traffic scene data were analyzed. Area deprivation index (ADI) was used to measure neighborhood socioeconomic disadvantage (NSD) based on home addresses. Traffic scene data from the California Statewide Integrated Traffic Records System were matched to clinical records. Traffic safety was assessed by the streetlight coverage, the proximity of the collision to home addresses, and sidewalk coverage. Descriptive statistics and univariate analysis for key variables and outcomes were calculated using Kruskal-Wallis, Wilcoxon, χ 2 , or Fisher's exact tests. Statistical significance was attributed to p values of <0.05. RESULTS: Among 770 patients, the majority were male (65%) and Hispanic (54%), with a median age of 8 years (interquartile range, 4-12 years). Hispanic patients were more likely to live in more disadvantaged neighborhoods than non-Hispanic patients (67% vs. 45%, p < 0.01). There were no differences in clinical characteristics or outcomes across ADI quintiles. Using the Statewide Integrated Traffic Records System (n = 272), patients with more NSD were more likely injured during dark streetlight conditions (15% vs. 4% least disadvantaged; p = 0.04) and within 0.5 miles from home ( p < 0.01). Pedestrian violations were common (65%). During after-school hours, 25% were pedestrian violations, compared with 12% driver violations ( p = 0.02). CONCLUSION: A larger proportion of Hispanic children injured in P-ACs lived in neighborhoods with more socioeconomic disadvantage. Hispanic ethnicity and NSD are each independently associated with P-ACs. Poor streetlight conditions and close proximity to home were associated with the most socioeconomically disadvantaged neighborhoods. This research may support targeted prevention programs to improve pedestrian safety in children. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level IV.

How to Make the CUTiest Sensor in Three Simple Steps for Computational Pedestrians.

Genetically encoded FRET sensors for revealing local concentrations of second messengers in living cells have enormously contributed to our understanding of physiological and pathological processes. However, the development of sensors remains an intricate process. Using simulation techniques, we recently introduced a new architecture to measure intracellular concentrations of cAMP named CUTie, which works as a FRET tag for arbitrary targeting domains. Although our method showed quasi-quantitative predictive power in the design of cAMP and cGMP sensors, it remains intricate and requires specific computational skills. Here, we provide a simplified computer-aided protocol to design tailor-made CUTie sensors based on arbitrary cyclic nucleotide-binding domains. As a proof of concept, we applied this method to construct a new CUTie sensor with a significantly higher cAMP sensitivity (EC50 = 460 nM).This simple protocol, which integrates our previous experience, only requires free web servers and can be straightforwardly used to create cAMP sensors adapted to the physicochemical characteristics of known cyclic nucleotide-binding domains.

Assessing the impact of the national traffic safety campaign: a nationwide cohort study in Japan.

OBJECTIVES: This study aimed to examine the difference in mortality from serious road traffic injuries during the National Traffic Safety Campaign compared with other periods and identify the common mechanisms of injury by age group in Japan. DESIGN: A retrospective review of Japan Trauma Data Bank (JTDB). SETTING: A total of 280 participating major emergency institutions across Japan. PARTICIPANTS: Patients with road traffic injuries registered in JTDB between 2004 and 2018 were recruited in the study. We included patients injured by traffic crashes during the National Traffic Safety Campaigns and controls using a double control method. The National Traffic Safety Campaign comprises 10 consecutive days in spring and fall (20 days in each year), and controls was the same calendar days 2 weeks before and after the days in the National Traffic Safety Campaigns (40 days in each year) to control for weekday, seasonal and yearly trends. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was in-hospital mortality. The secondary outcome was the incidences of severe traffic injury. RESULTS: Among 126 857 patients recorded as road traffic injuries in JTDB, we identified 6181 patients (21 cases per day) with injuries occurring during the National Traffic Safety Campaigns and 12 382 controls (21 cases per day). The overall in-hospital mortality was 11.4%. We did not observe a significant difference in in-hospital mortality between the groups (11.8% vs 11.1%) with an adjusted OR of 1.05 (95% CI 0.95 to 1.16). The most common mechanism of injury in each age group was bicycle crash among children, motorcycle crash among adults and pedestrian among the elderly. CONCLUSIONS: We found no change in the incidence of severe traffic injury or in-hospital mortality during the National Traffic Safety Campaign in Japan. Serious road trauma was high for bicycles among children, motorcycles among adults and pedestrian among the elderly.

Very high radiofrequency radiation at Skeppsbron in Stockholm, Sweden from mobile phone base station antennas positioned close to pedestrians' heads.

In urban environment there is a constant increase of public exposure to radiofrequency electromagnetic fields from mobile phone base stations. With the placement of mobile phone base station antennas radiofrequency hotspots emerge. This study investigates an area at Skeppsbron street in Stockholm, Sweden with an aggregation of base station antennas placed at low level close to pedestrians' heads. Detailed spatial distribution measurements were performed with 1) a radiofrequency broadband analyzer and 2) a portable exposimeter. The results display a greatly uneven distribution of the radiofrequency field with hotspots. The highest spatial average across all quadrat cells was 12.1 V m⁻1 (388 mW m⁻2), whereas the maximum recorded reading from the entire area was 31.6 V m⁻1 (2648 mW m⁻2). Exposimeter measurements show that the majority of exposure is due to mobile phone downlink bands. Most dominant are 2600 and 2100 MHz bands used by 4G and 3G mobile phone services, respectively. The average radiofrequency radiation values from the earlier studies show that the level of ambient RF radiation exposure in Stockholm is increasing. This study concluded that mobile phone base station antennas at Skeppsbron, Stockholm are examples of poor radiofrequency infrastructure design which brings upon highly elevated exposure levels to popular seaside promenade and a busy traffic street.

Eye image effect in the context of pedestrian safety: a French questionnaire study.

Human behavior is influenced by the presence of others, which scientists also call 'the audience effect'. The use of social control to produce more cooperative behaviors may positively influence road use and safety. This study uses an online questionnaire to test how eyes images affect the behavior of pedestrians when crossing a road. Different eyes images of men, women and a child with different facial expressions -neutral, friendly and angry- were presented to participants who were asked what they would feel by looking at these images before crossing a signalized road. Participants completed a questionnaire of 20 questions about pedestrian behaviors (PBQ). The questionnaire was received by 1,447 French participants, 610 of whom answered the entire questionnaire. Seventy-one percent of participants were women, and the mean age was 35 ± 14 years. Eye images give individuals the feeling they are being observed at 33%, feared at 5% and surprised at 26%, and thus seem to indicate mixed results about avoiding crossing at the red light. The expressions shown in the eyes are also an important factor: feelings of being observed increased by about 10-15% whilst feelings of being scared or inhibited increased by about 5% as the expression changed from neutral to friendly to angry. No link was found between the results of our questionnaire and those of the Pedestrian Behavior Questionnaire (PBQ). This study shows that the use of eye images could reduce illegal crossings by pedestrians, and is thus of key interest as a practical road safety tool. However, the effect is limited and how to increase this nudge effect needs further consideration.

Pedestrian exposure to black carbon and PM2.5 emissions in urban hot spots: new findings using mobile measurement techniques and flexible Bayesian regression models.

BACKGROUND: Data from extensive mobile measurements (MM) of air pollutants provide spatially resolved information on pedestrians' exposure to particulate matter (black carbon (BC) and PM2.5 mass concentrations). OBJECTIVE: We present a distributional regression model in a Bayesian framework that estimates the effects of spatiotemporal factors on the pollutant concentrations influencing pedestrian exposure. METHODS: We modeled the mean and variance of the pollutant concentrations obtained from MM in two cities and extended commonly used lognormal models with a lognormal-normal convolution (logNNC) extension for BC to account for instrument measurement error. RESULTS: The logNNC extension significantly improved the BC model. From these model results, we found local sources and, hence, local mitigation efforts to improve air quality, have more impact on the ambient levels of BC mass concentrations than on the regulated PM2.5. SIGNIFICANCE: Firstly, this model (logNNC in bamlss package available in R) could be used for the statistical analysis of MM data from various study areas and pollutants with the potential for predicting pollutant concentrations in urban areas. Secondly, with respect to pedestrian exposure, it is crucial for BC mass concentration to be monitored and regulated in areas dominated by traffic-related air pollution.

A survey of the smokefree status of pedestrian-only spaces in 10 New Zealand local government areas.

AIM: To describe the smokefree status and signage of outdoor pedestrian-only plazas/malls/boulevards in 10 New Zealand local government (council) areas. METHODS: The 10 council areas were a convenience sample. Council websites were examined for smokefree policies, and a systematic attempt was made to identify the five largest pedestrian-only sites with permanent seating in each council area (10 sites each for two larger cities). Field visits were conducted to all selected sites during January-May 2021. RESULTS: Smokefree policies with components covering smokefree outdoor plazas/malls/boulevards were common (80%; 8/10 councils), albeit with some gaps (eg, around signage and vaping policy). A total of 60 relevant pedestrianised sites with permanent seating were identified and surveyed. Of these, 63% were officially designated smokefree. Smokefree signage was only present in 15% (9/60) of all the sites and in 24% (9/38) of the designated smokefree sites. In these designated sites, the average number of smokefree signs was only 1.4 (range: 0 to 14). Issues identified with the signs included small size, being only a small part of a larger other sign, limited use of te reo Maori wording and not covering vaping. At sites where tables were present, 12% had ash trays on the tables (none at smokefree sites). CONCLUSIONS: Smokefree plazas/malls/boulevards in this survey had multiple policy and signage deficiencies that are inconsistent with achieving the national Smokefree 2025 goal. There is scope to address these issues with an upgrade to the national smokefree law.

Mortality following severe liver trauma is declining at Auckland City Hospital: a 14-year experience, 2006-2020.

INTRODUCTION: Liver injuries sustained in blunt and penetrating abdominal trauma may cause serious patient morbidity and even mortality. AIM: To review the recent experience of liver trauma at Auckland City Hospital, describing the mechanism of injury, patient management, outcomes and complications. METHODS: A retrospective cohort study was performed, including all patients admitted to Auckland City Hospital with liver trauma identified from the trauma registry. Patient clinical records and radiology were systematically examined. RESULTS: Between 2006-2020, 450 patients were admitted with liver trauma, of whom 92 patients (20%) were transferred from other hospitals. Blunt injury mechanisms, most commonly motor-vehicle crashes, predominated (87%). Stabbings were the most common penetrating mechanism. Over half of liver injuries were low risk American Association for the Surgery of Trauma (AAST) grade I and II (56%), whereas 20% were severe grade IV and V. Non-operative management was undertaken in 72% of patients with blunt liver trauma and 92% of patients with penetrating liver trauma underwent surgery. Liver complications occurred in 11% of patients, most commonly bile leaks (7%), followed by delayed haemorrhage (2%). Thirty-two patients died (7%), with co-existing severe traumatic brain injury as the leading cause of death. There was a significant reduction in death from haemorrhage in patients with grade IV and V liver trauma between the first and second half of the study period (p=0.0091). CONCLUSION: Although the incidence and severity of liver trauma at Auckland City Hospital remained stable, there was a reduction in mortality, particularly death as a result of haemorrhage.

Revised road traffic safety law and years of life lost due to traffic deaths in China, 2002-2019.

Legal intervention is a powerful tool to reduce road traffic injuries (RTIs). China amended the Road Traffic Safety Law in 2011, but the impact of amended law on traffic crash deaths is still unknown. In this study, we conducted an interrupted time series analysis and examined years of life lost (YLLs) per 100,000 population as the assessment indicator to evaluate the association of road traffic safety law and traffic crash mortality. Annual YLLs data due to traffic deaths from 2002 to 2019 in China were obtained from the Global Burden of Disease (GBD) 2019. After implementation of the revised law, the average level of total YLLs per 100,000 population due to traffic deaths decreased from 1133.14 to 848.87, and the slope of annual YLLs per 100,000 population decreased by 30.11 (95% CI: 22.46, 37.75), indicating a steeper downward trend. The revised traffic law was associated with YLLs reduction due to traffic deaths for males, females, all age groups, pedestrians, motor vehicle users, and other road users, as well as traffic deaths attributed to alcohol use and tobacco use. These findings suggested that the revised Road Traffic Safety Law improved road safety by decreasing YLLs due to traffic deaths in China. However, the burden of RTIs is still heavy and efforts to further improve traffic laws and the adoption of other interventions are urgently needed.

Collision avoidance behaviours between older adult and young adult walkers.

BACKGROUND: Collision avoidance between two walkers requires a mutual adaptation based on visual information in order to be successful. Age-related changes to visuomotor processing, kinesthetic input, and intersegmental dynamics increases the risk of collision and falls in older adults. However, few studies examine behavioural strategies in older adults during collision avoidance tasks with another pedestrian. RESEARCH QUESTION: Is there a difference between older adults' and young adults' collision avoidance behaviours with another pedestrian? METHODS: Seventeen older adults (x¯ = 68 ± 3 years) and seventeen young adults (x¯ = 23 ± 2 years) walked at a comfortable walking speed along a 12.6 m pathway while avoiding another walker. Trials were randomized equally to include 20 interactions with the same age group and 21 interactions with the opposite age group. Minimum predicted distance (mpd) was used to characterize collision avoidance behaviours between older adults and young adults. RESULTS: Older adults had riskier avoidance behaviours, passing closer to the other pedestrian (0.79 m ± 0.18 m) compared to when two young adults were on a collision course (0.93 m ± 0.17 m) (χ²(3) = 35.94, p < .0001). Whenever an older adult was on a collision course with a young adult, the young adult contributed more to the avoidance regardless of passing order. SIGNIFICANCE: The results from the current study highlight age-related effects during a collision avoidance task in older adults resulting in risky behaviour and a potential collision. Future studies should further investigate age-related visuomotor deficits during collision avoidance tasks in cluttered environments using virtual reality in order to tease out factors that contribute most to avoidance behaviours in older adults.

Pedestrian assessment: Is displaying automated driving mode in self-driving vehicles as relevant as emitting an engine sound in electric vehicles?

Pedestrians rely on vehicle dynamics, engine sound, and driver cues. The lack of engine sound now constitutes an addressed pedestrian safety issue for (hybrid) electric vehicles ((H)EVs). Analogously, lacking driver cues may constitute a pedestrian safety issue for self-driving vehicles (SDVs). The purpose of this study was to systematically compare the relevance of substituting driver cues with an external human-machine interface among SDVs (no eHMI vs. eHMI) with the relevance of substituting engine sound with artificial sound among (H)EVs (no engine sound vs. engine sound). In a within-subject design, twenty-nine participants acting as pedestrians encountered a simulated SDV in a parking lot. The results revealed that both informational cues have equally large effects on subjective measures such as perceived safety. In semi-structured interviews, participants stated that it is equally crucial to equip SDVs with an eHMI as equipping (H)EVs with an artificial sound generator. We conclude that an eHMI for SDVs seems to be as relevant as an artificial sound for (H)EVs.

Pediatric Trauma: Six Years of Experience in a Swiss Trauma Center.

OBJECTIVES: The purpose of this study was to provide an internationally comparable overview of pediatric trauma of the University Hospital of Lausanne to improve the care of children. METHODS: We analyzed the data from all injured children (<16 years of age) listed in our trauma registry from 2011 to 2016. These children were admitted to the resuscitation room after prehospital triage. Our data were analyzed using descriptive statistics. RESULTS: We included 327 children. Sixty-three percent were male, and the median age was 8 years. Severe trauma (Injury Severity Score (ISS), >15) occurred in 97 children. The principal mechanisms of injury were falls (45%), traffic accidents (29%), and burns (14%). The most frequently affected areas were the head and external body regions. Intensive care admissions amounted to 27%. Twenty percent of patients underwent immediate surgery (wound care, neurosurgery, and orthopedic surgery). The overall mortality rate was 5.5%, with a median ISS of 9. The mortality of severe trauma was 17.5%, with a median ISS of 22. Half of the children died within 6 hours. The main causes of death were falls from greater than 5 m and traffic accidents as pedestrians. CONCLUSIONS: The demographics and patterns of injury in the pediatric trauma population are similar to other European pediatric trauma centers, but the mortality and the severity of injuries can vary (United Kingdom, 3.7%, median ISS of 9; Denmark, 7.3%, median ISS of 9; and Germany, 13.4%, median ISS of 25). The elevated early mortality rate suggests that improvements in prehospital care and early resuscitation could decrease mortality.

Comparison of Maxillofacial Fractures Between Pedestrians and Passengers in Road Traffic Accidents.

PURPOSE: Road traffic accidents remain as the most common cause of maxillofacial injuries in developed countries. To the best of our knowledge, comparative analysis of fracture localizations and injury types of injured pedestrians and passengers is seldom performed. Thus, this study aimed to compare maxillofacial injuries between pedestrians and passengers injured in road traffic accidents in terms of demographic characteristics of the patients, localization of fractures, and treatment. MATERIALS AND METHODS: The study population was composed of patients who underwent surgery for maxillofacial fractures resulting from road traffic accidents. They were divided into the pedestrian group and passenger group. Demographic data, fracture sites, and treatment methods were investigated retrospectively. RESULTS: Most of the patients were 20 to 30 years of age. Isolated mandible fractures occurred in 55.71% of the pedestrian group and 43.78% of the passenger group. Panfacial fractures were observed in 5.71% (n = 8) of the patients in the pedestrian group compared with 14.28% (n = 21) in the passenger group. CONCLUSIONS: Based on the injury pattern and mechanism of in-vehicle accidents, fractures tend to be located in the middle and upper facial bones rather than in the mandible. Thus, careful management in triage is important, as each group has specific injury patterns. Patients with panfacial fractures require meticulous management because they are at risk for high-energy injury and comorbidities.

Tendência temporal das internações por acidentes de trânsito na cidade de São Paulo, Brasil, 2000-2019 / Time trend in hospitalizations from motor vehicle accidents in the city of São Paulo, Brazil, 2000-2019 / Tendencia temporal de los internamientos por accidentes de tráfico en la ciudad de São Paulo, Brasil, 2000-2019

Este estudo avaliou a tendência das taxas de internação por acidentes de trânsito no Sistema Único de Saúde (SUS), de residentes no Município de São Paulo, Brasil, entre 2000 e 2019, segundo sexo, faixa etária e meio de transporte (pedestres, ciclistas, motociclistas e ocupantes de veículo). Foi ajustado um modelo de regressão segmentada com resposta binomial negativa, com pontos de inflexão para acomodar possíveis mudanças de tendência. Foram registradas 189.765 internações durante o período de estudo, a maioria de homens (80,5%) com idade entre 20 e 49 anos (71,2%). O tipo de acidente mais frequente foi com motocicleta (42,8%), seguido dos atropelamentos de pedestres (33,7%). De um modo geral, o período de 2000 a 2007 foi marcado pelo crescimento das taxas de hospitalização por acidentes de trânsito para todos os meios de transporte, em ambos os sexos e na maioria das faixas etárias. O momento em que as taxas pararam de crescer ou que eventualmente passaram a cair foi diferente para os diferentes meios de transporte. Para ocupantes de veículos e ciclistas, a tendência na maioria das faixas etárias inverteu-se para uma de queda em 2008, mas para pedestres e motociclistas, isto só ocorreu em 2012. A partir de 2015, a queda cessou em pedestres e as taxas em ciclistas voltaram a subir, na maioria das faixas etárias. Para motociclistas, as taxas voltaram a crescer em homens de 20 a 59 anos (7,2% ao ano, atingindo valores superiores a 140 por 100 mil habitantes em 2019) e em mulheres, de 15 a 39 anos (4,9% ao ano). É possível que os benefícios das medidas de segurança implementadas até agora tenham atingido seu limite, de modo que as atuais medidas de controle e prevenção devem ser revistas.

This study assessed the hospitalization rates from motor vehicle accidents in the Brazilian Unified National Health System (SUS) in residents of the city of São Paulo, Brazil, from 2000 to 2019, according to sex, age bracket, and means of transportation (pedestrians, cyclists, motorcyclists, and motor vehicle occupants). A segmented regression model with negative binomial response was adjusted with inflection points to accommodate possible changes in trends. 189,765 hospitalizations were recorded during the study period, mostly males (80.5%) and from 20 to 49 years of age (71.2%). The most frequent type of accident involved motorcyclists (42.8%), followed by run-over pedestrians (33.7%). In general, the period from 2000 to 2007 was marked by increasing hospitalization rates from motor vehicle accidents involving all means of transportation, in both sexes, and in most age brackets. The year when the rates stopped increasing (or in some cases began to drop) differed according to the means of transportation. For vehicle occupants and cyclists, the trend in most age brackets turned downward in 2008, but the same did not happen with pedestrians and motorcyclists until 2012. Starting in 2015, the decline stopped in pedestrians, and the rates in cyclists turned upward again in most age brackets. For motorcyclists, the rates turned upward again in men 20 to 59 years of age (7.2% per year, exceeding 140 per 100,000 inhabitants in 2019) and in women 15 to 39 years of age (4.9% per year). The benefits of traffic safety measures implemented thus far in Brazil may have reached their limit, so that the current control and prevention measures need to be revised.

Este estudio evaluó la tendencia de las tasas de internamiento por accidentes de tránsito en el Sistema Único de Salud, de residentes en el Municipio de São Paulo, Brasil, entre 2000 y 2019, según sexo, franja de edad y medio de transporte (peatones, ciclistas, motociclistas y ocupantes de vehículo). Fue ajustado a un modelo de regresión segmentada con respuesta binomial negativa, con puntos de inflexión para acomodar posibles cambios de tendencia. Se registraron 189.765 internamientos durante el período de estudio, la mayoría de hombres (80,5%) con edad entre 20 y 49 años (71,2%). El tipo de accidente más frecuente fue con motocicleta (42,8%), seguido de atropellamientos de peatones (33,7%). De modo general, el período de 2000 a 2007 estuvo marcado por el crecimiento de las tasas de hospitalización por accidentes de tránsito para todos los medios de transporte, en ambos sexos, y en la mayoría de las franjas de edad. El momento en el que las tasas pararon de crecer, o que eventualmente pasaron a caer, fue diferente para los diferentes medios de transporte. En el caso de ocupantes de vehículos y ciclistas, la tendencia en la mayoría de las franjas de edad se invirtió hacia una caída en 2008, pero en peatones y motociclistas, esto solo ocurrió en 2012. A partir de 2015, la caída cesó en peatones y las tasas en ciclistas volvieron a subir, en la mayoría de las franjas de edad. Para los motociclistas, las tasas volvieron a crecer en hombres de 20 a 59 años (7,2% al año, alcanzando valores superiores a 140 por 100 mil habitantes en 2019) y en mujeres, de 15 a 39 años (4,9% al año). Es posible que los beneficios de las medidas de seguridad implementadas hasta ahora hayan alcanzado su límite, de modo que las actuales medidas de control y prevención deben ser revisadas.