Database Integration Correlates Street Crossing Design Strategies With Pedestrian Injury.

INTRODUCTION: Transportation databases have limited data regarding injury severity of pedestrian versus automobile patients. To identify opportunities to reduce injury severity, transportation and trauma databases were integrated to examine the differences in pedestrian injury severity at street crossings that were signalized crossings (SCs) versus nonsignalized crossings (NSCs). It was hypothesized that trauma database integration would enhance safety analysis and pedestrians struck at NSC would have greater injury severity. METHODS: Single-center retrospective review of all pedestrian versus automobile patients treated at a level 1 trauma center from 2014 to 2018 was performed. Patients were matched to the transportation database by name, gender, and crash date. Google Earth Pro satellite imagery was used to identify SC versus NSC. Injury severity of pedestrians struck at SC was compared to NSC. RESULTS: A total of 512 patients were matched (median age = 41 y [Q1 = 26, Q3 = 55], 74% male). Pedestrians struck at SC (n = 206) had a lower injury severity score (ISS) (median = 9 [4, 14] versus 17 [9, 26], P < 0.001), hospital length of stay (median = 3 [0, 7] versus 6 [1, 15] days, P < 0.001), and mortality (21 [10%] versus 52 [17%], P = 0.04), as compared to those struck at NSC (n = 306). The transportation database had a sensitivity of 63.4% (55.8%-70.4%) and specificity of 63.4% (57.7%-68.9%) for classifying severe injuries (ISS >15). CONCLUSIONS: Pedestrians struck at SC were correlated with a lower ISS and mortality compared to those at NSC. Linkage with the trauma database could increase the transportation database's accuracy of injury severity assessment for nonfatal injuries. Database integration can be used for evidence-based action plans to reduce pedestrian morbidity, such as increasing the number of SC.

Shedding light on the pedestrian safety crisis: An analysis across the injury severity spectrum by lighting condition.

OBJECTIVE: Pedestrian fatalities in the United States increased 51% from 2009 to 2019. During that time, pedestrian fatalities occurring at night increased by 63.7%, compared to a 17.6% increase for pedestrian fatalities occurring during daylight conditions. Have there also been increases in serious, minor, and possible pedestrian injuries (i.e., have all pedestrian collisions been occurring more frequently)? Have pedestrian collisions been getting more severe (i.e., are there now higher proportions of more severe injuries)? Have trends differed between night and day? What role does street lighting play in the nighttime trends? METHODS: We analyzed pedestrian fatalities, serious injuries, minor injuries, and possible injuries that occurred in California, North Carolina, and Texas from 2010 to 2019 using linear regressions to explore the strength and statistical significance of trends. We then parsed these trends by lighting condition, exploring outcomes during the day and night and with and without street lighting. RESULTS: Findings suggest that increases in daytime minor (7.9%) and possible (7.5%) injuries closely mirrored increases in population (9.8%). Increases in daytime fatal/serious injuries were significantly higher (43.1% and 35.1%, respectively), suggesting worsening severities during the day. Increases in nighttime minor/possible injuries (31.9% and 27.6%, respectively) were significantly larger than those during the day, suggesting that pedestrian collisions are occurring more frequently at night. Substantial increases in nighttime fatal/serious injuries (78.0% and 74.7%, respectively) likely reflect a combination of worsening severity (seen throughout the day) and increasing frequency (seen particularly at night). A pedestrian injured in the dark was found to be 5.0 times more likely to be killed than a pedestrian injured during the day. While a lack of street lighting does not seem to be the cause of the disproportionate increase in pedestrian injuries at night, pedestrians struck without a street light were 2.4 times more likely to be killed than those struck in the presence of a street light. CONCLUSIONS: As we find ourselves in the midst of a pedestrian safety crisis, understanding that severities have increased throughout the entire day and frequencies have increased particularly at night helps illuminate a path forward.

Police-reported pedestrian crash matching and injury severity misclassification by body region in New Mexico, USA.

Between 2009 and 2019, pedestrian fatalities in the U.S. increased 51.0% while all other traffic fatalities increased 0.4%. To mitigate pedestrian safety issues, practitioners increasingly use police-reported data to identify and treat locations that experience either serious or fatal injuries. We investigated how many and which types of pedestrian injuries were misclassified by police-reported data in New Mexico between 2014 and 2018 by matching pedestrian-vehicle crash victims reported in New Mexico Department of Transportation (NMDOT) crash data to patients treated at University of New Mexico Health-Science Center, an American College of Surgeons-certified level 1 trauma center (n = 3097 pedestrians in NMDOT data; n = 512 matched pedestrians). Findings suggest that injuries involving older pedestrians, males, alcohol, more serious injuries, and those that occur at night are more likely to match to the hospital data. Of the non-fatally injured pedestrians who police estimated as seriously-injured (n = 207), 21.7% were no more than minorly-injured (n = 45) (KABCO A and ISS < 9). Of pedestrians who police estimated as minorly-injured (n = 239), 55.6% were seriously-injured (n = 133) (KABCO B,C,O and ISS ≥ 9). Of pedestrians with true serious injuries (n = 295) (ISS ≥ 9), 45.1% were under-estimated by police (n = 133) (KABCO B,C,O and ISS ≥ 9) whereas 29.8% of pedestrians with true minor injuries (n = 151) (ISS < 9) were over-estimated by police (n = 45) (KABCO A and ISS < 9). Minorly-injured pedestrians who were over-estimated by police (KABCO A and ISS < 9) were more likely to have lower extremity injuries (62.2% vs 42.5%, p-value = 0.013) compared to minorly-injured pedestrians whose injury severities were estimated correctly (KABCO B,C,O and ISS < 9). Seriously-injured pedestrians who were under-estimated (KABCO B,C,O and ISS ≥ 9) were less likely to have injuries to the head (39.8% vs. 55.6%, p-value = 0.003), spine (30.1% vs. 50.0%, p-value < 0.001), thorax (53.4% vs. 66.7%, p-value = 0.0139), or abdomen (18.8% vs. 32.1%, p-value = 0.005) compared to seriously-injured pedestrians whose injury severities were estimated correctly (KABCO A and ISS ≥ 9). This research illustrates the importance of linking police and health outcome databases to provide a more complete understanding of traffic safety.

Nighttime pedestrian fatalities: A comprehensive examination of infrastructure, user, vehicle, and situational factors.

INTRODUCTION: Pedestrian fatalities in the United States increased 45.5% between 2009 and 2017. More than 85% of those additional pedestrian fatalities occurred at night. METHOD: We examine Fatality Analysis Reporting System (FARS) data for fatal pedestrian crashes that occurred in the dark between 2002 and 2017. Within-variable and before/after examinations of crashes in terms of infrastructure, user, vehicle, and situational characteristics are performed with one-way analysis of variance (ANOVA) and two-sample t-tests. We model changes in crash characteristic proportions between 2002-2009 and 2010-2017 using linear regressions and test for autocorrelation with Breusch-Godfrey tests. RESULTS: The increase in fatal nighttime pedestrian crashes is most strongly correlated with infrastructure factors: non-intersection unmarked locations (saw 80.8% of additional fatalities); 40-45 mph roads (54.6%); five-lane roads (40.7%); urban (99.7%); and arterials (81.1%). In addition, SUVs were involved in 39.7% of additional fatalities, overrepresenting their share of the fleet. Increased pedestrian alcohol and drug involvement warrant further investigation. The age of pedestrians killed increased more (18.1%) than the national average (3.2%). CONCLUSIONS: By identifying factors related to the increase in nighttime pedestrian fatalities, this work constitutes a vital first step in making our streets safer for pedestrians. Practical Applications: More research is needed to understand the efficacy of different solutions, but this paper provides guidance for such future research. Engineering solutions such as road diets or traffic calming may be used to improve identified infrastructure issues by reducing vehicle speeds and road widths. Rethinking vehicle design, especially high front profiles, may improve vehicle issues. However, the problems giving rise to these pedestrian fatalities are likely a result of not only engineering issues but also interrelated social and political factors. Solutions may be correspondingly comprehensive, employing non-linear, systems-based approaches such as Safe Systems.

Redefining the child pedestrian safety paradigm: identifying high fatality concentrations in urban areas.

OBJECTIVES: Child pedestrians are some of the most vulnerable users of our transportation systems, and they deserve particular attention when we consider traffic safety. The objective of this work is to identify urban locations in which child pedestrians are at particular risk for fatal collisions with vehicles. METHODS: This paper examines 30 years of crash data for six American cities to locate areas with high child pedestrian fatality concentrations. Phase I of the study, which examines Denver, Colorado, USA, reveals higher concentrations of child pedestrian fatalities around parks as compared with other areas that children have been shown to frequent. In phase II of the study, we specifically examine fatality concentrations near parks as compared with schools. RESULTS: Statistical analyses suggest that, once exposure is controlled for, child pedestrian fatalities concentrate around parks in densities 1.04-2.23 times higher than around schools. Also, the concentration of child pedestrian fatalities around parks is 1.16-1.81 times higher than the respective citywide concentration. CONCLUSION: Traffic risks for children around parks deserve further examination as we pursue the goals of Vision Zero and child safety on our streets.