A Pattern Emerges on Pedestrian Injuries Involving Children

By Bridgett Novak

NEW YORK (Reuters Health) - Automobile accidents involving pediatric pedestrians tend to occur mid-block, near bus stops, and when supervisors are not paying attention, new research hints.

The U.S. Department of Transportation reports that pedestrian versus motor vehicle accidents (PVMVA) caused approximately 4,700 deaths and 76,000 injuries in 2012, and data from the U.S. Department of Health and Human Services indicates that such accidents are the leading cause of death due to unintentional injury among children 5 to 14 years old.

According to previous research, PVMVA account for 31% to 61% of all injury-related hospital admissions in children and 11% require surgical intervention.

In an effort to build more precise models about the wheres and whys of these accidents, researchers reviewed the electronic records of all patients who arrived via ambulance to the emergency department of St. Christopher's Hospital for Children in Philadelphia after an automobile versus pedestrian accident in 2012.

A total of 100 patients (79 boys and 21 girls) with an average age of 8 years were included in the analysis, presented March 24 at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in Las Vegas. 

Sixty-one percent were evaluated only or were admitted for less than 24 hours; 39% were admitted for 24 hours or more with a mean stay of 1.98 days; 11% were admitted to the ICU for at least one day.

The most common orthopedic diagnoses were fractures of the tibial shaft (26%), femoral shaft (6%), and ankle (6%).

At the time of the accident, 40% of the children were accompanied by a parent or guardian, 34% by friends or peers, 13% by older siblings, and 13% were alone. Twenty-nine percent of the accidents occurred between 2:00 and 5:00 pm; 42% occurred between 5:00 and 9:00 pm. The greatest number of injuries occurred during June (13%), followed by April and May (each with 11%).

The most common locations were near schools and public bus stops used by students for transportation to and from school. Eighty-eight percent of the children were struck in the street - 70% mid-block (not at an intersection or crosswalk) and 18% at a crosswalk. Others were struck on private property, a sidewalk, or in a parking lot.

In an email to Reuters Health, Dr. Alexa J. Karkenny, lead researcher and orthopedic surgery resident at Montefiore Medical Center/Albert Einstein College of Medicine in the Bronx, New York, says the large proportion hit mid-block is especially troubling.

"We heard stories about children suddenly darting after balls or riding bikes or scooters into the street. These incidents occurred after a parent had turned away or when they did not have supervision by a parent but rather an older sibling or friends. Other narratives reported children just crossing the street while traveling alone or with family," Karkenny explained.

Dangerous patient behaviors, proximity to schools and bus stops, warm weather, and the type of supervision are key, believes Karkenny. "The fact that such a high percentage of these accidents occurred in the presence of parents may indicate that appropriate supervision does not simply require physical presence, but also full attention, as well as an understanding of road safety. With this in mind, we can infer that there is a role for parental education on the risks of pedestrian-struck injuries in children."

She added that injury prevention efforts should focus on improved supervision at school dismissal times and more public transportation safety near school zones.

Dr. David Horn, attending orthopedic surgeon at The Children's Hospital of Philadelphia, agrees. "Several steps can be taken to improve the safety of pediatric pedestrians. These include education of parents, children, schools and municipalities; improving the built environment to improve safety; and increased supervision of school-age children after school."

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