Non-traffic child pedestrian injuries

Injury patterns in motor vehicle collision-pediatric pedestrian deaths

OBJECTIVE

To describe fatal pediatric pedestrian injury patterns and correlate them with motor vehicle collision (MVC) characteristics and pedestrian kinematics using data from medicolegal death investigations of MVCs occurring in the current Canadian MV fleet and determine the applicability of the classical "Waddell's triad" comprising knee, hip (femur) or pelvis and craniocerebral injuries to present data injury patterns.

METHODS

An Injury Data Collection Form was used to extract MV, MVC, pedestrian demographic and injury information from the Office of the Chief Coroner for Ontario database using autopsy data from 2013 to 2018. Injuries were coded using the Abbreviated Injury Scale (AIS) 2015 revision. The study focused on AIS ≥3 injuries utilizing the Maximum Abbreviated Injury Scale (MAIS), MAIS by Body Region (MAISBR) and Injury Severity Score (ISS).

RESULTS

Between 2013 and 2018, there were 25 pediatric deaths. The pedestrians were either struck and run over (n = 17, 68%; 56% low speed) or struck and projected (n = 8, 32%). Twenty-two deaths were from frontal impacts; three were from reversing vehicles. Fourteen of the 17 (82.4%) run over cases occurred at low speed (<30 km/h). In 9 (36%) cases, the vehicle was turning at impact (right n = 3, left n = 6). A majority of the vehicles had a high hood edge. The head was the most severely injured (median MAISBR = 5 overall and ≤10 years; median MAISBR = 6 for 11-14 years old) followed by the neck (MAISBR = 3 overall; 6-14 years old), and the thorax (median MAISBR = 3 overall; all age groups). For the early adolescents (11-14 years old), the serious injury pattern included the abdomen (median MAISBR = 3.5). Nearly half (n = 11, 44%) sustained brainstem injuries. Over fifty percent of the 16 cases with neck injuries (n = 9, 56.3%) had atlanto-occipital or axial dislocation.

CONCLUSION

More than half of the deaths occurred during low speed run overs. MAIS ≥3 injuries trended to a dyad of head and thorax in ≤5 years old, a triad of head, neck, and thorax injuries in children 6-10 years old and a tetrad with the addition of abdominal injuries in pedestrians ≥11 years old. Waddell's triad was not applicable to the fatal cases in the present study.

Incidence and Characteristics of Low-Speed Vehicle Run-Over Events in Australian Aboriginal and/or Torres Strait Islander Children and Other Australian Children Aged 0 to 14 Years in Queensland: An 11-Year (1999-2009) Retrospective Analysis

The main objective of this study is to describe incidence rates (IRs) of low-speed vehicle run-over events among children aged 0 to 14 years in Queensland, Australia, from 1999 to 2009, by Indigenous Australian status. Data on low-speed vehicle run-over events among children aged 0 to 14 years in Queensland were obtained for 11 calendar years (1999-2009) from all relevant data sources using International Classification of Diseases (ICD) codes, text description, word searches, and medical notes and were manually linked. Crude fatal and nonfatal IRs were calculated for Indigenous and non-Indigenous children; trends over time were analyzed by chi-square test for trend. Relative risks (RRs) were also calculated. Data on demographics, health service usage/outcomes, incident characteristics, and injury characteristics were obtained. Descriptive and multivariate analyses were performed in order to investigate whether these characteristics varied with Indigenous status. IRs were higher among Indigenous Australian children aged 0 to 14 years (21.76/100,000/annum) than other Australian children (14.09), for every year of the 11-year study. The age group most at risk for low-speed vehicle run-over events were young children aged 0 to 4 years, where incidence was 2.13 times greater among Indigenous Australian children (95% confidence interval [CI] = 1.67-2.71). There were no significant changes in incidence of low-speed vehicle run-overs among Indigenous Australian children for 0 to 4, 5 to 9, and 10 to 14 years or overall (0-14 years), during the 11-year study period. Over three quarters (n = 107) of low-speed vehicle run-over events involving Indigenous Australian children occurred outside of major cities (43.7% in other Australian children). These data indicate that Indigenous Australian children are at increased risk of low-speed vehicle run-over events and that characteristics of these events may vary as a function of Indigenous status. These results highlight that culturally specific interventions to reduce low-speed vehicle run-over events are required.

Development, Implementation and Evaluation of an Educational Intervention to Prevent Low Speed Vehicle Run-Over Events: Lessons Learned

There is a growing body of literature regarding low speed vehicle runover (LSVRO) events among children. To date, no literature exists on evaluation of interventions to address this serious childhood injury. Knowledge, attitudes, and behaviour regarding LSVROs were assessed via survey at a shopping centre (pre-intervention), then five months later (post-intervention), to investigate the effect of a population level educational intervention in Queensland, Australia. Participants’ knowledge regarding frequency of LSVRO events was poor. No participant demonstrated ‘adequate behaviour’ in relation to four safe driveway behaviours pre-intervention; this increased at post-intervention (p < 0.05). Most of the sample perceived other’s driveway behaviour as inadequate, and this reduced significantly (<0.05). Perceived effectiveness of LSVRO prevention strategies increased from pre- to post-intervention, but not significantly. TV was the greatest source of knowledge regarding LSVROs pre- and post-intervention. This study provides some evidence that the educational campaign and opportunistic media engagement were successful in increasing awareness and improving behaviour regarding LSVROs. While there are several limitations to this study, our experience reflects the ‘real-world’ challenges associated with implementing prevention strategies. We suggest a multi-faceted approach involving media (including social media), legislative changes, subsidies (for reversing cameras), and education to prevent LSVROs.

Incidence of paediatric fatal and non-fatal low speed vehicle run over events in Queensland, Australia: eleven year analysis

BACKGROUND

The purpose of this study was to estimate the incidence of fatal and non-fatal Low Speed Vehicle Run Over (LSVRO) events among children aged 0-15 years in Queensland, Australia, at a population level.

METHODS

Fatal and non-fatal LSVRO events that occurred in children resident in Queensland over eleven calendar years (1999-2009) were identified using ICD codes, text description, word searches and medical notes clarification, obtained from five health related data bases across the continuum of care (pre-hospital to fatality). Data were manually linked. Population data provided by the Australian Bureau of Statistics were used to calculate crude incidence rates for fatal and non-fatal LSVRO events.

RESULTS

There were 1611 LSVROs between 1999-2009 (IR=16.87/100,000/annum). Incidence of non-fatal events (IR=16.60/100,000/annum) was 61.5 times higher than fatal events (IR=0.27/100,000/annum). LSVRO events were more common in boys (IR=20.97/100,000/annum) than girls (IR=12.55/100,000/annum), and among younger children aged 0-4 years (IR=21.45/100000/annum; 39% or all events) than older children (5-9 years: IR=16.47/100,000/annum; 10-15 years IR=13.59/100,000/annum). A total of 896 (56.8%) children were admitted to hospital for 24 hours of more following an LSVRO event (IR=9.38/100,000/annum). Total LSVROs increased from 1999 (IR=14.79/100,000) to 2009 (IR=18.56/100,000), but not significantly. Over the 11 year period, there was a slight (non -significant) increase in fatalities (IR=0.37-0.42/100,000/annum); a significant decrease in admissions (IR=12.39-5.36/100,000/annum), and significant increase in non-admissions (IR=2.02-12.77/100,000/annum). Trends over time differed by age, gender and severity.

CONCLUSION

This is the most comprehensive, population-based epidemiological study on fatal and non-fatal LSVRO events to date. Results from this study indicate that LSVROs incur a substantial burden. Further research is required on the characteristics and risk factors associated with these events, in order to adequately inform injury prevention. Strategies are urgently required in order to prevent these events, especially among young children aged 0-4 years.

Systematic literature review of incidence rates of low-speed vehicle run-over incidents in children

AIM

To systematically review the literature investigating the incidence of fatal and or nonfatal low-speed vehicle run-over (LSVRO) incidents in children aged 0-15 years.

METHODS

The following databases were searched using specific search terms, from their date of conception up to June 2011: Cochrane Library, Medline, CINAHL, Embase, AMI, Sociological Abstracts, ERIC, PsycArticles, PsycInfo, Urban Studies and Planning; Australian Criminology Database; Dissertations and Thesis; Academic Research Library; Social Services Abstracts; Family and Society; Scopus; and Web of Science. A total of 128 articles were identified in the databases (33 found by hand searching). The title and abstract of these were read, and 102 were removed because they were not primary research articles relating to LSVRO-type injuries. Twenty-six articles were assessed against the inclusion (reporting population level incidence rates) and exclusion criteria, 19 of which were excluded, leaving a total of five articles for inclusion in the review.

FINDINGS

Five studies were identified that met the inclusion criteria. The incidence rate in nonfatal LSVRO events varied in the range of 7.09 to 14.79 per 100,000 and from 0.63 to 3.2 per 100,000 in fatal events.

DISCUSSION

Using International Classification of Diseases codes for classifying fatal or nonfatal LSVRO incidents is problematic as there is no specific code for LSVRO. The current body of research is void of a comprehensive secular population data analysis. Only with an improved spectrum of incidence rates will appropriate evaluation of this problem be possible, and this will inform nursing prevention interventions. The effect of LSVRO incidents is clearly understudied. More research is required to address incidence rates in relation to culture, environment, risk factors, car design, and injury characteristics.

CONCLUSIONS

The lack of nursing research or policy around this area of injury, most often to children, indicates a field of inquiry and policy development that needs attention.

Risk factors associated with injury and mortality from paediatric low speed vehicle incidents: a systematic review

Objective. This study reviews modifiable risk factors associated with fatal and nonfatal injury from low-speed vehicle runover (LSVRO) incidents involving children aged 0–15 years. Data Sources. Electronic searches for child pedestrian and driveway injuries from the peer-reviewed literature and transport-related websites from 1955 to 2012. Study Selection. 41 studies met the study inclusion criteria. Data Extraction. A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables. Results. The most commonly reported risk factors for LSVRO incidents included age under 5 years, male gender, and reversing vehicles. The majority of reported incidents involved residential driveways, but several studies identified other traffic and nontraffic locations. Low socioeconomic status and rental accommodation were also associated with LSVRO injury. Vehicles were most commonly driven by a family member, predominantly a parent. Conclusion. There are a number of modifiable vehicular, environmental, and behavioural factors associated with LSVRO injuries in young children that have been identified in the literature to date. Strategies relating to vehicle design (devices for increased rearward visibility and crash avoidance systems), housing design (physical separation of driveway and play areas), and behaviour (driver behaviour, supervision of young children) are discussed.

Trauma Center-Based Surveillance of Nontraffic Pedestrian Injury among California Children

Introduction

Every year in the United States, thousands of young children are injured by passenger vehicles in driveways or parking areas. Little is known about risk factors, and incidence rates are difficult to estimate because ascertainment using police collision reports or media sources is incomplete. This study used surveillance at trauma centers to identify incidents and parent interviews to obtain detailed information on incidents, vehicles, and children.

Methods

Eight California trauma centers conducted surveillance of nontraffic pedestrian collision injury to children aged 14 years or younger from January 2005 to July 2007. Three of these centers conducted follow-up interviews with family members.

Results

Ninety-four injured children were identified. Nine children (10%) suffered fatal injury. Seventy children (74%) were 4 years old or younger. Family members of 21 victims from this study (23%) completed an interview. Of these 21 interviewed victims, 17 (81%) were male and 13 (62%) were 1 or 2 years old. In 13 cases (62%), the child was backed over, and the driver was the mother or father in 11 cases (52%). Fifteen cases (71%) involved a sport utility vehicle, pickup truck, or van. Most collisions occurred in a residential driveway.

Conclusion

Trauma center surveillance can be used for case ascertainment and for collecting information on circumstances of nontraffic pedestrian injuries. Adoption of a specific external cause-of-injury code would allow passive surveillance of these injuries. Research is needed to understand the contributions of family, vehicular, and environmental characteristics and injury risk to inform prevention efforts.

Driveway runover, the influence of the built environment: a case control study

AIM

Driveway runover injuries are a frequent cause of paediatric mortality and morbidity throughout the world. Driveway runovers occur as a result of an interaction between human factors (child and driver), vehicle factors (visibility) and environmental factors (driveway design and surroundings). This study investigates the environmental factors involved in these injuries.

METHODS

Case control study, Auckland, New Zealand. Cases were the properties where paediatric driveway injuries (age < 7 years) requiring hospital admission had occurred. Control properties were selected from the addresses of children presenting to the emergency department with a non-driveway injury. Blinded assessment of properties was completed using satellite images, site visits and searches of council records.

RESULTS

Analysis was completed on 88 case properties and 181 controls. The risk of injury was increased by a driveway length greater than 12m (OR = 1.8, 95%CI = 1.1-3.0), exiting the driveway onto a local road (OR = 5.5, 95% CI = 2.7-11.2) and the driveway exiting onto a cul-de-sac (OR = 2.3, 95%CI = 1.4-3.9). The risk of driveway injury was increased when more parking areas were on the property (accessed from the driveway) (OR = 3.0, 95%CI = 1.6-5.4) and when the driveway runs along the property boundary (OR = 2.9, 95%CI = 1.6-5.2). A separate pedestrian pathway on the property was associated with a lower risk of injury (OR = 0.4, 95%CI= 0.2-0.9).

CONCLUSIONS

A number of built environment features contribute to driveway runover injuries. This information should be used by those within the design and building community to reduce the risk of further driveway runover injury.

Violent deaths in small children in northern Sweden

OBJECTIVES

To identify causes and trends of violent deaths among children younger than 4 years in a northern region.

STUDY DESIGN

Retrospective analysis of medico-legal autopsy and police data.

METHODS

Data from all 72 deaths from "external causes" 1977-2004, in children < 4 years from the northern half of Sweden were analysed.

RESULTS

The death rate was 7.1 per 100,000 children and year during the first half of the study period, and 5.2 during the second half. Vehicle- and drowning-related deaths were halved. Fifteen were struck by motor vehicles (in 8 cases by heavy vehicles), 14 car occupants were killed in car crashes, 12 were killed by intentional violence inflicted by an adult, and 9 each were killed by (i) carbon monoxide/smoke inhalation, (ii) asphyxiation, or (iii) drowning. The boy:girl ratio was 1:1 in all groups, except in the groups "drowning" and "run over by motor vehicle", where boys dominated.

CONCLUSIONS

Medical professionals have a difficult but important task in identifying and taking action against child abuse and in promoting child safety especially in the traffic and home environments.

Family, social, and cultural factors in pedestrian injuries among Hispanic children

OBJECTIVES

In an earlier population based surveillance study of pediatric injuries, the rate of Hispanic children injured as pedestrians was 63/100,000 compared with 17/100,000 for non-Hispanic white children. The present study was designed to examine the effect of family, social, and cultural factors on the rate of pedestrian injury in a population of Hispanic children in the southwestern US.

METHODS

A case-control study of pedestrian injuries among Hispanic children. The sample consisted of 98 children 0-14 years of age hospitalized as a result of a pedestrian injury and 144 randomly selected neighborhood controls matched to the case by city, age, gender, and ethnicity. Cases were compared with controls using conditional logistic regression; in the study design the odds ratio (OR) estimates the incidence rate ratio.

RESULTS

The following family and cultural variables were associated with an increased risk of injury: household crowding (OR = 2.8, 95% confidence interval (CI) 1.1 to 7.1 for 1.01-1.5 persons per room, compared with < or = 1.0 persons per room), one or more family moves within the past year (OR 2.2, 95% CI 1.2 to 4.1), poverty (OR 1.9, 95% CI 1.1 to 3.3), and inability of mother (OR 3.6, 95% CI 1.3 to 10) or father (OR 5.6, 95% CI 1.5 to 20) to read well. However, children in single parent households and children whose parents did not drive a car, had less education, or were of rural origin, did not have an increased rate of injury.

CONCLUSIONS

These results have implications for childhood pedestrian prevention efforts for low income, non-English speaking Hispanic populations, and perhaps for other immigrant and high risk groups. Prevention programs and materials need to be not only culturally sensitive but also designed for those with limited reading skills. In addition, environmental interventions that provide more pedestrian friendly neighborhoods must be considered.

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.

Effect of environmental factors on risk of injury of child pedestrians by motor vehicles: a case-control study

OBJECTIVE

To identify and assess contribution of environmental risk factors for injury of child pedestrians by motor vehicles.

DESIGN

Community based case-control study. Environmental characteristics of sites of child pedestrian injury were compared with the environmental characteristics of selected comparison sites. Each comparison site was the same distance and direction from home of control child as was the injury site from home or relevant case child. Two control sites were selected for each injury site.

SETTING

Auckland region of New Zealand.

SUBJECTS

Cases were 190 child pedestrians aged < 15 who were killed or hospitalised after collision with a motor vehicle on a public road during two years and two months. Controls were 380 children randomly sampled from population and frequency matched for age and sex.

MAIN OUTCOME MEASURE

Traffic volume and speed and level of parking on curbs at injury sites and comparison sites.

RESULTS

Risk of injury of child pedestrians was strongly associated with traffic volume: risk of injury at sites with highest traffic volumes was 14 times greater than that at least busy sites (odds ratio 14.30; 95% confidence interval 6.98 to 29.20), and risk increased with increasing traffic volume. High density of curb parking was also associated with increased risk (odds ratio 8.12; 3.32 to 19.90). Risk was increased at sites with mean speeds over 40 km/h (odds ratio 2.68; 1.26 to 5.69), although risk did not increase further with increasing speed.

CONCLUSION

Reducing traffic volume in urban areas could significantly reduce rates of child pedestrian injury. Restricting curb parking may also be effective.

Application of capture-recapture methodology to estimate the completeness of child injury surveillance

This paper describes the use of the two sample capture-recapture method to estimate the completeness of ascertainment of injury events in both routine public hospital discharge statistics and in an active injury surveillance system. For all child pedestrian injuries public hospital discharge statistics were 90% complete and the active surveillance system 77% complete. For non-traffic child pedestrian injuries public hospital discharge statistics were 66% complete, the active surveillance system being 79% complete. Capture-recapture methods have the potential to improve the accuracy of traditional childhood injury surveillance systems.