Increased pedestrian mortality among the elderly

doi:10.1016/0735-6757(89)90044-2

The American Journal of Emergency Medicine

Volume 7, Issue 4, July 1989, Pages 387-390

https://doi.org/10.1016/0735-6757(89)90044-2 Get rights and content

Abstract

Elderly pedestrians struck by motor vehicles have the highest mortality rate of all pedestrian injury victims. One thousand eighty-two motor vehicle-pedestrian accidents occurring in a metropolitan area over a 5-year period were studied. Age-specific injury rates and fatality rates were evaluated with respect to the injury severity scores (ISS) for all fatally injured autopsied pedestrians. Of the 1,082 injuries, 131 fatalities occurred. Mean ISSs were found to be significantly higher for pedestrians dying at the scene of the accident (mean ISS, 54.83) and higher for those dying in the emergency department (mean ISS, 45.18), than for pedestrians who died in the hospital (mean ISS, 30.57) (P < .0001). The mortality rate for pedestrians aged ≥60 years was substantially higher than for those adults aged <60 years of age (P < .001). Elderly patients involved in accidents were much more likely to die than younger pedestrians (44.6% v 10.4%; P < .0001). Elderly pedestrians were significantly overrepresented in the group of pedestrians dying in the hospital compared with younger injury victims (52.5% v 21.5%; P < .008). This study shows that elderly pedestrians struck by motor vehicles die at a higher rate because they succumb to injuries in the hospital more frequently than younger pedestrians. This may reflect the greater susceptibility of the elderly to metabolic, surgical, and infectious complications after admission to the hospital. A decrease in mortality rates of elderly patients suffering pedestrian injuries will probably follow improved in-hospital intensive care services for the elderly.

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This systematic review sought to assess older adult pedestrian injury severity, injury by anatomical location and incidence proportions, including comparisons to younger age groups when available and provide an analysis of the quality of the existing evidence. A structured search was conducted in PubMed, Embase, Scopus, CINAHL, PsycInfo, AMED, Web of Science, LILACS and TRID. STROBE was used to assess the reporting quality of the included studies. Random-effect model meta-analysis served to obtain pooled relative risk, incidence proportions and standardized mean differences for different outcomes due to pedestrian crashes comparing older and younger pedestrians, while meta-analyses could not be conducted for pedestrian falls. We screened 7460 records of which 60 studies (1,012,041 pedestrians) were included in the review. Injured pedestrians 60+ compared to those <60 were found to have a higher relative risk of severe injury (pooled relative risk RR 1.6, 95 % CI: 1.4–2.0 p < 0.001), critical care admission (pooled RR 1.5, 95 %CI: 1.3–1.8 p < 0.001), and fatality (pooled RR of 3.7, 95 % CI: 3.0–4.5 p < 0.001). Pedestrians 60+ also had higher incidence rates of pedestrian falls causing higher injury severity. GRADE was used to evaluate evidence quality, with the results suggesting that the overall quality of the evidence supporting these findings was low. Further research is needed to understand health risks associated with older pedestrian trauma and to develop effective risk management strategies.
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Citation Excerpt :
As a consequence, in 2010 in the United States the fatality rate for older pedestrians (age 65+) was higher than the rate for all other ages (NHTSA, 2012). An extensive and test-based study on this topic was performed by Sklar et al. (1989). The logistic regression model is frequently used to compute injury risk function (e.g. Rosén and Sander, 2009 and the references therein).
Older adults and pedestrians both represent especially vulnerable groups in traffic. In the literature, hazards are usually described by the corresponding injury risks of a collision. This paper investigates the MAIS3 + F risk (the risk of sustaining at least one injury of AIS 3 severity or higher, or fatal injury) for pedestrians in full-frontal pedestrian-to-passenger car collisions.
Using some assumptions, a model-based approach to injury risk, allowing for the specification of individual injury risk parameters for individuals, is presented. To balance model accuracy and sample size, the GIDAS (German In-depth Accident Study) data set is divided into three age groups; children (0–14); adults (15–60); and older adults (older than 60). For each group, individual risk curves are computed. Afterwards, the curves are re-aggregated to the overall risk function.
The derived model addresses the influence of age on the outcome of pedestrian-to-car accidents. The results show that older people compared with younger people have a higher MAIS3 + F injury risk at all collision speeds. The injury risk for children behaves surprisingly. Compared to other age groups, their MAIS3 + F injury risk is lower at lower collision speeds, but substantially higher once a threshold has been exceeded. The resulting injury risk curve obtained by re-aggregation looks surprisingly similar to the frequently used logistic regression function computed for the overall injury risk. However, for homogenous subgroups – such as the three age groups – logistic regression describes the typical risk behavior less accurately than the introduced model-based approach.
Since the effect of demographic change on traffic safety is greater nowadays, there is a need to incorporate age into established models. Thus far, this is one of the first studies incorporating traffic participant age to an explicit risk function. The presented approach can be especially useful for the modeling and prediction of risks, and for the evaluation of advanced driver assistance systems.
Analyzing fault and severity in pedestrian-motor vehicle accidents in China
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Citation Excerpt :
Age and physical conditions are identified as the main risk factors (Sklar et al., 1989; Vestrup and Reid, 1989; Zegeer et al., 1996; Fontaine and Gourlet, 1997; Harruff et al., 1998; Al-Ghamdi, 2002; Retting, 2003; Chong et al., 2010; Kim et al., 2010). Speeding and drunk driving also increased the probability of severe injury to pedestrians (Miles-Doan, 1996; Jensen, 1999; Öström and Eriksson, 2001; Kim et al., 2008a,b; Damsere-Derry et al., 2003). Vehicle type and environmental conditions impact the risk for severe injury in pedestrian accidents.
The number of pedestrian–motor vehicle accidents and pedestrian deaths in China surged in recent years. However, a large scale empirical research on pedestrian traffic crashes in China is lacking. In this study, we identify significant risk factors associated with fault and severity in pedestrian–motor vehicle accidents. Risk factors in several different dimensions, including pedestrian, driver, vehicle, road and environmental factors, are considered. We analyze 6967 pedestrian traffic accident reports for the period 2006–2010 in Guangdong Province, China. These data, obtained from the Guangdong Provincial Security Department, are extracted from the Traffic Management Sector-Specific Incident Case Data Report. Pedestrian traffic crashes have a unique inevitability and particular high risk, due to pedestrians’ fragility, slow movement and lack of lighting equipment. The empirical analysis of the present study has the following policy implications. First, traffic crashes in which pedestrians are at fault are more likely to cause serious injuries or death, suggesting that relevant agencies should pay attention to measures that prevent pedestrians from violating traffic rules. Second, both the attention to elderly pedestrians, male and experienced drivers, the penalty to drunk driving, speeding, driving without a driver's license and other violation behaviors should be strengthened. Third, vehicle safety inspections and safety training sessions for truck drivers should be reinforced. Fourth, improving the road conditions and road lighting at night are important measures in reducing the probability of accident casualties. Fifth, specific road safety campaigns in rural areas, and education programs especially for young children and teens should be developed and promoted. Moreover, we reveal a country-specific factor, hukou, which has significant effect on the severity in pedestrian accidents due to the discrepancy in the level of social insurance/security, suggesting that equal social security level among urban and rural people should be set up. In addition, establishing a comprehensive liability distribution system for non-urban areas and roadways will be conducive to both pedestrians’ and drivers’ voluntary compliance with traffic rules.
Mapping patterns of pedestrian fatal accidents in Israel
2012, Accident Analysis and Prevention
Citation Excerpt :
The literature shows a great interest in comprehending pedestrian accident patterns in order to design preventive measures and to allocate resources for identified problems. In the last thirty years, the main interest has shifted from examining pedestrian accidents involving children (e.g., Bagley, 1992; Brison et al., 1988; Fortenberry and Brown, 1982) and elderly (e.g., Sklar et al., 1989; Zegeer et al., 1993) to analyzing determinants of collisions between pedestrian and vehicles (e.g., Al-Ghamdi, 2002; Ballesteros et al., 2004; Kim et al., 2008a; Lee and Abdel-Aty, 2005). In the last decade, the main interest has further shifted toward investigating factors that characterize pedestrian accidents at various spatial aggregation levels (e.g., Beck et al., 2007; Eluru et al., 2008; Fontaine and Gourlet, 1997; Harruff et al., 1998; Kim et al., 2008b; Mabunda et al., 2008; Preusser et al., 2002).
This study intends to provide insight into pedestrian accidents by uncovering their patterns in order to design preventive measures and to allocate resources for identified problems. Kohonen neural networks are applied to a database of pedestrian fatal accidents occurred during the four-year period between 2003 and 2006. Results show the existence of five pedestrian accident patterns: (i) elderly pedestrians crossing on crosswalks mostly far from intersections in metropolitan areas; (ii) pedestrians crossing suddenly or from hidden places and colliding with two-wheel vehicles on urban road sections; (iii) male pedestrians crossing at night and being hit by four-wheel vehicles on rural road sections; (iv) young male pedestrians crossing at night wide road sections in both urban and rural areas; (v) children and teenagers crossing road sections in small rural communities. From the perspective of preventive measures, results suggest the necessity of designing education and information campaigns for road users as well as allocating resources for infrastructural interventions and law enforcement in order to address the identified major problems.
Injury in Older People
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Are roadside pedestrian injury patterns predictable in a densely populated, urban setting?
2010, Journal of Surgical Research
Citation Excerpt :
In fact, mortality in our study was highest in the age older than 65 y group. Sklar et al. reviewed over 1000 roadside pedestrian injuries and also found that elderly pedestrians struck by motor vehicles die at higher rates because they succumb to their injuries more frequently during their hospitalization than younger patients [8]. These authors allude to the fact that this may be due to a greater susceptibility of the elderly to metabolic, surgical, and infectious complications after admission to the hospital.
Roadside pedestrian injuries represent a significant portion of trauma team activations, especially at urban trauma centers. Patient demographics and severity of injury vary greatly in this patient population. Herein, we hypothesize that injury patterns may be predictable, especially with respect to age.
All patients with roadside pedestrian injuries evaluated at our urban, level one trauma center from January 2006 through December 2008 were retrospectively reviewed. Data were collected from the institutional trauma registry. Age was used as an independent variable and compared with injury type, substance abuse, discharge setting, and mortality.
There were 226 roadside pedestrian injuries during the study period. Patients were divided into groups according to age, under 20 y, 21–40 y, 41–65 y, and over 65 y. Head injuries were more prevalent in patients over age 65, 30.4% versus 14.0% (P = 0.05). There was a trend for increasing alcohol use in the younger population. The likelihood of discharge to a rehab facility increased with age, 0%, 11.8%, 38.2%, 50.0%, respectively (P < 0.001). Mortality was significantly higher in patients older than 65 y, 15.2% versus 3.3% (P = 0.049).
Roadside pedestrian injuries have predictable injury patterns based on age. Older patients are more likely to have a head injury, longer length of stay, need for a rehab stay, and have a higher mortality. Further studies are needed to correlate precise injuries with collision mechanism and evaluate specific risk factors in this high risk population.

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Original contributionIncreased pedestrian mortality among the elderly

Abstract

Accident Ann Prevention

J Chron Dis

Urban-rural location and the risk of dying in a pedestrian-vehicle collision

J Trauma

The man in the street—A tale of two cities

Am J Public Health

Geriatric trauma

Duration of survival in traffic accident fatalities

Med J Aust

The injury severity score: An update

J Trauma

Original contribution
Increased pedestrian mortality among the elderly