Automobile-Pedestrian Injuries: Are Pedestrian Safety Features Associated With Injury Severity?

Introduction: Automobile-pedestrian (AP) crashes can cause severe injuries and are increasing in frequency. We sought to determine factors contributing to severe injuries.

Methods: Patients ≥15 y with AP injuries admitted from January 1, 2020, through December 31, 2022, comprised the study population. Demographic data, injury severity score (ISS), and abbreviated injury scale (AIS) were obtained from the trauma registry. An electronic medical record review collected location, time and description of the incident, and substance use. Locations were grouped into multilane, high speed (>40 mph) streets, residential streets, and off-road. Pedestrian safety features were assessed using Google Street View. Each location census tract Area Deprivation Index was determined. Logistic regression was used to determine if safety features predicted increasing ISS or AIS.

Results: There were 426 patients. The mean ISS was 13.3. AP patients struck with a sidewalk present had a higher ISS (P = 0.03) and higher AIS head or neck (P = 0.01). Those struck on a street with <6 lanes had a lower ISS (P = 0.035). AP victims under the influence of a substance had higher ISS (P = 0.035) and AIS external (P = 0.049). More AP accidents occurred between 18:00-23:59 (43.8%). Most AP fatalities occurred between 18:00-5:59 (76%). Most AP injuries, 94.06% (P = 0.0), occurred in areas with an Area Deprivation Index of 9 or 10.

Conclusions: More severe AP injuries occurred along multilane roads with high-speed traffic and with a sidewalk. Injuries and fatalities more commonly occurred at night. Pedestrians using substances suffered more severe injuries. Most AP injuries occurred in socioeconomically disadvantaged areas.