title: Pediatric pedestrian versus motor vehicle patterns of injury: debunking the myth.
abstract: BACKGROUND
  Mechanism of injury has been widely used to enhance the ability of EMS providers to recognize predictable injury patterns. One such pattern, referred to as "Waddell's triad," identifies a triad of injuries associated with pedestrian/motor vehicle collision (MVC), including trauma to the head, abdomen, and lower extremities. We questioned this choice as a common injury pattern for this mechanism.
  
  
  METHODS
  A retrospective chart review of 4444 pediatric trauma patients admitted to a regional pediatric trauma center between 1992 and 1996. The source of this information was the medical center's trauma registry.
  
  
  RESULTS
  Four-hundred-sixty-five patients suffered a pedestrian/MVC and were included in the study; 231 suffered head injury, and 78 experienced a combination of head and leg injury. Only 11 patients (2.4%) suffered the predicted "triad" of head, leg, and abdominal injury as a result of pedestrian/MVCs. Two of these children suffered minor head injury, and only one patient (0.2%) suffered injury as originally described by Waddell.
  
  
  CONCLUSIONS
  Although the concept of Waddell's triad is logical, and a high index of suspicion should be maintained, the incidence of this predictable injury pattern is low. Educational emphasis should be placed on other aspects of mechanism of pedestrian injury.
authors.affiliation: Columbus MedFlight, Columbus, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Orsborn
authors.forename: K
authors.initials: K
authors.lastname: Haley
authors.forename: S
authors.initials: S
authors.lastname: Hammond
authors.forename: R E
authors.initials: RE
authors.lastname: Falcone
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology; D000063:Accidents, Traffic / Q000145:classification / Q000706:statistics & numerical data*; D001336:Automobiles; D015984:Causality; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D007869:Leg Injuries / Q000453:epidemiology; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014193:Trauma Centers; D016138:Walking; D014947:Wounds and Injuries / Q000145:classification* / Q000453:epidemiology / Q000209:etiology