Motor vehicle and pedestrian collisions: burden of severe injury on major versus neighborhood roads.
OBJECTIVE
To determine whether the severity of injuries sustained by pedestrians involved in motor vehicle collisions varies by road type and age.


METHODS
All police-reported pedestrian motor vehicle collisions in the city of Toronto, Canada, between January 1, 2000, and December 31, 2005, were analyzed. Geographic Information Systems software was used to determine whether the collisions occurred on major or neighborhood roads. Age-specific estimates of the burden of pedestrian collisions are presented. Odds ratios and 95 percent confidence intervals were calculated to examine age-specific relationships between injury severity and road type. A second analysis comparing the distribution of severe injury location between age groups was also performed.


RESULTS
The majority of collisions involved adults (68%), although elderly pedestrians were overrepresented in fatal collisions (49%). Severe and fatal collisions involving working-age and elderly adult pedestrians were more likely on major roads. Odds of severe injury occurring on a major road were 1.36 (95% CI: 1.17-1.57) times higher for adults ages 18 to 64, and 1.55 (95% CI: 1.22-1.99) times higher for elderly aged 65+. By contrast, severe injuries among children were more common on neighborhood roads, with odds of severe injury on a major road of 0.64 (95% CI: 0.37-1.1) for children aged 5 to 9. Among children under 9, 64-67 percent of hospitalized or fatal injuries occurred on neighborhood roads, a marked difference from the distribution of such injuries in adults or the elderly, for whom only 29-30 percent of hospitalized or fatal injuries occurred on neighborhood roads (chi-square = 52.6, p < or =.001).


CONCLUSIONS
Targeting interventions toward the adult pedestrian burden on major roads alone will not make child pedestrians safer. Pedestrian interventions specific to children and focused on neighborhood roads must be considered in urban centers like Toronto.
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
Linda
L
Rothman
Morgan
M
Slater
Christopher
C
Meaney
Andrew
A
Howard
D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D017281:Cost of Illness; D004779:Environment Design / Q000706:statistics & numerical data*; D040362:Geographic Information Systems; D006801:Humans; D007223:Infant; D008875:Middle Aged; D018986:Motor Vehicles; D016017:Odds Ratio; D012111:Residence Characteristics; D018570:Risk Assessment; D015599:Trauma Severity Indices; D014505:Urban Population; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology*; D055815:Young Adult