title: Injury severity and mortality of adult zebra crosswalk and non-zebra crosswalk road crossing accidents: a cross-sectional analysis.
abstract: BACKGROUND
  Over a million people worldwide die each year from road traffic injuries and more than 10 million sustain permanent disabilities. Many of these victims are pedestrians. The present retrospective study analyzes the severity and mortality of injuries suffered by adult pedestrians, depending on whether they used a zebra crosswalk.
  
  
  METHODS
  Our retrospective data analysis covered adult patients admitted to our emergency department (ED) between 1 January 2000 and 31 December 2012 after being hit by a vehicle while crossing the road as a pedestrian. Patients were identified by using a string term. Medical, police and ambulance records were reviewed for data extraction.
  
  
  RESULTS
  A total of 347 patients were eligible for study inclusion. Two hundred and three (203; 58.5%) patients were on a zebra crosswalk and 144 (41.5%) were not. The mean ISS (injury Severity Score) was 12.1 (SD 14.7, range 1-75). The vehicles were faster in non-zebra crosswalk accidents (47.7 km/n, versus 41.4 km/h, p<0.027). The mean ISS score was higher in patients with non-zebra crosswalk accidents; 14.4 (SD 16.5, range 1-75) versus 10.5 (SD13.14, range 1-75) (p<0.019). Zebra crosswalk accidents were associated with less risk of severe injury (OR 0.61, 95% CI 0.38-0.98, p<0.042). Accidents involving a truck were associated with increased risk of severe injury (OR 3.53, 95%CI 1.21-10.26, p<0.02).
  
  
  CONCLUSIONS
  Accidents on zebra crosswalks are more common than those not on zebra crosswalks. The injury severity of non-zebra crosswalk accidents is significantly higher than in patients with zebra crosswalk accidents. Accidents involving large vehicles are associated with increased risk of severe injury. Further prospective studies are needed, with detailed assessment of motor vehicle types and speed.
authors.affiliation: University Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Pfortmueller
authors.affiliation: University Department of Emergency Medicine, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Mariana
authors.initials: M
authors.lastname: Marti
authors.affiliation: Department of Anesthesiology, Kantonsspital Winterthur, Winterthur, Switzerland.
authors.forename: Mirco
authors.initials: M
authors.lastname: Kunz
authors.affiliation: University Department of General Internal Medicine, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Gregor
authors.initials: G
authors.lastname: Lindner
authors.affiliation: University Department of Emergency Medicine, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000328:Adult; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*