title: Injury pattern, outcome and characteristics of severely injured pedestrian.
abstract: BACKGROUND
  Pedestrians who are involved in motor vehicle collisions present with a unique trauma situation. The aim of this study was to demonstrate the specific clinical characteristics of this patient population in comparison to injured motor vehicle occupants in the medical emergency setting.
  
  
  METHODS
  A total of 4435 pedestrian traffic collision victims admitted to hospitals participating at TraumaRegister DGU® between 2002 and 2012 (primary admission, Injury Severity Score, ISS ≥ 9; age ≥ 2 years) was assessed and compared to 16,042 severely injured motor vehicle occupants. Analyses included features such as demographic distribution, injury patterns, treatment course, subsequent complications and overall clinical outcome.
  
  
  RESULTS
  Severely injured pedestrians more commonly were female (42 % vs. 34 % of motor vehicle occupants) and children below 16 years (12 % vs. 2 %) or seniors above 60 years of age (39 % vs. 17 %). Pedestrians were injured more severely (ISS: 26 vs. 25; NISS 32 vs. 30) with higher rates of head injuries (64 % vs. 47 %), pelvic injuries (32 % vs. 23 %) and lower extremity injuries (52 % vs. 43 %). Accordingly, pedestrians more commonly presented with Glasgow Coma Scale <9 (36 % vs. 28 %) and a systolic blood pressure below 90 mmHg (18 % vs. 13 %) accumulating in a worse prognosis (RISC-Score 24 % vs. 15 %) despite of a shorter on-scene treatment time (26 min vs. 38 min) and a shorter period from the collision until hospital admission (61 min vs. 78 min). Finally, pedestrians showed a higher mortality (22 % vs. 12 %).
  
  
  CONCLUSIONS
  Severely injured pedestrians represent a challenging patient population with unique injury patterns and high subsequent mortality. Emergency team members should be sensitized to the trigger term "pedestrian" in order to improve the initial emergency management and thus the overall clinical outcome.
authors.affiliation: Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Cologne, Germany. Georg.Reith@gmail.com.|Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie, Lehrstuhl der Universität Witten/Herdecke, Klinikum Köln-Merheim der Kliniken der Stadt Köln gGmbH, Ostmerheimerstr. 200, Köln, Germany. Georg.Reith@gmail.com.
authors.forename: Georg
authors.initials: G
authors.lastname: Reith
authors.affiliation: Institute for Research in Operative Medicine, IFOM, Witten/Herdecke University, Cologne, Germany. Rolf.Lefering@uni-wh.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Cologne, Germany. WafaisadeA@kliniken-koeln.de.
authors.forename: Arasch
authors.initials: A
authors.lastname: Wafaisade
authors.affiliation: ZBAF, Center for Biomedical Education and Research, Witten/Herdecke University, Witten, Germany. Kai.Hensel@gmail.com.
authors.forename: Kai O
authors.initials: KO
authors.lastname: Hensel
authors.affiliation: Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Cologne, Germany. PaffrathT@kliniken-koeln.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Paffrath
authors.affiliation: Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Cologne, Germany. BouillonB@kliniken-koeln.de.
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.affiliation: Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Cologne, Germany. ProbstC@kliniken-koeln.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Probst
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D000069636:Pedestrians; D015996:Survival Rate / Q000639:trends; D055815:Young Adult