|Community interventions result in a 61 percent decrease in pedestrian injuries|
By Carolyn Rogers
Pedestrian injury is second only to cancer as the leading cause of death in children between five and nine years of age. According to a recently completed study published in the Journal of Bone and Joint Surgery (May 2002), however, the incidence of childhood pedestrian-motor vehicle trauma can be greatly reduced with the help of environmental and community interventions.
Thomas S. Renshaw, MD, study co-author and chief of pediatric orthopaedics at Yale University School of Medicine in New Haven, Conn., reported on the study during the AAOS "Orthopaedics Update 2002" Web conference on Oct. 16, 2002. Dr. Renshaws co-authors were orthopaedic surgeons Gregory A. Merrell, MD, and Jon C. Driscoll, MD, department of orthopaedic surgery, and Linda C. Degutis, DrPH, department of surgery, Yale University School of Medicine.
"In 1994, we examined the frequency and location of pediatric pedestrian injuries that had occurred over an 18-month period in New Havenfrom June 1992 through December 1993," explained Dr. Renshaw. "Over the next several years, five interventions were implemented in the community. Six years later, we reexamined these injury rates and found substantial decreases in pediatric pedestrian injuries."
Collecting the data
The data on pediatric pedestrian injuries were collected from two sourcesthe New Haven Police Department accident database and the Childrens Hospital at Yale/New Haven Hospital Emergency Department records.
"Both sources were used because some pedestrians struck by a motor vehicle are brought to the emergency room without a police report being filed, and conversely, some cases are reported to the police, but medical attention is not required or sought," Dr. Renshaw explained.
Pedestrian-motor vehicle collisions had decreased a full 61 percentfrom 223 in 1992-1993 to 87 in 1998-1999, the data showed. The five-to-nine year age group showed the greatest decrease in pedestrian injuries, from 78 incidents to 27 incidentsa 65 percent drop. This age group also was found to be most at risk for injury, accounting for more than 30 percent of the incidents in 1998-1999.
Fifty-three percent of incidents occurred between the hours of 3 p.m. and 8 p.m., it was found, and boys were more commonly involved than girls, by a ratio of 2-to-1.
During the six-year span between the two fact-finding periods, New Haven officials implemented five initiatives that may account for the decrease in injuries:
"The factors that traditionally affect the frequency of pediatric pedestrian injuries had not changed meaningfully between 1992 and 1999," Dr. Renshaw pointed out. "These included population, traffic volume, speed limits, laws allowing right turns at red lights, parking regulations, public parks, one-way streets, crosswalks and crossing guards."
The five interventions instituted in New Haven were:
"The effect of this campaign may or may not be a causal factor in the decreased number of incidents, since it was started relatively recently," the authors noted.
Other cities follow, see similar decreases
Although additional studies over longer periods of time may be necessary to determine whether the improvements will be permanent, similar results have been reported in other locations. A substantial decrease in pedestrian injuries also has occurred as a result of pedestrian safety programs in four Alabama schools, as well as in Milwaukee, Los Angeles and Columbus, Ohio.
The authors believe their study can be used as a model for other communities to collect data and effect positive change.
"This study demonstrates that reductions in childhood pedestrian injuries can be achieved without changing some of the intractable problems that correlate with pediatric pedestrian injury, such as poverty," they write. "To the best of our knowledge, this is the first long-term study of citywide initiatives that proposes methods to drastically reduce pediatric pedestrian injuries."
Added Dr. Renshaw: "This work suggests an opportunity for orthopaedic surgeons and others to provide an impetus for change in their communities."
To start the authors say communities should:
Additional safety initiatives
The authors also suggest a number of additional initiatives communities might consider when developing a plan to reduce child pedestrian injuries.
According to Dr. Renshaw, most pedestrian-motor vehicle accidents happen due to driver distraction. "Cell phones are a huge factorthere is no way a driver can devote his full attention to the road while hes on the phone."
In addition to banning the use of cellular phones while driving, the authors suggest: