Pedestrian versus motor vehicle accidents: an analysis of 5,000 patients.

BACKGROUND Pedestrian versus motor vehicle accidents are associated with substantial morbidity and mortality. Previous studies have examined pedestrian injury profiles on an individual hospital basis and have been limited by small patient populations. The objective of this study was to examine the demographics and injury profiles of pedestrian versus motor vehicle accidents in a large trauma system. STUDY DESIGN Five thousand pedestrians injured by motor vehicles whose records were entered in a centralized county trauma database were reviewed retrospectively over 3 years. Patients were grouped by age: pediatric (less than 15 years), adult (15 to 65 years), and elderly (older than 65 years). The main outcome measures included mortality, hospital stay, ICU stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, level of residual disability, and payer source. RESULTS The pediatric group represented 38.1% of the study population, adults 53.9%, and the elderly 8.0%. Mortality was highest among the elderly (27.8%), followed by adults (8.1%) and children (3.1%). Overall, the pediatric group had the lowest Injury Severity Score (6.8 +/- 0.2, mean +/- SEM), the highest Revised Trauma Score (7.5 +/- 0.9), and the highest Glasgow Coma Scale (13.9+/-0.1). Hospital stay (4.9+/-0.2 days) and ICU stay (4.6 +/- 0.3 days) were also shortest in this age group. Among all patients, injuries included musculoskeletal (34.3%), head and neck (30.0%), external (24.4%), abdomen and pelvis (3.9%), chest (2.4%), spine (1.8%), and other (3.2%). Operations were required in 11%: orthopaedic (67%), thoracic (2%), abdominal (11%), neurosurgical or head (6%), and other (14%). At the time of discharge, 78% of patients had a temporary disability, 4% had a permanent handicap, and only 16% were functioning at preadmission capacity. Among those with identifiable payer sources, 45% were state or federal, 25% were cash or self-pay, 18% of patients belonged to an HMO or had a group carrier, and 12% were from other sources. CONCLUSIONS This study contributes the largest database reported on motor vehicle versus pedestrian accidents and finds that these accidents are common in a large urban trauma system. Hospital stay, Injury Severity Score, Revised Trauma Score, Glasgow Coma Scale, and the mortality rate worsen with age. The high mortality rate among the elderly indicates the need for more aggressive and effective prevention efforts.