Review of Pediatric Pedestrian Fatalities Through a Safe System Lens to Prevent Future Deaths: Differences in Child and Adolescent Risk Factors

Tanya Charyk Stewart, MSc
Kevin McClafferty, BESc
Moheem Halari, MBBS
Allison Pellar, MEng
Pascal Verville, PEng
Michael Pickup, MD
Douglas Fraser, MD
Jason Gilliland, PhD
Mike Shkrum, MD

Pediatric pedestrians are a particularly vulnerable road user group, comprising an increasing proportion of road traffic injuries and deaths. The objective of this study was to review the epidemiology of child and adolescent pedestrian fatalities to identify risk factors to target via a safe system approach.

Fatal pedestrian collision and injury data were collected from the Office of the Chief Coroner (2013-19), with selected crash investigations. Descriptive analyses were undertaken. Child (< 14 years) and adolescent (15-19 years) pedestrian crashes were compared with Pearson chi square and Mann Whitney U tests. Multivariate logistic regression modeling was performed with risky behavior as the outcome, followed by an assessment of model fit and predictive accuracy.

There were 59 pediatric fatalities, 25 (42%) children and 34 (58%) adolescents, with median (IQR) age=17.0 (7.0-19.0) and ISS=75 (33-75). The head was the most frequent (90%), and severely injured body region, followed by the thorax (88%). Thirty-six pedestrians (61%) engaged in risky behavior. Logistic regression modeling found being male (OR=5.883), in an urban environment (OR=7.209), at nighttime (OR=13.562) significantly associated with pedestrian risky behavior. Significantly more children were involved in collisions during the daytime (6:00-1800) (83% vs. 30%; p<0.001), in crosswalks (42% vs. 10%; p=0.007) and intersections (45% vs. 20%; p=0.042), while crossing with the right of way (42% vs. 7%; p=0.003). Adolescents had higher impairment (36% vs. 0%; p=0.001), dark conditions (80% vs. 12%; p<0.001) and high-speed collisions (77% vs. 46%; p=0.017). There were 6 intentional adolescent pedestrian deaths (20% vs. 0%; p=0.027). Two-thirds (4/6) of these intentional injuries were death by suicide.

Pediatric pedestrians engage in risky behaviors. Being male, in an urban environment, at night increased the odds of risky behaviors. A safe system approach recognizes that people are vulnerable and inevitably make mistakes. Incorporating multiple countermeasures can help provide a safe and equitable transportation system that mitigates crash risk and protects all road users. Increased mental health and substance use services, higher rated vehicle headlight performance and reducing speeds were identified as prevention strategies to target adolescents. For children, implementing crossovers, safe routes to school programs and increased use of collision avoidance vehicle safety features, which are effective at low speeds, in lighted areas, could be effective strategies to mitigate pedestrian crash risk.

1. By the end of this presentation, participants will be able to identify risk factors for child (age < 14 years) pedestrian crash fatalities, including low speed, daytime collisions in crosswalks and intersections, that can be used to target prevention strategies to mitigate child pedestrian crash risk.
2. Participants will be able to identify adolescent (age 15-19 years) pedestrian unintentional and intentional fatality risk factors, including high speed collisions at night, often involving impairment, that can be used to target prevention strategies to mitigate adolescent pedestrian crash risk.
3. Participants will learn the key principles of a safe system approach to be able to proactively identify risks in the transportation system and develop multiple countermeasures to help provide a safe and equitable transportation system for all road users.