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Do Light Truck Vehicles (LTV) Impose Greater Risk of Pedestrian Injury Than Passenger Cars? A Meta-analysis and Systematic Review

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Abstract

Pedestrian crashes present a growing challenge for public health trauma and road safety researchers around the world. They are associated with substantial morbidity, mortality, and cost, yet there is an international lack of published work on the topic, especially when compared with vehicle occupant safety studies. Our review attempts to quantify the risk of fatal injury among vulnerable road users. The specific objective of this systematic review and meta-analysis is to quantify and compare the impact of light truck vehicles (LTVs) versus conventional cars on pedestrian fatal injury. A protocol was developed using methods of the Cochrane Collaboration. We conducted a search for the studies in bibliographic databases that included ATI (Australian Transport Index); Cochrane Injuries Group Specialized Register; EMBASE; ERIC; MEDLINE; National Research Register; PsycINFO; Road Res (ARRB); SIGLE; Science (and Social Science) Citation Index; TRANSPORT (NTIS, TRIS, TRANSDOC, IRRD). Web sites of traffic and road accident research bodies, government agencies, and injury prevention organizations were searched for grey literature. Reference lists from selected papers or topic reviews were scanned for potentially relevant papers. Our initial search identified 878 potentially eligible studies. After thorough review by three of the researchers a total of 12 studies were included in the systematic review, 11 of which were included in the meta-analysis. The overall pooled odds ratio for the risk of fatal injury in pedestrian collisions with LTVs compared to conventional cars was odds ratio 1.54, 95 percent confidence interval 1.15-1.93, p = 0.001. Thus, the risk for pedestrians of sustaining fatal injury is 50 percent greater in collisions with LTVs than in collisions with conventional cars. Our systematic review and meta-analysis suggests that LTVs pose a greater risk of pedestrian injury death compared to conventional cars. These findings have important implications for the automotive industry and the safety of vulnerable road users.
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Traffic Injury Prevention
ISSN: 1538-9588 (Print) 1538-957X (Online) Journal homepage: http://www.tandfonline.com/loi/gcpi20
Do Light Truck Vehicles (LTV) Impose Greater Risk
of Pedestrian Injury Than Passenger Cars? A Meta-
analysis and Systematic Review
E. Desapriya , S. Subzwari , D. Sasges , A. Basic , A. Alidina , K. Turcotte & I.
Pike
To cite this article: E. Desapriya , S. Subzwari , D. Sasges , A. Basic , A. Alidina , K. Turcotte
& I. Pike (2010) Do Light Truck Vehicles (LTV) Impose Greater Risk of Pedestrian Injury Than
Passenger Cars? A Meta-analysis and Systematic Review, Traffic Injury Prevention, 11:1, 48-56,
DOI: 10.1080/15389580903390623
To link to this article: https://doi.org/10.1080/15389580903390623
Published online: 08 Feb 2010.
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Traffic Injury Prevention, 11:48–56, 2010
Copyright C
2010 Taylor & Francis Group, LLC
ISSN: 1538-9588 print / 1538-957X online
DOI: 10.1080/15389580903390623
Do Light Truck Vehicles (LTV) Impose Greater Risk
of Pedestrian Injury Than Passenger Cars? A
Meta-analysis and Systematic Review
E. DESAPRIYA,1,2S. SUBZWARI,1D. SASGES,3A. BASIC,1A. ALIDINA,1
K. TURCOTTE,1and I. PIKE1,2
1BC Injury Research and Prevention Unit, Developmental Neurosciences and Child Health: Neurons to Neighbourhoods,
Formerly Centre for Community Child Health Research, BC Children’s Hospital, Vancouver, British Columbia, Canada
2Department of Paediatrics, BC Children’s Hospital, Vancouver, British Columbia, Canada
3Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Objective: Pedestrian crashes present a growing challenge for public health trauma and road safety researchers around
the world. They are associated with substantial morbidity, mortality, and cost, yet there is an international lack of published
work on the topic, especially when compared with vehicle occupant safety studies. Our review attempts to quantify the risk
of fatal injury among vulnerable road users. The specific objective of this systematic review and meta-analysis is to quantify
and compare the impact of light truck vehicles (LTVs) versus conventional cars on pedestrian fatal injury.
Methods: A protocol was developed using methods of the Cochrane Collaboration. We conducted a search for the studies
in bibliographic databases that included ATI (Australian Transport Index); Cochrane Injuries Group Specialized Register;
EMBASE; ERIC; MEDLINE; National Research Register; PsycINFO; Road Res (ARRB); SIGLE; Science (and Social
Science) Citation Index; TRANSPORT (NTIS, TRIS, TRANSDOC, IRRD). Web sites of traffic and road accident research
bodies, government agencies, and injury prevention organizations were searched for grey literature. Reference lists from
selected papers or topic reviews were scanned for potentially relevant papers.
Results: Our initial search identified 878 potentially eligible studies. After thorough review by three of the researchers a
total of 12 studies were included in the systematic review, 11 of which were included in the meta-analysis. The overall pooled
odds ratio for the risk of fatal injury in pedestrian collisions with LTVs compared to conventional cars was odds ratio 1.54,
95 percent confidence interval 1.15–1.93, p =0.001. Thus, the risk for pedestrians of sustaining fatal injury is 50 percent
greater in collisions with LTVs than in collisions with conventional cars.
Conclusions: Our systematic review and meta-analysis suggests that LTVs pose a greater risk of pedestrian injury death
compared to conventional cars. These findings have important implications for the automotive industry and the safety of
vulnerable road users.
Keywords Pedestrian fatal injury crashes; Light truck vehicles; Greater mass; Increased stiffness; Bumper height; Front
design modifications
INTRODUCTION
Road traffic crashes are a major cause of death and disabil-
ity worldwide. It is estimated that by 2020, road traffic crashes
will be the third leading cause of disability adjusted life years
(DALY) worldwide and the second leading cause of DALYs
in rapidly motorizing countries (Murray and Lopez 1997a). The
Received 29 May 2009; accepted 6 October 2009.
No author has a financial or proprietary interest in any material or method
mentioned.
Address correspondence to: Dr. Ediriweera Desapriya, Developmental Neu-
rosciences and Child Health: Neurons to Neighbourhoods, Formerly Centre for
Community Child Health Research, L408-4480 Oak St., Vancouver, BC V6H
3V4, Canada. E-mail: edesap@cw.bc.ca
World Health Organization predicts that road traffic crashes will
become the third leading cause of mortality in the near future
(Krug et al. 2000; Murray and Lopez 1997b). Pedestrian crashes
present a growing challenge for public health trauma and road
safety researchers around the world (Desapriya et al. 2006;
Mohan 2002). Annually, there are an estimated 1.2 million
pedestrian road deaths and 50 million injuries, more than 85 per-
cent of which occur in developing countries (Krug 1999; Peden
et al. 2004). Unfortunately, it is predicted that pedestrian road
deaths will increase by 65 percent in the next 10 years (Peden
et al. 2004). Pedestrian crashes are associated with substantial
morbidity, mortality, and cost, but there is an international lack
of published work on the topic, especially compared to vehicle
occupant related studies (Simms and O’Neill 2005). A recent
48
LIGHT TRUCK VEHICLES AND PEDESTRIAN INJURIES 49
United Nations resolution encouraged Member States to con-
tinue using the World Report on Road Traffic Injury Prevention
(Peden et al. 2004) as a framework for road safety efforts and im-
plementing its recommendations by paying particular attention
to the needs of vulnerable road users such as pedestrians.
Unfortunately, recent changes in the composition of the
global vehicle fleet may mean even greater threat to pedes-
trians. Over the past 10 years, there has been an extraordinary
explosion in the popularity and purchase of larger vehicles,
such as light truck vehicles (LTVs). LTVs are defined as any
vehicle with the body on frame construction historically found
on trucks. This category includes minivans, pickup trucks, and
sport utility vehicles (SUVs), also called 4 ×4s. Further, LTVs
are designed to appeal to the buyer’s self-image, many of them
evoking an impression of speed, power, esteem, and maximum
safety to their occupants. Such impressions conflict and jeop-
ardize safety and the needs of pedestrians and other vulnerable
road users. In the United States, 40 percent of new vehicles
purchased fall under this classification. A recent report shows
that in last decade alone about 36 million SUVs were sold in the
United States (Lieber and Bernard 2008). In Europe in 2004,
sales of SUVs increased by 15 percent, whereas sales of smaller
passenger cars dropped by 4 percent (Simms and O’Neill 2005).
It is estimated that globally, in both developed and underdevel-
oped countries, LTVs make up 30 percent of vehicles found on
the road. In Chile, LTVs make up 25 percent of the top-selling
vehicles. In South Africa, there has been a threefold increase
in LTV popularity since 2001. In India, there was a 50 percent
increase in LTV sales in 2003 alone (Dandona 2005).
White (2004) used a random sample of all police-reported
motor vehicle crashes to demonstrate that when collision occurs,
light trucks impose significant externalities on other cars, trucks,
and pedestrians. Importantly, the results of this study suggest
that a 1 percentage point increase in the light truck share of the
vehicle fleet increases annual traffic fatalities by approximately
0.34 percent, or 143 deaths per year. One recent study in Japan
showed that LTVs are significantly increasing the fatality risk
in crashes (Sekine at al. 2008).
LTVs differ from cars in three key areas: they have greater
mass and increased stiffness and the bumper is much higher off
the ground. These factors change the anatomy of a pedestrian-
involved collision (Crandall et al. 2002; Desapriya, Chipman
et al. 2005; Simms and O’Neill 2005). Contrary to popular
belief, pedestrians are often vaulted over a striking LTV, rather
than run over (Crandall et al. 2002; Simms and O’Neill 2005).
This means that the bumper and the upper surface of the front
of the LTVs are the direct cause of injury to the legs and head of
the pedestrian (Desapriya and Pike 2005; Roudsari et al. 2004;
Rowe et al. 2004). Because LTV bonnets are higher than those
of cars, there is more severe initial impact on the upper leg and
pelvis and a doubling of injuries to vulnerable regions such as the
head, thorax, and abdomen (Ashton et al. 1978; Paulozzi 2005;
Pinkney et al. 2006; Roudsari et al. 2004; Rowe et al. 2004).
Studies suggest that the expanded number of LTVs in the ve-
hicle fleet represents an increased risk to vulnerable road users.
The chief determinants for the severity of injuries in motor vehi-
cle collisions are vehicle size and weight (Crandall et al. 2002;
Desapriya, Chipman 2005; Roudsari et al. 2004; Rowe et al.
2004; Simms and O’Neill 2005). A recent U.S. study reported
that the increased number of SUVs and pickup trucks on the
roads was associated with more pedestrian deaths and higher
injury severity (Ballesteros et al. 2004). A study done in the
United Arab Emirates found that pedestrians were two times
more likely to die in a collision with an LTV than in a collision
with a passenger car (Bener et al. 2006). It has been estimated
that the changing composition of the car fleet increased the num-
ber of road fatalities by 1 percent between 2001 and 2002 in the
UK (Broughton 2005). This percentage increase represents ap-
proximately 40 additional deaths (Broughton 2005). LTVs are
also more likely than cars to be involved in back-over crashes in-
volving child pedestrians. The National Highway Traffic Safety
Administration (NHTSA) estimates that more than 7000 injuries
and 200 deaths, more than 60 percent of which are suffered by
children under 5 or adults over 70, occur every year as a result
of back over crashes (Insurance Institute for Highway Safety
2008).
A recent British Medical Journal article has shown that the
increased threat to vulnerable road users posed by LTVs is likely
to reverse some of the hard earned improvements in road safety
that have been made over the past decades (Simms and O’Neill
2005).
Systematic reviews of observational studies are rather rare
and the relevant experience is limited (Dickersin 2002; Stroup
et al. 2000). Most of the work in this area relates to questions for
which randomized controlled trials (RCTs) are difficult, impos-
sible, or unethical to conduct (e.g., testing pedestrian fatal injury
differences according to vehicle type) However, in many situa-
tions randomized controlled designs are not feasible, and only
data from observational studies are available (Berlin 1995). Ex-
perimental tests with cadavers and dummies can answer many
questions regarding pedestrian collisions. However, due to the
dynamic nature of the crash, many important biomechanical
aspects, such as vehicle-pedestrian interaction, cannot be evalu-
ated in such experimental studies. In order to better understand
how pedestrian injuries are influened by changes in vehicle de-
sign, in depth studies of real world crashes are necessary (Mock
et al. 2000). All available dummy and cadaver studies further
demonstrate that LTV inflict more serious injuries and fatalities
to pedestrians as compared to cars (Ishikawa et al. 1993; Kerri-
gan et al. 2005; Mizuno and Kajzer 1999; Okamoto et al. 2003;
Wood and Simms 2002; Yao et al. 2007).There is great need
for more comprehensive data from real-world crashes. Retro-
spective cohort studies conducted in this area demonstrate the
increased risk of severe pedestrian injury and fatality in col-
lisions with LTVs compared to collisions with passenger cars
(Ballesteros et al. 2004; Lefler and Gabler 2004; Simms and
O’Neill 2005).
This meta-analysis represents an attempt by the researchers
to identify all relevant literature and to recognize and high-
light any differences in pedestrian injury outcomes in collisions
50 DESAPRIYA ET AL.
with LTVs compared to collisions with conventional passen-
ger cars. There are a limited number of individual studies that
show the impact of LTVs on pedestrian crashes; however, there
are no systematic reviews to demonstrate the impact of LTVs
on pedestrian crash outcomes. Because systematic reviews are
comprehensive, they represent a far more reliable basis for the
decision-making process. We believe that this systematic re-
view can help identify the risk posed by LTVs on vulnerable
road users. It will enable policy makers in the automotive indus-
try and government to make necessary design changes to LTVs
to minimize fatal injuries to vulnerable road users.
METHODS
Due to the inclusion of observational studies in our review,
strict protocols for the meta-analysis of observational studies
were followed (Stroup et al. 2000).There was a thorough proto-
col. Our study protocol was developed in order to synthesize ev-
idence for a well-defined question by using comprehensive and
explicit search techniques, specific inclusion criteria for study
selection, and methodological quality assessment, followed by
systematic review and meta-analysis. We followed Cochrane
Collaboration protocols to guide us in this meta-analysis and
systematic review (Subzwari et al. 2009). A thorough study
quality evaluation was performed using one of the best quality
assessment tools available to researchers. There were 878 titles
identified by our search; 17 (1.9%) studies survived the selection
process, but only 12 (1.3%) were of a satisfactory quality. The
Effective Public Health Project Quality Assessment Tool was
used to assess study quality by applying criteria to assign over-
all component ratings as strong, moderate, or weak (Effective
Public Health Practice Project 2003).Two reviewers, blinded to
the study findings, independently assessed study quality, and
inter-reviewer reliability was measured (kappa =83%).
Study Identification
We conducted a search for the studies in bibliographic databases
including ATI (Australian Transport Index); Cochrane Injuries
Group Specialized Register; EMBASE; ERIC; MEDLINE;
National Research Register; PsycINFO; Road Res (ARRB);
SIGLE; Science (and Social Science) Citation Index; TRANS-
PORT (NTIS, TRIS, TRANSDOC, IRRD).
Grey literature and unpublished studies. Web sites of traffic
and road accident research bodies, government agencies, and
injury prevention organizations were searched for grey litera-
ture. Reference lists from selected papers or topic reviews were
scanned for potentially relevant papers.
Screening process. Our initial search identified 878 poten-
tially eligible studies. Upon completion of the database searches,
titles and abstracts of all references were screened for relevance
to the scope of the study. A team of three reviewers (SS, AB, ED)
independently evaluated titles and, when available, abstracts to
determine whether the articles might meet eligibility criteria. If
any reviewer concluded that there was a possibility that the ar-
ticle would fulfill eligibility criteria, we obtained and evaluated
the full-text publication.
Eligibility criteria. Our inclusion criteria indicated that
RCTs could be included as a potential study design, but we
were unable to find any RCTs that met our inclusion criteria.
There are no RCTs assessing LTV-related injury and fatality
outcomes in the literature. Due to the lack of RCT evidence,
we assessed the evidence of the risk of LTV in pedestrian im-
pact crashes using data that were available from observational
studies. There are several reasons why there may be a lack of
RCTs in this area. Obviously, one reason is that it is unethi-
cal to ask pedestrians to intentionally collide with LTVs and
cars. Though there are inherent difficulties in assessing the risk
of LTV pedestrian crashes, we have used an appropriate study
design to demonstrate the potential injury and fatality risks of
pedestrian–LTV collisions. We included published and unpub-
lished prospective or retrospective observational studies using
real-world pedestrian crash data to compare injury rates among
LTV- versus car-associated crashes. Further studies based on
real-world crash data with injury as a primary outcome and fatal
injuries as a secondary outcome were selected for our review.
We excluded computer simulation and other available studies
derived from dummy and cadaver studies because interpretabil-
ity of these studies is limited by their inability to account for the
dynamic nature of pedestrian crashes.
Assessment of study eligibility. Our research assistant (AB)
blacked out the results in tables and text of all studies identi-
fied for full evaluation in the screening process. Two reviewers
(SS, ED) independently assessed all studies identified for full
evaluation and resolved disagreements by discussion.
Methodological quality assessment. The Effective Public
Health Project Quality Assessment Tool was used to assess study
quality by applying criteria to assign overall component ratings
as strong, moderate, or weak (Effective Public Health Practice
Project 2003).Two reviewers, blinded to the study findings, inde-
pendently assessed study quality, and inter-reviewer reliability
was measured (kappa =83%).
Data Extraction
Data were extracted using a predesigned data abstraction form.
Two ×2 tables were created for studies that reported vision
changes and differences in the number of injuries between cases
and controls. Thus, a full 2 ×2 table was completed. This
process was performed independently by two reviewers (ED
and SS) to ensure validity and reproducibility of methods. The
abstractors were blinded from the article summary, introduction,
and conclusion. Only the methods section of the studies was
photocopied and provided to the abstractors to ensure unbiased
ratings.
Data analysis. Data analysis was performed using RevMan
version 5 software (http://www.ims.cochrane.org/revman). The
2×2 tables were combined using the Mantel Haenszel pooling
method. For continuous data, standard mean differences and
standard deviations were used. We also pooled odds ratios (OR)
by calculating their standard errors and used a generic inverse
variance method to pool the results. Funnel plots are a visual tool
for investigating publication and other bias in meta-analysis. In
LIGHT TRUCK VEHICLES AND PEDESTRIAN INJURIES 51
this review we have used funnel plots to examine the publication
bias.
The reviewers ensured objectivity of data abstraction by
using a standardized data abstraction form. Two reviewers
(SS, ED) independently extracted data for each eligible study,
which included the number and description of participants,
type of intervention, duration of follow-up, method of allo-
cation concealment, and outcomes evaluated. Discrepancies
were resolved at a meeting of the reviewers. The meta-analysis
was performed using Review Manager Software version 5
(http://www.ims.cochrane.org/revman). We combined odds ra-
tios after calculating their standard errors and weighting them
according to the inverse of their variances.
RESULTS
Our initial search identified 878 potentially eligible studies,
of which 432 were judged appropriate for full-text review. After
thorough review of 432 full-text articles by two reviewers (ED,
SS) a total of 17 studies were selected for further screening.
After thorough review of 17 full-text articles by three of the
reviewers (ED, SS, AB), a total of 12 studies were included in
the systematic review, 11 of which were included in the meta-
analysis (Table I). Data from one study were not available for
extraction and inclusion in the meta-analysis.
Twelve studies met our inclusion criteria; 10 were retrospec-
tive and 2 were cross-sectional studies.
The overall pooled odds ratio for the risk of injury in pedes-
trian collisions with LTVs compared to with conventional cars
was 1.54 (95%, CI 1.15–1.93, p=0.001) (Table II). Thus,
the risk for pedestrians of sustaining fatal injury is 50 percent
greater in collisions with LTVs than in collisions with conven-
tional cars.
We assessed for publication bias by producing funnel plots.
The symmetry of the plot distribution suggests absence of pub-
lication bias. This suggests that our search strategy was com-
prehensive, and that we located most of the includable studies.
DISCUSSION
Compared to those hit by conventional passenger cars, pedes-
trians hit by LTVs were more likely to suffer injuries (OR 1.54;
95% CI 1.15–1.93). More than 10 million crashes involving
passenger cars and light trucks occurred in the United States in
2005 (McMullin et al. 2009). As this meta-analysis along with
the previous literature has shown, certain characteristics of ve-
hicle design can have a marked impact on the injury and fatality
outcomes of pedestrians struck by motor vehicles (Crandall et al.
2002; Desapriya and Pike 2005; Matsui 2006; Peden et al. 2004;
Sekine at al. 2008; Simms and O’Neill 2005). In addition, light
trucks possess several unique features such as relatively poor
braking and maneuverability, making them difficult to handle
and more dangerous to pedestrians and other vulnerable road
users (Anderson 2008).
This issue is especially critical in rapidly motorizing coun-
tries. Such countries generally lack the resources to physically
Tab le I Characteristics of studies included in the meta-analysis and
systematic review
Duration of
follow-up in number Inclusion
Study of years criteria
DiMaggio et al. (2006)
(United States)
Children pedestrian aged
5–19 years
Pinkney et al. (2006)
(United States)
5 Injury involving child
younger than 10 years old
injured by a vehicle
traveling in a reverse
direction in a driveway
Paulozzi (2005) (United
States)
1 Pedestrians including
wheelchairs, skateboarders,
roller-bladers, or cherry
pickers
Ivarsson et al. (2005)
(United States)
4 Pedestrian involved with a
forward-moving late model
year vehicle. First impact
must be forward of the top
of the A-pillar
Lefler and Gabler (2004)
(United States)
9 Crash involving pedestrian
fatal injuries
Margaritis et al. (2004)
(The Netherlands)
1 Passenger car and LTV
occupants and pedestrians
involved in crashes
Roudsari et al. (2004)
(United States)
4 Pedestrian hit by vehicle
moving forward,
pedestrian should not have
been lying or sitting at the
time of crash, only
passenger cars and LTVs
made after 1990, and the
striking portion of the
vehicle should have been
forward of the A pillar and
without previous damage
Henary et al. (2003)
(United States)
4 Pedestrian involved with a
forward-moving late model
year vehicle. First impact
must be forward of the top
of the A-pillar. Age from 2
to 14 years and 19 to 50
years
Ballesteros et al. (2004)
(United States)
4 Pedestrians struck either by
LTV or a car and treated at
Maryland trauma center
Nadler et al. (2001)
(United States)
12 Children sustaining motor
vehicle injuries in or
around the driveway
Holland et al. (2000)
(Australia)
4.33 Children younger than 16
years in back-over injuries
Lane et al. (1994)
(Canada)
8 Pedestrian involved in
crashes with passenger cars
and LTVs sustaining fatal
or other injuries
separate vulnerable road users from car traffic (Desapriya et al.
2007). Many of these countries have no sidewalks or bicycle
paths, and where such amenities do exist they are often heavily
obstructed by trees, trash, drainage ditches, and vendors selling
goods. Unfortunately, pedestrians, cyclists, rickshaw operators,
and moped users still represent the majority of road users in such
52 DESAPRIYA ET AL.
Tab le I I Overall pooled odds ratio of the meta-analysis for the risk of fatal
injury in pedestrian collision with LTV compared to conventional cars
Odds ratio Weight Odds ratio
Study (SE) % (fixed) 95% CI
Lane et al. (1994) 1.9200 (0.6523) 9.44 1.92 (0.64–3.20)
Holland et al. (2000) 2.5000 (0.9163) 4.78 2.50 (0.70–4.30)
Nadler et al. (2001) 0.7000 (0.3567) 31.57 0.70 (0.00–1.40)
Ballesteros et al. (2004) 1.7200 (0.5423) 13.66 1.72 (0.66–2.78)
Henary et al. (2003) 3.3400 (1.2200) 2.70 3.34 (0.95–5.73)
Roudsari et al. (2004) 3.4000 (1.2238) 2.68 3.40 (1.00–5.80)
Margaritis et al. (2004) 0.5600 (0.5798) 11.95 0.56 (0.58–1.70)
Lefler and Gabler (2004) 3.2500 (1.1700) 2.93 3.25 (0.96–5.54)
Paulozzi (2005) DiMaggio
et al. (2006)
1.9300 (0.6570) 9.31 1.93 (0.64–3.22)
Pinkney et al. (2006) 2.3000 (0.8329) 5.79 2.30 (0.67–3.93)
Total (95%CI) 2.4100 (0.8796) 5.19 2.41 (0.69–4.13)
100.00 1.54 (1.15–1.93)
Test for heterogeneity χ2=18.74, df =10 (P=0.04), P=46.6 percent.
Test for overall effect Z=7.68 (P<0.00001).
countries (Desapriya et al. 2007). Consideration of the needs of
these vulnerable road users is essential to the safe motorization
of developing countries, especially with the increasing propor-
tion of LTVs in the vehicle fleet.
Beyond road and sidewalk engineering, there are other ways
to reduce the threat to pedestrians posed by LTVs. The European
Commission (EC) has stated that an estimated 50 percent of all
fatal and disabling injuries involving motor vehicles could be
avoided if all vehicles were designed to be equal in standard to
the safest model currently available in each class (Peden et al.
2004). Though mass is an important issue with respect to sur-
vivability in crashes, researchers are finding that good vehicle
geometry and inclusion of energy-absorbing interfaces could
lead to the development of heavy vehicles that are crash com-
parable with the average mass car fleet (Acierno et al. 2004).
The development of pedestrian impact test procedures by the
European Experimental Vehicle Committee (EEVC) and the In-
ternational Standards Organization (ISO) have allowed for the
identification of the aspects of vehicle design that are related to
injuries sustained by pedestrians (McLean 1996). LTVs differ
from cars in three key areas: they have greater mass and in-
creased stiffness, and the bumper is much higher off the ground.
These factors change the mechanics of a pedestrian-involved
collision (Desapriya and Pike 2005; Crandall et al. 2002; Simms
and O’Neill 2005). Contrary to popular belief, pedestrians are
often vaulted over a striking LTV, rather than run over. This
means that the bumper and the upper surface of the front of
the LTVs are the direct cause of injury to the legs and head of
the pedestrian (Crandall et al. 2002; Desapriya and Pike 2005;
Mock et al. 2002). Because LTV bonnets are higher than those
of cars there is a more severe initial impact on the upper leg and
pelvis and a doubling of injuries to vulnerable body regions such
as the head, thorax, and abdomen (Ashton et al. 1978; Paulozzi
2005; Pinkney et al. 2006; Roudsari et al. 2004). Dummy and
cadaver studies reiterated that LTVs more also rigid, absorbing
less force during a crash and transferring more energy to what
they have hit. Analysis of real-world crash data from the United
Staets by Lefler and Gabler (2004) showed that 11.5 percent
of pedestrians struck by LTV are fatally injured compared with
only 4.5 percent of pedestrians struck by passenger cars. Many
studies in North America and Europe have identified that the
front, side, and rear design of LTVs can be modified to sig-
nificantly reduce the harm potential of heavy vehicle crashes
and that safety standards for front-end construction could make
the vehicles less hazardous to pedestrians and cyclists (Acierno
et al. 2004; Crandall et al. 2002; Desapriya and Pike 2005;
Simms and O’Neill 2005). Additionally, vehicle shape and
energy-absorbing properties of the bumper and the upper sur-
face of the front of the LTVs could be redesigned to reduce the
severity of LTV–pedestrian crashes (Crandall et al. 2002; Feist
et al. 2008; Hobbs 2001; Matsui 2004, 2005; Roudsari et al.
2004).
The European Commission is investing more resources in
developing cars that have increased energy-absorption proper-
ties and changing the shape of the front end to enhance safety.
The overall objective is to improve the protection of vulnerable
road users (Feist et al. 2008).
Unfortunately, the automobile industry is resistant to adopt-
ing design changes that could affect consumer selling points
such as style and speed, and until recently, political obstacles
have made it difficult to pass legislation requiring improved
standard safety features (Pless 2004). Recent research has reit-
erated that LTVs play a considerable role in the phenomenon of
back-over collisions (Agran et al. 1994; NHTSA 2006).
There is evidence of progress. In February 2008, the U.S.
government enacted the Cameron Gulbrasen Kids Transporta-
tion Safety Act. This legislation requires the U.S. Department
of Transportation to force automakers to implement new safety
standards aimed at preventing three vehicle-related causes of
child death and injury: back-overs due to large blind spots such
as those that many LTVs possess, collisions caused by children
being able to put the car in gear, and strangulation by power win-
dows (Senator John Sununu honored for work in helping to enact
Cameron Gulbrasen Kids Transportation Safety Act, February
14, 2008; http://nhpolitics.com/). This act of governance is an
important step in improving child and other pedestrians’ safety.
Hopefully, other countries will soon start working toward imple-
mentation of similar measures. Policy makers in collaboration
with the public health community need to work with the vehicle
industry to encourage development of safer vehicle front ends
in LTVs. Consumer Reports (2008) showed that LTVs have an
average blind spot of 14 feet, compared to 5 feet for a smaller
mid-sized sedan. Vehicle manufacturers are also should be en-
couraged to invest in vehicle back-over avoidance technology.
Meaningful investment in vehicle back-over avoidance technol-
ogy is necessary to detect children behind vehicles of a large size
such as LTVs (NHTSA 2006). The NHTSA’s (2006) research
on nine vehicles equipped with currently available technology
such as cameras and electronic sensor-based systems found that
the detection of objects was not consistent, and children were
not well detected (Mazzae 2007).
LIGHT TRUCK VEHICLES AND PEDESTRIAN INJURIES 53
Strengths and Limitation of Our Review
One of the main strengths of our review was the comprehen-
sive search strategy including multiple electronic databases.
Our search strategy yielded a large number of records (close
to 2000). This is partly due to the fact that searching accord-
ing to study type is possible only for controlled trials. Ini-
tial screening by titles and abstracts to select relevant studies
reduced the number of potentially relevant reports to a reason-
ably manageable level. However, it was not always straight-
forward to judge relevance from abstracts and this has been
a tedious and time-consuming process. We face the same dif-
ficulty and important challenged for systematic reviews. We
could not identify LTV–pedestrian crash literature from less-
developed countries. Even though rapidly developing countries
face more problems related to rapid motorization in their re-
spective countries, there is still a lack of research done in
these countries to understand vehicle crash-related problems
due to resource constraints and conflict of priorities. Accord-
ingly, we have found no candidate studies from developing
countries that met our inclusion criteria. Studies from these
countries are likely to be published in non-indexed and non-
English journals. There is much less research conducted in
those countries, considering the difficulties surrounding se-
curing funds for research. Our systematic review was based
largely on studies derived from the United States. We suggest
that our current analysis has significant advantages because
it is based on several large databases, including the National
Highway Traffic Safety Administration (Fatality Analysis Re-
porting System, General Estimates System, PCD-CIREN and
NASS) and health care–related patient and insurance industry
databases. The Crashworthiness Data System (CDS) is a na-
tional probability sample of light passenger vehicles (passenger
cars). As such, the sample populations within this study main-
tain the diversity to be representative of the population as a
whole. Importantly, the NHTSA-CIREN and NASS databases
that were used among studies function as a coordinated net-
work, with uniform methods for case enrollment, crash in-
vestigation, medical and injury data collection and analysis
of injury sources, and biomechanical causation. In addition,
our review includes studies from Australia, Canada, and The
Netherlands.
Implications for Future Research and Policy
Our findings document a major risk associated with LTVs.
This systematic review provides new evidence that LTVs are
a risk factor for pedestrian fatal injuries. Our findings have
important implications for future vehicle design modification.
The traffic safety research community must respond. There are
still important questions to be answered concerning the LTVs
and risk of fatal injury in traffic crashes. This may require
an internationally funded, well-designed study that should be
conducted within a clear, well-supported international collab-
orative framework. There is an urgent need to conduct com-
prehensive research on LTV and pedestrian crashes utilizing
data from developing countries, where there is no sufficient
and effective road infrastructure to separate pedestrians and
vehicles.
The increased risk of severe injury and fatality in collisions
with LTVs is also evident in the pediatric population. A recent
study shows that LTVs were four times as likely to be associ-
ated with fatal injury in 5- to 9-year-old pedestrians compared
with passenger cars (OR 4.2; 95% CI 1.9–9.5; DiMaggio et al.
2006). However, available literature and crash investigation has
not sufficiently evaluated the mechanisms of child pedestrian
collisions outside driveway crashes. In order to answer the criti-
cal questions regarding the differences in children injury profile
among passenger vehicle and LTVs, further studies with larger
sample sizes are required.
There is increasing interest in the health-promoting poten-
tial of physical activity including walking in our communities
around the globe. A systematic review of strategies that promote
physical activity (Sonkin et al. 2006) concluded that walking is
the most important form of physical activity that should be en-
couraged to improve public health given that it is the activity
most widely available. Vehicle danger is a disincentive to ac-
tive transport and reducing the traffic fatal injury risks for child
pedestrians and cyclists must be an important part of any strategy
to encourage walking and cycling to reduce childhood obesity
and active lifestyles in our communities. In particular, research
in the United States (Centers for Disease Control 2005) and in
the UK shows that traffic danger is an inhibitor for children to
walk to school and cycle (Rowland et al. 2003). This fear results
in parents discouragingtheir children from walking and cycling
to school. An additional study, also in the UK, found that chil-
dren of parents who were quite worried or very worried about
traffic danger were 1.6 times more likely to be driven to and
from school (odds ratio 1.6, 95% confidence interval 1.0–2.5;
DiGuiseppi et al. 1995).
In the report and other follow-up memoranda, the British
Medical Association (BMA) identified traffic danger as an in-
hibitor of walking and cycling and suggested strategies that
make roads safer for vulnerable road users (BMA 2003). In ac-
cordance with the BMA, the World Health Organization (WHO)
also identified fear of traffic danger as an inhibitor of pedes-
trian activity, especially in older individuals (WHO 2002). In
2009, a Committee on Injury, Violence, and Poison Prevention,
American Academy of Pediatrics policy statement urged leg-
islation that allows communities to create programs and en-
vironmental improvements to neighborhoods that can support
children’s safer commuting to school.
The problem is not limited to Western nations; researchers in
India report that children are being discouraged from walking
or bicycling to school because of fears of road traffic and crime
(Bhave et al. 2004).Therefore, it is paramount that vehicle man-
ufacturers apply significant changes to vehicle front designs as
early as possible (Pucher and Dijkstra 2003). It is necessary that
public health policy makers focus their attention on promoting
safer vehicle fronts, incorporating the evidence-based strate-
gies to reduce pedestrian injuries and fatalities. In the coming
years, in part because of the current economic recession and
54 DESAPRIYA ET AL.
the concern over dwindling oil supplies and environmentalism,
the automotive industry will need to make significant changes.
As it faces pressures to redefine vehicle manufacturing, there
is good opportunity for public health to influence the industry
to incorporate into their production processes effective technol-
ogy that could reduce risk of injuries to vulnerable pedestrians
(Desapriya et al. 2009).
A recent European study utilizing numerical simulations and
experimental testing, including a full-scale test with a pedestrian
dummy, shows that an energy-absorbing front end (and changing
the shape of the front end) and side of LTVs and other heavy
vehicles can reduce up to 90 percent of injuries to the head and
lower extremities at impact velocities of up to 40 km/h (Feist
et al. 2008).
We believe that vulnerable road users could be better pro-
tected from the impact of LTVs if they were fitted with external
airbags and energy-absorbing bodywork. An energy-absorbing
bumper system made of a foam-type resin of polypropylene,
polyurethane, or a similar product is one such concept (Evans
and Morgan 1999).
To date, bumper systems of LTVs are basically designed
to prevent or limit physical damage to expensive components
of the vehicle and thereby reduce insurance costs of replacing
parts of the vehicles in crashes by merely protecting the hood,
trunk, grill, fuel, exhaust, and cooling system in low-velocity
crashes. Now it is time to think equally on insurance cost
reduction in crashes and incorporate effective technology and
materials that could reduce the impact of LTV crashes on
vulnerable road users.
Road users everywhere deserve better and safer road travel
(Bener et al. 2006; Desapriya et al. 2006; Matsui 2005; Mohan
2002; Peden et al. 2004). With the ever increasing rates of obe-
sity around the world, the rights of pedestrians to use roadways
safely, both as a means of transport and as a leisure activity, need
to be safeguarded. LTVs pose a risk to pedestrians, but modifi-
cations in their front design, energy-absorbing properties of the
bumper and the upper surface of the front of the LTVs, and in
road engineering (traffic calming) could improve the safety of
all road users.
ACKNOWLEDGMENTS
The British Columbia Ministry of Healthy Living and Sports
has provided funding toward this project. We appreciate Dian
Leung and Giulia Scime, our research assistants, and their as-
sistance with the revision of this manuscript.
We acknowledge the outstanding work of selecting candi-
date studies for this systematic review and meta-analysis by
Dr. Sayed Subzwari (lead author of recent Cochrane Systematic
Review on vision screening and older driver traffic crashes and
systematic review meta analysis of cataract surgery and older
driver traffic crashes, published recently in Injury Prevention)
Dr. Ediriweera Desapriya (coauthor of the same recent Cochrane
Systematic Review), and Ana Maria Basic, who blinded articles
for us.
REFERENCES
Acierno S, Kaufman R, Rivara FP. (2004) Vehicle Mismatch: Injury
Patterns and Severity. Accid. Anal. Prev., Vol. 36, pp.761–772.
Agran PF, Winn DG, Anderson CL. (1994) Differences in Child Pedes-
trian Injury Events by Location. Pediatrics, Vol. 93, pp. 284–288.
Anderson M. (2008) Safety for Whom? The Effects of Light Trucks on
Traffic Fatalities. J. Health Econ., Vol. 27, pp. 973–989.
Ashton SJ, Pedder JB, Mackay GM. (1978) Influence of Vehicle Design
on Pedestrian Leg Injuries. Proc. 22nd Annual Conference of the
American Association for Automotive Medicine, pp. 216–236.
Ballesteros MF, Dischinger PC, Langenberg P. (2004) Pedestrian In-
juries and Vehicle Type in Maryland, 1995–1999. Accid. Anal. Prev.,
Vol. 36, pp. 73–81.
Bener A, Ghaffar A, Azab A, Kutty MS, Toth F, Lovasz G. (2006)
The Impact of Four-Wheel Drives on Traffic Disability and Deaths
Compared to Passenger Cars. J. Coll. Phys. Surg. Pakistan, Vol. 16,
pp. 257–260.
Berlin JA. (1995) Invited Commentary. Am. J. Epidemiol., Vol. 142,
pp. 383–387.
Bhave S, Bavdekar A, Otiv M. (2004). IAP National Task Force for
Childhood Prevention of Adult Diseases: Childhood Obesity. Indian
Pediatr., Vol. 41, pp. 559–575.
British Medical Association. (2003) Children’s Environment and
Health Action Plan for Europe. British Medical Association, Lon-
don.
Broughton J. (2005) Car Occupant and Motor-cyclist Deaths, 1994–
2002. Transport Research Laboratory, Crowthorne, England. TRL
Report 629.
Centers for Disease Control. (2005) Barriers to Children Walking to or
from School—United States, 2004. Morb. Mortal. Wkly. Rep.,Vol.
54, pp. 949–952.
Committee on Injury, Violence, and Poison Prevention, American
Academy of Pediatrics. (2009) Policy Statement-Pedestrian safety.
Pediatrics, Vol. 124, pp. 802–812.
Consumer Reports. (2008) The Problem of Blind Spots: The Area Be-
hind Your Vehicle Can Be a Killing Zone. Available at: http://www.
consumerreports.org/cro/cars/car safety/car-safetyreviews/mind-
that-blind-spot-1005/overview/ (accessed August 13, 2009).
Crandall JR, Bhalla KS, Madeley NJ. (2002) Designing Road Ve-
hicles for Pedestrian Protection. Br. Med. J., Vol. 324, pp. 1145–
1148.
Dandona R. (2005) SUV’s and Road Safety in Developing Countries—
BMJ Rapid Response. Available at: http://www.bmj.com/cgi/
eletters/331/7520/787#118814 (accessed on August 12, 2007).
Desapriya EB, Chipman M, Joshi P, Pike I. (2005) The Risk of Injury
and Vehicle Damage in Vehicle Mismatched Crashes. Int. J. Inj.
Contr. Saf. Promot., Vol. 12, pp. 191–192.
Desapriya EB, Pike I. (2005) Sports Utility Vehicles and Older
Pedestrians—Achieving Compatibility in Motor Vehicle Crashes.
Br. Med. J., Vol. 331, pp. 966–967.
Desapriya E, Pike I, Joshi P. (2006) Risks on the Roads. Can. Med.
Assoc. J., Vol. 1, p. 1743.
Desapriya EB, Pike I, Kinney J. (2005) The Risk of Injury and Vehicle
Damage Severity in Vehicle Mismatched Side Impact Crashes in
British Columbia Canada. Int. Assoc. Traffic Saf. Sci. Res., Vol. 29,
pp. 60–66.
Desapriya, EB, Pike I, Raina P. (2006) Severity of Alcohol-Related
Motor Vehicle Crashes in British Columbia: Case-Control Study.
Int. J. Inj. Contr. Saf. Promot., Vol. 13, pp. 89–94.
LIGHT TRUCK VEHICLES AND PEDESTRIAN INJURIES 55
Desapriya E, Pike I, Turcotte K. (2007) Sports Utility Vehicles and
Vulnerable Road Users. Am. J. Publ. Health, Vol. 97(Suppl. 1), pp.
S4–S5.
Desapriya E, Turcotte K, Subzwari S, Pike I. (2009) Smoking Inside
Vehicles Should Be Banned Globally. Am. J. Publ. Health, Vol. 99,
pp. 1158–1159.
Dickersin K. (2002) Systematic Reviews in Epidemiology: Why Are
We So Far Behind? Int. J. Epidemiol., Vol. 31, pp. 6–12.
DiGuiseppi C, Roberts I, Li L, Allen D. (1995) Determinants of Car
Travel on Daily Journeys to and from School. Br. Med. J., Vol. 316,
pp. 1426–1428.
DiMaggio C, Durkin M, Richardson LD. (2006) The Association of
Light Trucks and Vans with Paediatric Pedestrian Deaths. Int. J. Inj.
Contr. Saf. Promot., Vol. 13, pp. 95–99.
Effective Public Health Practice Project. (2003). Effective Public
Health Project Quality Assessment Tool. Available at: https://www.
myhamilton.ca/NR/rdonlyres/04A24EBE-2C46-411D-AEBA-95
A60FDEF5CA/0/QualityTool2003.pdf (accessed August 10, 2007).
Evans D, Morgan T. (1999) Engineering Thermoplastic Energy Ab-
sorbers for Bumpers. SAE Paper 1999-01-1011. http://www.sae.org/
technical/papers/1999-01-1011
Feist F, Gugler J, Giorda A, Avalle M, Puppini R. (2008) Improvements
to the Protection of Vulnerable Road Users: Retrofittable, Energy-
absorbing front End for Heavy Goods Vehicles. J. Crashworthiness,
Vol. 13, pp. 609–627.
Henary BY, Crandall J, Bhalla K, Mock CN, Roudsari BS. (2003)
Child and Adult Pedestrian Impact: The Influence of Vehicle Type
on Injury Severity. Annu. Proc. Assoc. Adv. Automot. Med., Vol. 47,
pp. 105–126.
Hobbs A. (2001) Safer Car Fronts for Pedestrians and Cyclists. Euro-
pean Transport Safety Council, Brussels, Belgium.
Holland AJ, Liang RW, Singh SJ, Schell DN, Ross FI, Cass DT. (2000)
Driveway Motor Vehicle Injuries in Children. Med. J. Aust., Vol. 21,
pp. 192–195.
Insurance Institute for Highway Safety. (2008) Status Rep., 43(5).
Ishikawa H, Kajzer J, Schroeder G. (1993) Computer Simulation of the
Impact Response of the Human Body in Car Pedestrian Accidents.
Proc. 37th Stapp Car Crash Conference, pp. 235–248.
Ivarsson BJ, Crandall JR, Okamoto M. (2006) Influence of Age-Related
Stature on the Frequency of Body Region Injury and Overall Injury
Severity in Child Pedestrian Casualties. Traffic Inj. Prev., Vol. 7, pp.
290–298.
Kerrigan J, Kam C, Murphy D, Bose D, Ivarsson J, Crandall J. (2005)
Kinematic Comparison of the Polar II and PMHS in Pedestrian
Impacts with a Sport Utility Vehicle. Proc. IRCOBI Conference, pp.
159–174.
Krug E. (1999) Injury: A Leading Cause of Global Burden of Disease.
Geneva: WHO.
Krug EG, Sharma GK, Lozano R. (2000) The Global Burden Injuries.
Am. J. Publ. Health, Vol. 90, pp. 523–526.
Lane PL, McClafferty KJ, Nowak ES. (1994) Pedestrians in Real World
Collisions. J Trauma, Vol. 36, pp. 231–236.
Lefler DE, Gabler HC. (2004) The Fatality and Injury Risk of Light
Truck Impacts with Pedestrians in the United States. Accid. Anal.
Prev., Vol. 36, pp. 295–304.
Lieber R, Bernard TS. (2008) Ditch the Gas Guzzler? Well, Maybe
Not Yet. New York Times- http://www.nytimes.com/2008/08/02/
business/yourmoney/02money.html
Margaritis D, Hoogvelt B, Vries, Y, Klootwijk C, Mooi H. (2004) An
Analysis of Sport Utility Vehicles Involved in Road Accidents.TNO
Automotive, The Netherlands, Paper Number 05-0370. http://www-
nrd.nhtsa.dot.gov/pdf/esv/esv19/05-0370-O.pdf
Matsui Y. (2004) Evaluation of Pedestrian Subsystem Test Method
Using Legform and Upper Legform Impactors for Assessment of
High-Bumper Vehicle Aggressiveness. Traffic Inj. Prev., Vol. 5, pp.
76–86.
Matsui Y. (2005) Effects of Vehicle Bumper Height and Impact Velocity
on Type of Lower Extremity Injury in Vehicle-Pedestrian Accidents.
Accid. Anal. Prev., Vol. 37, pp. 633–640.
Mazzae, E. (2007) NHSTA’s Backover Crash Prevention Research.
Available at: http://www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/
NRD/Multimedia/PDFs/Public%20Paper/SAE/2007/2007%20SAE
%20Gov%20Ind%20Mtg Mazzae.pdf (accessed August 18, 2009).
McLean AJ. (1996) Pedestrian Friendly Vehicle Front Structures: A
Review of the Literature. Australian Government Publishing Service,
Canberra, Australia.
McMullin BT, Rhee JS, Pintar FA, Szabo A, Yoganandan N. (2009) Fa-
cial Fractures in Motor Vehicle Collisions: Epidemiological Trends
and Risk Factors. Arch. Facial Plast. Surg., Vol. 11, pp. 165–170.
Mock C, MacKenzie E, Jurkovich G, Burgess A, Cushing B, deLateur
B, McAndrew M. (2000) Determinants of Disability after Lower
Extremity Fracture. J Trauma., Vol. 49, pp. 1002–1011.
Mock CN, Grossman DC, Kaufman RP, Mack CD, Rivara FP. (2002)
The Relationship between Body Weight and Risk of Death and Se-
rious Injury in Motor Vehicle Crashes. Accid Anal Prev., Vol. 34,
pp. 221–228.
Mohan D. (2002) Road Safety in Less-Motorized Environments: Future
Concerns. Int. J. Epidemiol., Vol. 31, pp. 527–32.
Mizuno K, Kajzer J. (1999) Compatibility Problems in Frontal, Side,
Single Car Collisions and Car-to-Pedestrian Accidents in Japan. Ac-
cid. Anal. Prev., Vol. 31, pp. 381–389.
Murray CJ, Lopez AD. (1997a) Alternative Projections of Mortality and
Disability by Cause 1990–2020: Global Burden of Disease Study.
Lancet, Vol. 349, pp. 1498–1504.
Murray CJ, Lopez AD. (1997b) Global Mortality, Disability, and the
Contribution of Risk Factors: Global Burden of Disease Study.
Lancet, Vol. 17, pp. 1436–1442.
Nadler EP, Courcoulas AP, Gardner MJ, Ford HR. (2001) Driveway
Injuries in Children: Risk Factors, Morbidity, and Mortality. Pe di -
atrics, Vol. 108, pp. 326–328.
National Highway Traffic Safety Administration, US Department
of Transportation. (2006) Vehicle Backover Avoidance Technology
Study—Report to Congress. Available at: http://www.nhtsa.dot.gov/
staticfiles/DOT/NHTSA/Vehicle%20Safety/Studies%20&%20 Re-
ports/Associated%20Files/BackoverAvoidance TechStudy.pdf (ac-
cessed August 13, 2008).
Okamoto Y, Sugimoto T, Enomoto K, Kikuchi J. (2003) Pedestrian
Head Impact Conditions Depending on the Vehicle Front Shape and
Its Construction—Full Model Simulation. Traffic Inj Prev., Vol. 4,
pp. 74–82.
Paulozzi LJ. (2005) United States Pedestrian Fatality Rates by Vehicle
Type. Inj. Prev., Vol. 11, pp. 232–236.
Peden M, Scurfield R, Sleet D. (2004) World Report on Road Traffic
Injury Prevention. World Health Organization, Geneva.
Pinkney KA, Smith A, Mann NC, Mower GD, Davis A, Dean JM.
(2006) Risk of Pediatric Back-over Injuries in Residential Driveways
by Vehicle Type. Pediatr. Emerg. Care, Vol. 22, pp. 402–407.
Pucher J, Dijkstra L. (2003) Promoting Safe Walking and Cycling to
Improve Public Health: Lessons from The Netherlands and Germany.
Am.J.Publ.Health, Vol. 93, pp. 1509–1516.
56 DESAPRIYA ET AL.
Roudsari BS, Mock CN, Kaufman R, Grossman D, Henary BY, Cran-
dall J. (2004) Pedestrian Crashes: Higher Injury Severity and Mortal-
ity Rate for Light Truck Vehicles Compared with Passenger Vehicles.
Inj. Prev., Vol. 10, pp. 154–158.
Rowe SA, Sochor MS, Staples KS, Wahl WL, Wang SC. (2004) Pelvic
Ring Fractures: Implications of Vehicle Design, Crash Type, and
Occupant Characteristics. Surgery., Vol. 136, pp. 842–847.
Rowland B, DiGuiseppi C, Gross M, Afolabi E, Roberts I. (2003)
Randomized Controlled Trial of Site Specific Advice on School
Travel Patterns. Arch.Dis.Child, Vol. 88, pp. 8–11.
Sekine Y, Takahashi K, Hayamizu H, Kawamoto D, Nakagawa D.
(2008) Compatibility between Sports-Utility Vehicles and Sedan-
Type Vehicles. Int. J. Crashworthiness, Vol. 13, pp. 551–558.
Senator John Sununu Honored for Work in Helping to Enact Cameron
Gulbrasen Kids Transportation Safety Act, February 14, 2008. Avail-
able at: http://nhpolitics.com/ (accessed August 12, 2008).
Simms C, O’Neill D. (2005) Sports Utility Vehicles and Older Pedes-
trians. Br.Med.J., Vol. 8, pp. 787–788.
Sonkin B, Edwards P, Roberts I, Green J. (2006) Walking, Cycling and
Transport Safety: An Analysis of Child Road Deaths. J. Roy. Soc.
Med., Vol. 99, pp. 402–405.
Starnes M, Longthorne A. (2003) Child Pedestrian Fatality Rates by
Striking Vehicle Body Type: A Comparison of Passenger Cars, Sport
Utility Vehicles, Pickups, and Vans. National Highway Traffic Safety
Administration. DOT HS 809 640 (Traffic Safety Facts Research
Note).
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D,
Moher D, Becker BJ, Sipe TA, Thacker SB. (2000) Meta-analysis of
Observational Studies in Epidemiology: A Proposal for Reporting.
Meta-analysis of Observational Studies in Epidemiology (MOOSE)
Group. J.Am.Med.Assoc., Vol. 83, pp. 2008–2012.
Subzwari S, Desapriya E, Babul-Wellar S, Pike I, Turcotte K, Rajabali
F, Kinney J. (2009) Vision Screening of Older Drivers for Preventing
Road Traffic Injuries and Fatalities. Cochrane Database of System-
atic Reviews, Vol. 21, No. 1: CD006252.
White M. (2004) The “Arms Race” on American Roads: The Effect of
Sport Utility Vehicles and Pickup Trucks on Traffic Safety. J. Law
Econ., Vol. 47, pp. 333–355.
Wood DP, Simms CK. (2002) Car Size and Injury Risk: A Model for
Injury Risk in Frontal Collisions. Accid. Anal. Prev., Vol. 34, pp.
93–99.
World Health Organization. (2002) Physical Activity through Trans-
port as Part of Daily Living Changes in the Global Vehicle Fleet and
Associated Risks to Vulnerable Road Users. World Health Organi-
zation, Geneva.
Yao J, Yang J, Otte D. (2007) Head Injuries in Child Pedestrian
Accidents—In-Depth Case Analysis and Reconstructions. Traffic
Inj. Prev., Vol. 8, pp. 94–100.
... This relationship was also observed in Zhang et al. in China. [8] Furthermore, a study by Desapriya et al. in 2010 showed that the risk of death in collision of trucks with pedestrian was 55% higher than conventional vehicles (P < 0.001). [24] The heavyweight and volume of heavy vehicles compared with motorcycle and bicycle can be a reason for the increased rate of pedestrian fatalities. ...
... [8] Furthermore, a study by Desapriya et al. in 2010 showed that the risk of death in collision of trucks with pedestrian was 55% higher than conventional vehicles (P < 0.001). [24] The heavyweight and volume of heavy vehicles compared with motorcycle and bicycle can be a reason for the increased rate of pedestrian fatalities. A study by Ballesteros et al. in 2004 on pedestrian injuries and vehicle type in Maryland indicated that vehicle heavyweight and speed were associated with an increase in pedestrian's death and injuries. ...
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Aims: Traffic accidents are one of the major causes of death and disability worldwide. The aim of this study was to determine the causes of road accidents in northwestern Iran in the period of 2010–2018. Materials and Methods: This cross-sectional study was performed on all road traffic accidents recorded by traffic police of West Azerbaijan Province during 2010–2018. Data were analyzed using descriptive statistics, Chi-square t-test, and time series by SPSS 16. Results: A total of 95,788 registered accidents were included in the study. Most of the accidents were in September with the frequency of 9960 cases (10.4%), in residential, office, and industrial regions 58,550 (56%), by cars and taxi 80,949 (66%), in collisions between a vehicle with a bicycle and a motorcycle 56,728 (58%), in front-to-rear and right-side crashes 49,714 (47%), in rural and main roads 59,855 (62%), in clean weather 73,887 (73%), and on Thursday 14891 (15%); the occurrence of traffic accidents showed a significant relationship with all of these variables (P = 0.001). Conclusions: Month of accident, type of accident, day of the week, location of accident, use of vehicle, type of collision, mode of collision, accident path, and weather were the effective factors contributing in the occurrence of the traffic accidents. It is suggested that, in addition to educating people regarding the prevention of traffic accidents, policymakers take steps to improve the safety and standardization of roads and increase the safety of vehicles.
... The probability of survival and the severity of the injuries not only depend on the speed of the vehicle. Other recurrent factors, that we found in the different studies, are the age of the pedestrian, the response time of emergency assistance, or the type of the vehicle (Ballesteros et al 2004;Desapriya et al 2010;Hussain, 2019;Kröyer, 2015;Lefler and Gabler 2004;Rosén, 2009;Sze, and Wong, 2007). For example, for pedestrian older than 15 years, Rosén (2009), proposed the following pedestrian fatality risk function (P) (Eq. ...
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... Head and neck trauma are the most common causes of mortality in pedestrian traffic injuries (Yadollahi et al, 2017;Hasani et al, 2017). Pedestrians struck by pickup trucks, vans or light trucks are at a higher risk of severe injury and mortality (Roudsari et al, 2004;Desapriya et al, 2010;Damsere-Derry et al, 2010). Blunt injuries are the most common type of pedestrian traffic injuries (Dragu et al, 2009;Ehsaei et al, 2014;Sae-Tae et al, 2018) but penetrating injuries alone or in combination with blunt injuries carry a higher risk of mortality than blunt injuries alone (Ehsaei et al, 2014;Peng et al, 2015). ...
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Pedestrians who walk near roads are at increased risk for injury by vehicles. In this study we aimed to identify factors and injuries associated with road traffic accident mortality among pedestrians in southern Thailand who received medical treatment in order to inform policy makers on preventing road traffic mortality. Study subject inclusion criteria were injured pedestrians admitted to the general hospitals in five provinces of southern Thailand during 2008-2013. Injured pedestrians with unknown survival status were excluded from this study. The data were obtained retrospectively by reviewing the 2008-2013 Injury Surveillance (IS) database of the Office of Disease Prevention and Control (ODPC) Region 11. Logistic regression analysis (with significance set at p<0.05) was used to determine associations between injuries and mortality. A total of 2,777 subjects were included in the study; 59.3% males. The mean (+standard deviation) age of study subjects was 29.3 (+22.9) years. The mortality rate among study subjects was 3.6%. The factors significantly associated with mortality were: an injury time during 18:01-24:00, older age, being hit by a 4-wheeled vehicle, having penetrating or a combination of blunt and penetrating injury and having a head or neck injury (p <0.001). These factors need to be taken into consideration when developing programs to prevent pedestrian traffic mortality.
... The increased pedestrian fatality and injury risk of LTV as compared to BTV was first published by Lane et al. (1994) for the Canadian accident situation, by Maki et al. (2003) for the Japanese market, and by Roudsari et al. (2004) for the US. A more recent meta-analysis confirmed their findings (Desapriya et al., 2010), as did an extensive simulation study by Watanabe et al. (2012). ...
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Introduction: Fatal pedestrian and pedalcyclist crashes have been on the rise in the United States since 2009. This rise in fatalities coincides with the rise of large vehicles on American roadways, continuing a trend that began years earlier. Method: Through rare access to both crash and hospital records, this report investigates the relationship between striking vehicle type and medical outcomes of pedestrian and pedalcyclist cases. Results: Results suggest that children are eight times more likely to die when struck by a SUV compared to those struck by a passenger car. Passenger cars were the striking vehicle in most fatal pedestrian and pedalcyclist crashes, though they were underrepresented relative to the proportion of all crashes in which they were involved. Though pickup trucks were the striking vehicle in just 5.6% of pedestrian and pedalcyclist crashes, they were involved in 12.6% of fatalities. SUVs were similarly overrepresented in fatalities relative to the proportion of their involvement in all crashes. SUVs struck 14.7% of the pedestrians and pedalcyclists investigated here, but were involved in 25.4% of the fatalities. Head and thorax injury severities are examined by vehicle type and age. Hospital charges of pedestrian and pedalcycle crash victims are also analyzed by striking vehicle type and victim age. Practical applications: Findings suggest larger vehicles are involved in pedestrian and pedalcyclist crashes with more severe injuries that result in higher hospital charges. By race, Blacks are also found to be overrepresented as pedestrian and pedalcyclist crash victims.
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In previous research, the effects of commercial vehicle proportions (CVP) on overall crash propensity have been found to be significant, but the results have been varied in terms of the effect direction. In addition, the mediating or moderating effects of roadway attributes on the CVP-vs-safety relationships, have not been investigated. In addressing this gap in the literature, this study integrates databases on crashes, traffic, and inventory for Hong Kong road segments spanning 2014 to 2017. The classes of commercial vehicles considered are public buses, taxi, and light-, medium- and heavy-goods vehicles. Random-parameter Tobit models were estimated using the crash rates. The results suggest that the CVP of each class show credible effects on the crash rates, for the various crash severity levels. The results also suggest that the interaction between CVP and roadway attributes is credible enough to mediate the effect of CVP on crash rates, and the magnitude and direction of such mediation varies across the vehicle classes, crash severity levels, and roadway attribute type in four ways. First, the increasing effect of taxi proportion on slight-injury crash rate is magnified at road segments with high intersection density. Second, the increasing effect of light-goods vehicle proportion on slight-injury crash rate is magnified at road segments with on-street parking. Third, the association between the medium- and heavy-goods vehicle proportion and killed/severe injury (KSI) crash rate, is moderated by the roadway width (number of traffic lanes). Finally, a higher proportion of medium- and heavy-goods vehicles generally contributes to increased KSI crash rate at road segments with high intersection density. Overall, the findings of this research are expected not only to help guide commercial vehicle enforcement strategy, licensing policy, and lane control measures, but also to review existing urban roadway designs to enhance safety.
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We examined the public health consequences of unsafe and inconvenient walking and bicycling conditions in American cities to suggest improvements based on successful policies in The Netherlands and Germany. Secondary data from national travel and crash surveys were used to compute fatality trends from 1975 to 2001 and fatality and injury rates for pedestrians and cyclists in The Netherlands, Germany, and the United States in 2000. American pedestrians and cyclists were much more likely to be killed or injured than were Dutch and German pedestrians and cyclists, both on a per-trip and on a per-kilometer basis. A wide range of measures are available to improve the safety of walking and cycling in American cities, both to reduce fatalities and injuries and to encourage walking and cycling.
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... 11.↵: Fredriksson R,; Häland Y,; Yang J. .Evaluation of a new pedestrian head injury protection system with a sensor in the bumper and lifting of the bonnet&apos;s rear edge. Paper No 131. In: Proceedings of the 17th International Conference ...
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The current study aims to evaluate the influence of age-related stature on the frequency of body region injury and overall injury severity in children involved in pedestrian versus motor vehicle collisions (PMVCs). A trauma registry including the coded injuries sustained by 1,590 1- to 15-year-old pedestrian casualties treated at a level-one trauma center was categorized by stature-related age (1-3, 4-6, 7-9, 10-12, and 13-15 years) and body region (head and face, neck, thorax, abdomen and pelvic content, thoracic and lumbar spine, upper extremities, pelvis, and lower extremities). The lower extremity category was further divided into three sub-structures (thigh, leg, and knee). For each age group and body region/sub-structure the proportion of casualties with at least one injury was then determined at given Abbreviated Injury Scale (AIS) severity levels. In addition, the average and distribution of the Maximum Abbreviated Injury Score (MAIS) and the average Injury Severity Score (ISS) were determined for each age group. The calculated proportions, averages, and distributions were then compared between age groups using appropriate significance tests. The overall outcome showed relatively minor variation between age groups, with the average +/- SD MAIS and ISS ranging from 2.3 +/- 0.9 to 2.5 +/- 1.0 and 8.2 +/- 7.2 to 9.4 +/- 8.9, respectively. The subjects in the 1- to 3-year-old age group were more likely to sustain injury to the head, face, and torso regions than the older subjects. The frequency of AIS 2+ lower extremity injury was approximately 20% in the 1- to 3-year-old group, but was twice as high in the 4- to 12-years age range and 2.5 times as high in the oldest age group. The frequency of femur fracture increased from 10% in the youngest group to 26% in the 4- to 6-year-old group and then declined to 14% in the 10- to 15-years age range. The frequency of tibia/fibula fracture increased monotonically with group age from 8% in the 1- to 3-year-old group to 31% in the 13- to 15-year-old group. While the overall outcome of child pedestrian casualties appears to be relatively constant across the pediatric stature range considered ( approximately 74-170 cm), subject height seems to affect the frequency of injury to individual body regions, including the thorax and lower extremities. This suggests that vehicle safety designers need not only account for the difference in injury patterns between adult and pediatric pedestrian casualties, but also for the variation within the pediatric group.
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Each year, approximately 900 pediatric pedestrians younger than 19 years are killed. In addition, 51000 children are injured as pedestrians, and 5300 of them are hospitalized because of their injuries. Parents should be warned that young children often do not have the cognitive, perceptual, and behavioral abilities to negotiate traffic independently. Parents should also be informed about the danger of vehicle back-over injuries to toddlers playing in driveways. Because posttraumatic stress syndrome commonly follows even minor pedestrian injury, pediatricians should screen and refer for this condition as necessary. The American Academy of Pediatrics supports community- and school-based strategies that minimize a child&apos;s exposure to traffic, especially to high-speed, high-volume traffic. Furthermore, the American Academy of Pediatrics supports governmental and industry action that would lead to improvements in vehicle design, driver manuals, driver education, and data collection for the purpose of reducing pediatric pedestrian injury.
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Roberts I, Norton R, Hassall I. 1978-1987. NZJ Med 1992; 105: 51-52. Agran P, Winn D, Anderson C. in by . Pediatrics 1994; 93: 284-288. Roberts I, Kolbe A, White J. Non-traffic .