Navigating Risk: A Comprehensive Study on Pedestrian-Vehicle Collision Factors

While older adults, young children, and individuals with psychiatric illnesses are commonly believed to be most susceptible to becoming pedestrians struck by motor vehicles (PSMV), substantial empirical evidence is lacking. This study aimed to discern the risk factors predisposing trauma patients requiring hospital evaluation to being struck by a vehicle.

The 2017-2021 Trauma Quality Improvement Program database was queried for all blunt trauma patients. Two groups were compared: PSMV and those presenting with other blunt trauma mechanisms. A multivariable logistic regression analysis was performed to identify predictors for PSMV and to analyze the risk difference between children (age <12 y), adolescents (12-17 y), and elderly patients (≥65 y) compared to adults (18-64 y).

Of 4,769,055 blunt trauma patients, 174,314 (3.7%) were PSMV. The pedestrian struck cohort had increased rates of lung injuries (20.8% versus 10.6%, P < 0.001) and rib fractures (24.0% versus 16.4%, P < 0.001), as well as overall complications (8.3% versus 4.3%, P < 0.001). On multivariable analysis, children (odds ratio [OR] 0.87, confidence interval [CI] 0.85-0.88, P < 0.001) and elderly patients (OR 0.36, CI 0.36-0.37, P < 0.001) were less likely to present as a pedestrian struck compared to adult patients. The strongest independent associated risk factor for PSMV was substance use disorder (OR 2.13, CI 2.09-2.16, P < 0.001), followed by alcohol use disorder (OR 1.21, CI 1.19-1.23, P < 0.001) and psychiatric illness (OR 1.12, CI 1.11-1.14, P < 0.001).

This study found that substance use disorders and psychiatric illness were the strongest predictor of PSMV among trauma patients. Surprisingly, children and the elderly were less likely to present as a PSMV compared to other blunt mechanisms, challenging prevailing beliefs. A 2-fold increase in complications and nearly 3-fold increase in mortality after PSMV highlights the need for both pedestrians and drivers to exercise caution in shared spaces and increased efforts for primary prevention.