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Vulnerable roadway users struck by motor vehicles at the center of the safest, large US city

Dultz, Linda A. MD, MPH; Foltin, George MD; Simon, Ronald MD; Wall, Stephen P. MD, MSc; Levine, Deborah A. MD; Bholat, Omar MD; Slaughter-Larkem, Dekeya BSc; Jacko, Sally RN, MPH; Marr, Mollie BFA; Glass, Nina E. MD; Pachter, H. Leon MD; Frangos, Spiros G. MD, MPH

Journal of Trauma and Acute Care Surgery: April 2013 - Volume 74 - Issue 4 - p 1138–1145
doi: 10.1097/TA.0b013e31827ab722
Original Articles

BACKGROUND Road safety constitutes an international crisis. In 2010, 11,000 pedestrians and 3,500 bicyclists were injured by motor vehicles in New York City. This study aims to identify the demographics, behaviors, injuries, and outcomes of vulnerable roadway users struck by motor vehicles in New York City’s congested central business district and surrounding periphery.

METHODS A prospective, descriptive study of pedestrians and bicyclists struck by motor vehicles and treated at a Level I regional trauma center was performed. Data were collected between December 2008 and June 2011 by interviewing patients and first responders supplemented with imaging and outcomes variables. Main outcome measures included patient demographics, behavior patterns, scene-related data, Injury Severity Score (ISS), and outcomes including mortality. Multivariate ordinal logistic regression modeling was performed to isolate effects of predictor variables on outcome of ISS categories.

RESULTS Injured pedestrians (n = 1,075) and bicyclists (n = 382) differ by age (p < 0.001), sex (p < 0.001), ethnicity/race (p < 0.001), and involved motor vehicle type (p < 0.001). Pedestrians sustain more severe/critical injuries (p < 0.001) and hospital admissions (p < 0.001). Bicyclists are more commonly struck by taxis (p < 0.001) and infrequently wear helmets (29.6%). Variables associated with low ISS include bicycling (adjusted odds ratio [AOR], 0.43; 95% confidence interval [CI], 0.29–0.63), above normal body mass index (AOR, 0.73; 95% CI, 0.54–0.99), Latino (AOR, 0.65; 95% CI, 0.46–0.94) or black (AOR, 0.63; 95% CI, 0.41–0.96) ethnicity/race, and struck by a taxicab (AOR, 0.50; 95% CI, 0.33–0.76) or turning vehicle (AOR,0.49; 95% CI, 0.34–0.70). Variables associated with high ISS include alcohol (AOR, 2.71; 95% CI, 1.81–4.05), age less than 18 years (AOR, 1.73; 95% CI, 1.05–2.86), hearing impairment (AOR, 2.24; 95% CI, 1.24–4.03), and struck by a truck or bus (AOR, 1.91; 95% CI, 1.18–3.10). Mortality was 1.2%.

CONCLUSION Injured pedestrians and bicyclists represent distinct entities. Prevention modalities must be tailored accordingly with a focus on high-risk subgroups and compliance with traffic laws. Studying fatality or admissions data fail to capture the extent of the epidemic.

LEVEL OF EVIDENCE Prospective epidemiologic study, level II.

From the Departments of Surgery (L.A.D., R.S., O.B., D.S.-L., S.J., N.E.G., H.L.P., S.G.F.), and Pediatrics and Emergency Medicine (G.F., S.P.W., D.A.L., M.M.), Bellevue Hospital Center, New York University School of Medicine, New York, New York.

Submitted: September 2, 2012, Revised: October 18, 2012, Accepted: October 19, 2012.

Address for reprints: Spiros G. Frangos, MD, MPH, New York University, School of Medicine, 550 First Ave, NBV 15 S7, New York, NY 10016-9196; email:

© 2013 Lippincott Williams & Wilkins, Inc.