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A community traffic safety analysis of pedestrian and bicyclist injuries based on the catchment area of a trauma center

Slaughter, Dekeya R. BSc(Hons); Williams, Nick PhDc; Wall, Stephen P. MD, MSc; Glass, Nina E. MD; Simon, Ronald MD; Todd, S. Rob MD; Bholat, Omar S. MD; Jacko, Sally RN, MPH; Roe, Matthew MS; Wilson, Chad T. MD, MPH; Levine, Deborah A. MD; Marshall, Gary MD; Ayoung-Chee, Patricia MD, MPH; Pachter, H. Leon MD; Frangos, Spiros G. MD, MPH

Journal of Trauma and Acute Care Surgery: April 2014 - Volume 76 - Issue 4 - p 1103–1110
doi: 10.1097/TA.0000000000000176
Original Articles

BACKGROUND This study was designed to examine the characteristics of pedestrian and bicyclist collisions with motor vehicles within New York City’s high-density hub. The primary objectives were to map crash locations and to identify hot spots within these injury clusters. The secondary objective was to quantify differences in injury severity based on road type and user behaviors.

METHODS Between December 2008 and June 2011, data were prospectively collected from pedestrians and bicyclists struck by motor vehicles and brought to Bellevue Hospital, a Level 1 trauma center in New York City. Behaviors by cohort (i.e., crossing patterns for pedestrians, riding patterns for bicyclists), Injury Severity Score (ISS), and collision locations were extracted from the database. Analyses of mean ISS were performed using a Student’s t test with a p < 0.05 considered significant. Geomaps were created to identify clusters or “hot spots,” where higher volumes of crashes occurred over time. Spatial analysis was performed to demonstrate whether these were random events.

RESULTS A total of 1,457 patients (1,075 pedestrians and 382 bicyclists) were enrolled. Collision locations were known for 97.5%. Of the injured pedestrians, those crossing avenues (n = 277) had higher ISSs than those crossing streets (n = 522) (p = 0.01) and were more likely to die (p = 0.002). Pedestrians crossing midblock (n = 185) had higher mean ISSs than those crossing with the signal in the crosswalk (n = 320) (8.12 vs. 5.01, p < 0.001). Based on density mapping, hot spots of pedestrian collisions were detected in midtown Manhattan, while hot spots for bicyclists were detected at bridge and tunnel portals. Spatial analysis indicates that these are not random events (p < 0.05).

CONCLUSION Pedestrians injured on avenues sustained more serious injuries than those injured on narrower streets. A better understanding of collision locations and features may allow for tailored injury prevention strategies. Trauma centers serve an important role in public health surveillance within their local communities.

LEVEL OF EVIDENCE Epidemiologic study, level III.

From the Departments of Surgery (D.R.S., N.E.G., R.S., S.R.T., O.S.B., S.J., C.T.W., G.M., P.-A.C., H.L.P., S.G.F.), Emergency Medicine (N.W., S.W., D.A.L.), and Pediatrics (D.A.L.), Bellevue Hospital Center, New York University School of Medicine; and Office of Research, Implementation and Safety (M.R.), NYC Department of Transportation, New York, New York.

Submitted: November 1, 2013, Revised: December 16, 2013, Accepted: December 17, 2013.

The sponsor of this study did not participate in the design or conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

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

© 2014 Lippincott Williams & Wilkins, Inc.