Brison RJ, Wicklund K, Mueller BA. Fatal pedestrian
injuries to young children: a different pattern of injury. Am J
Public Health 1988 Jul;78(7):793-5.
This research examined Washington State death
certificates from 1979-83 with ICD 9 E-Codes 814-825 (motor vehicle-related
incidents) indicated as the cause of death. This study also reviewed
coroners’ reports when needed and if such a report was available
as well as police reports if necessary to obtain details of the incidents
involved.
The study identified 71 fatal motor vehicle
injuries to children less than five years of age during the five-year
study period. Of these, 41 were found to be non-traffic related, with
30 incidents occurring in driveways and 11 having occurred in apartment
or store parking lots.
The projected average annual death rate data
presented in this study show that all of the non-traffic deaths involved
children between the ages of 1 and 4. That data appear in the following
chart:
Table XXII: (from Brison,
et. al.) Average Annual Death Rates by Age and Sex of Child for Non-Traffic
and Traffic-Related Pedestrian Incidents
| |
Non-traffic |
Traffic |
| Age
(years) |
Number |
Rate/100,000
population |
Number |
Rate/100,000
population |
| 0 |
0 |
-- |
2 |
0.6 |
| 1 |
19 |
5.8 |
7 |
2.2 |
| 2 |
11 |
3.4 |
4 |
1.2 |
| 3 |
7 |
2.2 |
10 |
3.1 |
| 4 |
4 |
1.2 |
7 |
2.2 |
| 1-4 |
41 |
3.2 |
28 |
2.2 |
| Male |
25 |
3.8 |
16 |
2.4 |
| Female |
16 |
2.5 |
14 |
2.2 |
The propensity for SUVs or small
trucks to be involved in non-traffic incidents as well as for a parent
or family member to be driving is demonstrated in the following data
that was presented in this study.
Table XXIII: (from Brison,
et. al.) Characteristics of Non-Traffic and Traffic-Related Pedestrian
Vehicle Collisions to Children Less than Age Five
|
Characteristics |
Non-traffic |
Traffic |
| |
|
|
| Light Truck |
16 |
1 |
| 4 x 4 Truck or Jeep |
6 |
0 |
| Van |
6 |
3 |
| Passenger Auto |
9 |
25 |
| Vehicle
Direction |
|
|
| Forward |
9 |
29 |
| Reverse |
23 |
1 |
| Fell/Jump from vehicle |
3 |
0 |
| Driver |
|
|
| Father |
10 |
0 |
| Mother |
4 |
0 |
| Other family or visiting friend |
6 |
0 |
| Other |
8 |
27 |
Winn DG, Agran PF, Castillo DN. Pedestrian
injuries to children younger than 5 years of age. Pediatrics 1991
Oct;88(4):776-82.
Similar results were found in this study that
examined the differences in pedestrian injuries between toddlers (children
two years old and younger) and preschoolers (children three and four
years old). The study found that toddlers more often die in non-traffic
accidents than do preschoolers and it confirmed that children aged one
to four are the ones most affected by driveway incidents. “In
the entire sample of child pedestrians 0 through 14 years of age, all
of the hospital admissions for driveway related events involved children
younger than 5 years of age and all of the fatalities were younger than
2 years of age,” the study reported.
This study was based on data derived from a
hospital-based monitoring system of motor vehicle-related injuries to
children in Orange County, CA over a two-year period (April 1987 through
March 1989). The monitoring system includes 9 of 38 hospitals in the
county as well as the coroner’s office. The sample examined in
this study included 67 toddlers and 102 preschoolers either injured
or killed in non-traffic events. Backing was the vehicle action most
common among incidents involving toddlers, accounting for 32 or 57 percent
of the incidents reviewed. In incidents involving preschoolers, on the
other hand, backing was the vehicle action in only 13 or 17 percent
of the cases. The data relating to this issue appear below.
Table XXIV: (from Winn
et. al.) Action of Vehicles Involved in Non-traffic Accidents Involving
Toddlers and Preschoolers
|
Characteristic |
Toddlers (n=67) |
Preschoolers (n=102) |
| |
No. (% of total) |
No. (% of total) |
| Turning |
|
6 (8) |
| Traveling Straight |
22 (39) |
57 (75) |
| Backing |
32 (57) |
13 (17) |
| Not ascertained |
11 |
26 |
The majority of the vehicles involved
in the 169 non-traffic events included in this study were automobiles,
35 or 71 percent of the incidents involving toddlers and 52 or 74 percent
of the incidents involving preschoolers.
Of the 10 fatalities identified in the study,
six involved toddlers and all of those involved a vehicle backing up.
Four of these six incidents involved a van or pickup truck and five
of the six incidents occurred in a driveway. All of the four deaths
of preschoolers occurred mid-block and involved a vehicle (three cars,
one motorcycle) proceeding straight.
In addition to the 6 toddler and 4 preschooler
deaths, the study identified 27 toddlers (40 percent) who required emergency
department treatment only and 34 (51 percent) who were hospitalized.
Some 44 (43 percent) of the preschoolers required emergency department
treatment only and 54 (54 percent) required hospitalization.
Agran PF, Winn DG, Anderson CL. Differences
in child pedestrian injury events by location. Pediatrics 1994
Feb;93(2):284-8.
This research compared “child pedestrian
injury events occurring in driveways and parking lots and at mid-block
and intersections with respect to the characteristics and activity of
the child, injury outcome measures, and characteristics of the vehicle
and roadway.”
Data for this study were derived from a large
multi-hospital and coroner monitoring system for motor vehicle-related
injuries to children in Orange County, CA. Data in the study cover the
two-year period, April 1, 1987 through March 31, 1989. The sample consisted
of 345 child pedestrians 0 to 14 years of age, who were injured during
this period.
With respect to non-traffic events, the study
found:
Some of the data presented in
the article and that supports these observations follow.
Table XXV: (from Agran
et. al.) Location of Pedestrian Injury Events (N=345)
|
Location |
N (%) |
| |
182
(53) |
| Intersection |
95
(28) |
| Driveway |
39
(11) |
| Parking lot* |
29
(8) |
*The authors of the study found, “The results
for events occurring in parking lots were similar to the driveway events.”
Table XXVI: (from Agran
et. al.) Movement and Type of Vehicle That Struck Pedestrian by Location
of Injury,
for Four Major Location Types
| |
Driveway
(N=39) n(%) |
Parking Lot (N=29) n(%) |
Midblock (N=182) n(%) |
Intersection (N=95) n(%) |
| Movement |
|
|
|
|
| Backing |
28(78) |
16(59) |
6(3) |
… |
| Forward |
6(17) |
10(37) |
162(93) |
61(72) |
| Turning |
2(6) |
1(4) |
6(3) |
24(28) |
| Unknown |
3 |
2 |
8 |
10 |
| Type
of vehicle |
|
|
|
|
| Van, truck,
pickup &
4-wheel drive |
13(41) |
11(39) |
42(24) |
17(19) |
| Passenger
car |
19(59) |
17(61) |
134(76) |
71(81) |
| Unknown |
7 |
1 |
6 |
7 |
Table XXVII: (from Agran
et. al.) Gender and Age of Pedestrians by Location of Injury,
for Four Major Location Types
| |
Driveway
(N=39) n(%) |
Parking Lot (N=29) n(%) |
Midblock (N=182) n(%) |
Intersection (N=95) n(%) |
| Gender |
|
|
|
|
| Female |
10(26) |
7(24) |
48(26) |
40(42) |
| Male |
29(74) |
22(76) |
134(74) |
55(58) |
| Age in years |
|
|
|
|
| 0-2 |
22(56) |
7(24) |
17(9) |
0(0) |
| 3-4 |
8(21) |
9(31) |
42(23) |
8(8) |
| 5-9 |
5(13) |
4(14) |
87(48) |
34(36) |
| 10-14 |
4(10) |
9(31) |
36(20) |
53(56) |
Table XXVIII: (from Agran
et. al.) Companions by Location of Injury, for Four Major Types
| |
Driveway
(N=39) n(%) |
Parking Lot (N=29) n(%) |
Midblock (N=182) n(%) |
Intersection (N=95) n(%) |
| Companions |
|
|
|
|
| With adults |
14(45) |
14(50) |
41(23) |
21(24) |
| With other children |
11(36) |
13(46) |
101(57) |
43(49) |
| Alone |
6(19) |
1(4) |
34(19) |
23(26) |
| Unknown |
8 |
1 |
6 |
8 |
Table XXIX: (from Agran
et. al.) Disposition by Location of Injury for Four Major Location Types
| |
Driveway
(N=39) n(%) |
Parking Lot (N=29) n(%) |
Midblock (N=182) n(%) |
Intersection (N=95) n(%) |
| Fatality |
4(10) |
… |
8(4) |
4(4) |
| Admitted to hospital and discharged home |
15(38) |
11(38) |
103(57) |
50(53) |
| Treated in emergency department and released |
20(51) |
18(62) |
71(39) |
41(33) |
Duhaime AC, Eppley M, Marguilies S, Heher KL,
Bartlett SP. Crush injuries to the head in children. Neurosurgery
1995 Sept;37(3):401-6.
While the focus of this article was on the clinical
and treatment aspects of dealing with crush injuries to a child’s
head, it was nonetheless interesting and noteworthy for this NHTSA research
effort that of the seven cases chosen to be reported in this article,
four involved a child’s head being run over by a motor vehicle
backing up in a driveway or parking lot. Of these cases, three involved
oversized vehicles --one van, one truck, and one small bus. One involved
a car. The article does not indicate the years in which the cases occurred.
Partrick BA, Bensard DD, Moore EE, Partington
MD, Karrer FM. Driveway crush injuries in young children: a highly
lethal, devastating, and potentially preventable event. J Pediat
Surg 1998 Nov;33(11):1712-5.
This study was based on a six-year review (1991
to 1996) of child (less than 18 years of age) pedestrian injuries treated
at two urban trauma centers. In the study sample of 527 children who
as pedestrians were injured by automobiles, the authors found 51 (9.7%)
incidents that were driveway-related and in which the car rolled backwards
over the child. Children under five made up the majority of the driveway
cases (41 of 51, 80%). Six driveway cases involved children between
the ages of five and nine. Four cases involved children older than nine.
Of the children who died as a result of a driveway incident, all were
in the 0 to 4 age group.
As with other studies discussed here, this study
considered who was driving the vehicle in driveway incidents. A parent
was the driver in at least 14 (34%) of the driveway rollover accidents.
Siblings were the drivers in four cases (10%), a grandmother in one
incident (2%), and neighbors in three (7%) incidents. The person driving
the vehicle was not specified in 19 incidents.
Silen ML, Kokoska ER, Fendya DG, Kurkchubasche
AG, Weber TR, Tracy TF. Rollover injuries in residential driveways:
age-related patterns of injury. Pediatrics 1999 Jul;104(1):e7.
This research addressed rollover injuries in
driveways and age-related patterns involved. From the medical records
of 3,971 consecutive admissions to a single urban trauma service between
March 1990 and October 1994, the authors found 26 children (0.7%) who
sustained rollover injuries caused by a motor vehicle in a residential
driveway. Eighteen (69%) of these injures occurred as the result of
the child being struck by an adult driver in a vehicle backing up. The
other 8 incidents involved either a sibling under the age of 16 rolling
over the child (n=4) or the child putting the vehicle in gear then attempting
to get out of the vehicle (n=4). Two of the children died as a result
of their injuries and were excluded from the remainder of the study.
Nineteen of the 24 survivors in this study were less than 5 years old.
The study also determined that younger children were more likely to
sustain more severe injuries as a result of these incidents, particularly
those less than two years old.
Nadler EP, Courcoulas AP, Gardner MJ, Ford HR.
Driveway injuries in children: risk factors, morbidity, and mortality.
Pediatrics 2001 Aug: 108(2):326-8.
A study published in 2001 by Nadler et. al.
focused on a cohort of 64 patients admitted to the Children’s
Hospital of Pittsburgh after having sustained motor vehicle-related
injuries in a driveway. This cohort was derived from a total of 9,820
patients admitted to the hospital’s trauma program between May
1986 and August 1999. The cohort was divided into two groups based on
the types of events in which they were involved. Group 1 involved an
adult driver striking a child because he or she was unaware of the child’s
presence. Group 2 consisted of children who were injured by a vehicle
set in motion by a child. More than 85 percent of the incidents included
in Group 1 involved a vehicle going in reverse.
The findings of this study are consistent with
those previously discussed with respect to the age of the children most
affected by backing incidents in driveways (less than 5 years old) and
the types of vehicles involved (more often an SUV or truck). Data supporting
this presented in the study appear below.
Table XXX: (from Nadler
et. al.) Age Distribution of Children Injured in Driveway Related Accidents
and
Types of Vehicles Involved
| |
Total
(n=64) |
Group 1 (n=44) |
Group 2 (n=20) |
| Age in yrs (mean) |
|
|
|
| <2 |
|
19
(43%) |
3
(15%) |
| 2-5 |
|
22
(50%) |
9
(45%) |
| >5 |
|
3
(7%) |
8
(40%) |
| Type of vehicle |
|
|
|
| SUV or truck |
31 |
28 |
3 |
| Car |
26 |
16 |
10 |
| Not available |
7 |
0 |
7 |
Di Scala C, Sege R, Guohua L. Outcomes of
Pediatric Pedestrian Injuries By Locations of Event. 45th Annual
Proceedings, Association for the Advancement of Automotive Medicine,
Sept. 24-26, 2001.
This study by DiScala, et. al. focused on medical
outcomes of pediatric pedestrian victims of motor vehicle accidents
based on the location where the accident occurs. Data presented in this
article relate entirely to the location of the incident. No data specific
to backing incidents were presented. However, based on the review of
the data involved, the following statement was made in the article with
respect to incidents that occur in driveways, “Typically, a very
young child is playing in the driveway, and is run over by a family
member or a visiting friend reversing a vehicle out of a home driveway.”
Nonoccupant Fatalities Associated With Backing
Crashes. Research Note, Revised February 1997, National Highway
Traffic Safety Administration.
The principal investigator involved in preparing
this note retired from the agency several years ago. It was therefore
not possible for the researchers involved in this report to clarify
the methodology used in generating the data that are presented in this
research note. The research note is based on 1992 and 1993 death certificate
data from the National Center for Health Statistics (NCHS) and on traffic
fatality data from police reports contained in NHTSA’s Fatality
Analysis Reporting System (FARS). The research note reports that data
from these two sources “were used to obtain average annual estimates
of the number of fatalities associated with off-road and on-road fatal
backing crashes.” The note makes clear, “Due to the lack
of detailed information on death certificates (the source of NCHS data),
it is not possible to determine the exact number of nonoccupants killed
in off-road backing crashes. The NCHS data, therefore, provide an estimate
of the maximum number of fatalities associated with these crashes.”
Data presented in this research note confirm
one of the patterns associated with backing fatalities that was identified
in the research on which this report is based. The research note found
that children ages 1-4 are particularly affected by backing crashes.
The numbers presented in the note, however, are higher than were found
either in counts made as part of the research done for this report or
in projections of annual national totals based on those counts.
The disparity between the numbers presented
in this report and those in this research note is likely rooted in the
fact that different approaches were taken in the two research efforts.
Those who did the work for the research note seemed to be addressing
the question, “What is the maximum possible number of backing
deaths that could be occurring annually based on NCHS death certificate
and FARS data?” This may have caused those working on the research
note to make certain assumptions concerning the data that were used
to determine the maximum possible number of backing fatalities. On the
other hand, the goal of those who did the work on which this report
is based was to simply count the number of backing (and other) incidents
that occur in a given time period and that can be verified through various
sources. There may be additional backing incidents that occurred in
1998, for example, the year that was the focus of death certificate
research for this report, but only the incidents reflected in the counts
presented in this report could be identified or verified.
In addition to the different research approaches,
some of the disparity may result from the fact that the data used for
the research note were from 1992 and 1993 while the years covered in
this report are 1998 and later.
Data presented in the research note appear below.
Table XXXI: (from NHTSA
Research Note) Annual Estimates of Nonoccupant Fatalities in Off-Road
Backing Crashes – 1992-1993 Average
|
Age Group |
# of Fatalities |
% of Total |
% of Population |
| 1-4 |
116 |
30 |
6 |
| All
Other Ages |
274 |
70 |
94 |
| Total |
390 |
100 |
100 |
Table XXXII: (from NHTSA
Research Note) Annual Number of Nonoccupant Fatalities in On-Road Backing
Crashes – 1992-1993 Average
|
Age Group |
Number of Fatalities |
% of Total |
| 1-4 |
14 |
16 |
| All
Other Ages |
71 |
84 |
| Total |
85 |
100 |