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April 2004, Vol 94, No. 4 | American Journal of Public Health 554-556
© 2004 American Public Health Association

RESEARCH AND PRACTICE

The Epidemic of Pediatric Traffic Injuries in South Florida: A Review of the Problem and Initial Results of a Prospective Surveillance Strategy

S. Morad Hameed, MD, MPH, Charles A. Popkin, BA, Stephen M. Cohn, MD, E. William Johnson, MPH and the Miami Pediatric Traffic Injury Task Force

S. Morad Hameed, Charles A. Popkin, Stephen M. Cohn, and E. William Johnson are with the Divisions of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery, University of Miami School of Medicine Miami, Florida.

Correspondence: Requests for reprints should be sent to Stephen M. Cohn, MD, Medical Director, Ryder Trauma Center, Daughtry Family Department of Surgery, University of Miami School of Medicine, 1800 NW 10th Ave, Suite 227, Miami, FL 33136 (e-mail: stephen.cohn{at}miami.edu).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 

This study identified specific regional risk factors for the high rate of pediatric pedestrian trauma in Florida. Of the 29 cases studied prospectively, 3 (10%) occurred near ice cream trucks and 13 (45%) involved "dart-outs"; mean hospital charges were $24 478 ±$43 939. Recommendations included an engineering change for a dangerous intersection, and a population-based recommendation was to equip ice cream trucks with extending stop signs.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
Approximately 30 000 children are struck by cars each year in the United States.1 Florida is home to 4 of the 5 most dangerous cities for pedestrians in this country, and the mortality rate after pedestrian trauma (3.9 per 100 000) is higher than the national average (2.3 per 100 000).2 Pediatric pedestrian injuries are frequently encountered at our trauma referral center in Miami, Florida.

Efforts to reduce the rates of pedestrian injury previously centered primarily on education programs and met with little success.3 This may be partly due to an absence of data from prospective studies. Broad demographic trends and socioeconomic and geographic risk factors identified in the literature are often either region-specific or too generalized to be useful in the creation of practical, site-specific prevention strategies.

The purpose of this study was to outline the distribution, determinants, and effects of pediatric pedestrian trauma (PPT) in our community. We hypothesized that careful data collection would uncover community-specific PPT risk factors and suggest avenues for prevention and resource allocation.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
This study, set at the Jackson Memorial Hospital/University of Miami Ryder Trauma Center (the sole trauma center for approximately 3 million Miami-Dade County residents), was performed in 2 phases.

Phase 1—Retrospective Review
Medical records of pediatric pedestrians (younger than age 16 years) who presented to our institution between January 1994 and December 1996 were reviewed. Demographic parameters were defined and analyzed to assess the impact of PPT in our communities.

Phase 2—Prospective Data Collection
Recommendations from a multidisciplinary task force (including local medical, police, and government agencies) were incorporated into a design of a 4-month prospective cohort study. Detailed information from hospital records, crash scene visits, patients, families, and police interviews was compiled on consecutive cases of PPT treated at our center (July 1 through October 31, 2000). Injury scene conditions were systematically assessed and especially emphasized in the analysis.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Retrospective Review
A total of 235 PPT cases were evaluated. Grade school children were most often (53%) injured, usually in the vicinity of schools. Boys predominated, and African American children accounted for 60% of the cases. High mean hospital charges ($16 553) resulted from the high incidence rates (32%) of head injuries.

Prospective Data Collection
Population, scene, environmental, and cost issues were explored in 29 consecutive cases of PPT. Many children (69%) were from single-parent homes. Although Miami is ethnically diverse, a disproportionate number of PPT events occurred in predominantly African American neighborhoods. Thirty-five percent of children came from homes where at least 1 parent had some postsecondary education.

At most sites, intervals between marked intersections were long, allowing vehicle acceleration and predisposing random pedestrian crossing patterns. Some intersections (Figure 1Go) were observed to be poorly regulated by misplaced traffic lights and were a source of long-standing community apprehension. Mechanisms involving obstruction of view ("dart-outs")4 were common (46%), although most PPT incidents (64%) occurred in clear daylight conditions. Site visits provided insight into situational dynamics. For example, 3 events (10%) resulted from traffic disruption by ice cream trucks.



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  		FIGURE 1—— Problematic intersection at 2nd Ave and NW 67th St, Miami, Fla. During this site visit, numerous bystanders approached the investigators to find out when the city was planning to modify the control of this dangerous intersection. The visit was prompted by the injuries of a 5-year-old African American boy who had been holding his mother’s hand at the bus stop on the corner. The driver of car A, after waiting behind a bus ahead of the traffic lights, swerved onto the shoulder area at a high rate of speed and entered the intersection unaware that the light had changed. The ensuing events are depicted. After the collision with car B, the driver of car A lost control, striking the boy, his sister, and their mother. The car then struck a fence at the corner and proceeded toward the wall of a nearby house with the child still trapped underneath.

 
Hospital charges ranged from $336 to $172 283, and at the time of the site visit (25 ±13 days post-PPT), 44% of children had not returned to school.


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
Previous studies (Table 1Go) have characterized region-specific risk factors for PPT, which may not be completely generalizable to Miami, with its unique cultural and geographic milieu. As indicated by our review, South Florida is fertile ground for a comprehensive PPT prevention strategy. Groups such as the North Miami Crash Traffic Safety Team and the Safe Kids prevention programs have taken an active role in pedestrian education, but to date, prevention initiatives have not been designed with specific references to objectively measured risk factors.


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  		TABLE 1—— A Summary of the Pediatric Pedestrian Traffic Injury Literature
 
Available information sources, including police reports and hospital records, lacked sufficient detail to clarify the causes of PPT. The second phase of this study was designed to provide useful information for development of directed multidisciplinary prevention policy.

All 29 cases studied during our surveillance period had implications for the design of high-risk or population-based prevention strategies. Miami’s uninhibited westward growth has resulted in the creation of communities with high volumes of rapid commuter traffic and long residential streets without sidewalks. Situations such as that summarized in Figure 1Go will require innovative engineering approaches to eliminate high-risk scenarios. Other high-risk situations, such as those involving ice cream trucks, will require legislation mandating the use of safety measures such as extending stop signs on these vehicles to help reduce the impact of the frequently observed dart-outs. Conscientious regulation of school bus access and pickup and drop-off practices would reduce the incidence of injuries observed during school hours.

Although this study was performed without external funding, a grant from the Florida Department of Transportation will allow us to address some of the limitations of this initial surveillance. Information will be collected over a school year along with an economic evaluation, and more objective scene measurements will be made. We hope to delineate a cost-effective surveillance-based prevention plan that reduces the incidence of children struck by motor vehicles.


   Acknowledgments
 
The members of the Miami Pediatric Traffic Injury Task Force are Frank Pernas, BA, David Henderson, AICP, Mimi Sutherland, RN, MS, Margaret Brown, MSN, J. Esteban Varela, MD, Dimeter Hristov, MD, Kimberly Schwartz, MD, Officer Luis Taborda, BA, Julie Jackowski, RN, Tracy Byrd, BA, Gilian Hotz, PhD, Lewis Saye, BA, and Jose Guerrier, MD.

Human Participant Protection
Institutional review board approval was obtained from the University of Miami before this study was initiated.


   Footnotes
 
Contributors
S. M. Hameed contributed to the study design, data collection, data analysis, and manuscript preparation. C. A. Popkin contributed to the data collection and manuscript preparation. S. M. Cohn contributed to the study design, data analysis, and manuscript preparation. W. M. Johnson contributed to the study design and data collection.

Peer Reviewed

Accepted for publication June 30, 2002.


   References
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Accident Facts—1996 Edition. Ithasca, Ill: National Safety Council; 1996.

2. McCann B, DeLille B. Mean Streets 2000 report. Surface Transportation Policy Project June 2000. Available at: http://www.transact.orgFCC/Reports/ms2000/natpress.htm2000. Accessed May 15, 2002.

3. Roberts I, Norton R, Jackson R, Dunn R, Hassall I. Effect of environmental factors on risk of injury of child pedestrians by motor vehicles: a case-control study. BMJ. 1995;310:91–94.[Abstract/Free Full Text]

4. Brison RJ, Wicklund K, Mueller BA. Fatal pedestrian injuries to young children: a different pattern of injury. Am J Public Health. 1988;78:793–795.[Abstract/Free Full Text]

5. Rivara FP, Barber M. Demographic analysis of childhood pedestrian injuries. Pediatrics. 1985;76:375–381.[Abstract/Free Full Text]

6. Mueller BA, Rivara FP, Lii SM, Weiss NS. Environmental factors and the risk for childhood pedestrian-motor vehicle collision occurrence. Am J Epidemiol. 1990; 132:550–560.[Abstract/Free Full Text]

7. Braddock M, Lapidus G, Gregorio D, Kapp M, Banco L. Population, income, and ecological correlates of child pedestrian injury. Pediatrics. 1991;88:1242–1247.[Abstract/Free Full Text]

8. Agran PF, Winn DG, Anderson CL, Tran C, Del Valle CP. The role of the physical and traffic environment in child pedestrian injuries. Pediatrics. 1996;98:1096–1103.[Abstract/Free Full Text]

9. Calhoun AD, McGwin G Jr, King WD, Rousculp MD. Pediatric pedestrian injuries: a community assessment using a hospital surveillance system. Acad Emerg Med. 1998;5:685–690.[Web of Science][Medline]

10. Durkin MS, Laraque D, Lubman I, Barlow B. Epidemiology and prevention of traffic injuries to urban children and adolescents. Pediatrics. 1999;103(6):e74.[Abstract/Free Full Text]





This Article
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