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Abstract
Objective
To describe fatal pediatric pedestrian injury patterns and correlate them with motor vehicle collision (MVC) characteristics and pedestrian kinematics using data from medicolegal death investigations of MVCs occurring in the current Canadian MV fleet and determine the applicability of the classical “Waddell’s triad” comprising knee, hip (femur) or pelvis and craniocerebral injuries to present data injury patterns.
Methods
An Injury Data Collection Form was used to extract MV, MVC, pedestrian demographic and injury information from the Office of the Chief Coroner for Ontario database using autopsy data from 2013 to 2018. Injuries were coded using the Abbreviated Injury Scale (AIS) 2015 revision. The study focused on AIS ≥3 injuries utilizing the Maximum Abbreviated Injury Scale (MAIS), MAIS by Body Region (MAISBR) and Injury Severity Score (ISS).
Results
Between 2013 and 2018, there were 25 pediatric deaths. The pedestrians were either struck and run over (n = 17, 68%; 56% low speed) or struck and projected (n = 8, 32%). Twenty-two deaths were from frontal impacts; three were from reversing vehicles. Fourteen of the 17 (82.4%) run over cases occurred at low speed (<30 km/h). In 9 (36%) cases, the vehicle was turning at impact (right n = 3, left n = 6). A majority of the vehicles had a high hood edge. The head was the most severely injured (median MAISBR = 5 overall and ≤10 years; median MAISBR = 6 for 11–14 years old) followed by the neck (MAISBR = 3 overall; 6–14 years old), and the thorax (median MAISBR = 3 overall; all age groups). For the early adolescents (11-14 years old), the serious injury pattern included the abdomen (median MAISBR = 3.5). Nearly half (n = 11, 44%) sustained brainstem injuries. Over fifty percent of the 16 cases with neck injuries (n = 9, 56.3%) had atlanto-occipital or axial dislocation.
Conclusion
More than half of the deaths occurred during low speed run overs. MAIS ≥3 injuries trended to a dyad of head and thorax in ≤5 years old, a triad of head, neck, and thorax injuries in children 6–10 years old and a tetrad with the addition of abdominal injuries in pedestrians ≥11 years old. Waddell’s triad was not applicable to the fatal cases in the present study.
Acknowledgements
This project was a collaboration between the Motor Vehicle Safety (MOVES) Research Team (Department of Pathology & Laboratory Medicine, Western University) funded by Transport Canada, the Motor Vehicle Safety Directorate (Transport Canada, Ottawa), the Office of the Chief Coroner for Ontario (OCCO) and the Provincial Forensic Pathology Unit (PFPU) in Toronto. We are thankful to Andrew Stephen (Information Management Lead) at the PFPU (Toronto) for providing the MVPCs list, access to case files and space for data collection.
Funding and disclosure statements
The authors have no known competing financial interests or personal relationships that influenced the work reported in this paper to disclose.