Beruflich Dokumente
Kultur Dokumente
DOI 10.1007/s00268-012-1797-4
Abstract
Background The type of injuries caused by sport utility
vehicles may be different from those caused by small
passenger cars. We studied prospectively the effects of the
offending vehicle type and design on severity and pattern
of pedestrian injuries.
Methods All injured pedestrians admitted to the two
major trauma centers of Al-Ain city were studied prospectively during the period of April 2006 to October 2007.
Patients were classified into two groups according to the
offending vehicle type: small vehicle and sport utility
vehicle. These two groups were compared regarding the
distribution of injury and its severity.
Results The anatomical distribution of injury in a
descending order were the lower extremities (56.3, 67 %),
head (53.8, 57.1 %), face (37.5, 57.1 %), and upper
extremities (32.5, 28.6 %) in small vehicle and sport utility
vehicle groups, respectively. No significant statistical difference has been found between the two groups regarding
the anatomical distribution and severity.
Conclusions The vehicle size and design did not affect
the anatomical injury distribution and severity in our setting. High-impact speed may overcome the vehicle type
when it comes to injury severity and pattern of distribution.
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Introduction
The United Arab Emirates (UAE) is a rapidly developing
country. Within 40 years, it became a country with
metropolitan cities and well-developed infrastructure. Tolls
came along with these developments; injuries due to road
traffic collisions (RTC) in the UAE are reported to be
among the highest in the world [1]. RTC is the second
leading cause of death in the country [2]. The Statistics
Center of Abu Dhabi Emirate reported more than 5,000
RTC causalities that occurred in 2009 having a mortality of
7.9 %. Twenty percent of these were pedestrian injuries
[3].
Al-Ain city is the largest city in the eastern region of the
Emirate of Abu Dhabi and had a population of 568,221 in
2010; with a male to female ratio of 2:1 and a non-national
to national ratio of 2.2:1. It extends over a large area of
30 9 20 km with an internal length of roads of 1,227 km
[3]. A recent study looking at the driving behavior of road
users in UAE indicated that 5 % of the drivers never
yielded for pedestrians and *11 % occasionally yielded
for them [4]. This puts pedestrians at a high risk of injury
when crossing these lengthy roads. A study from Al-Ain
City showed that 13 % of RTC-injured patients who were
treated at hospitals were pedestrians [5]. Furthermore,
pedestrian injuries accounted for 28.5 % of road traffic
mortality in UAE [6].
Different aspects of pedestrian road traffic injury have
been studied; an important aspect is the biomechanics of
pedestrian injury. During collision, energy is transferred
between objects. Energy is calculated as mass times
velocity squared (E = mv2). It is worth noting that the
velocity is exponential; thus, every kilometer per hour
increase in velocity actually highly increases the energy
that the vehicle possesses and, therefore, the higher the
137
energy it transfers to a pedestrian at impact [7]. Accordingly, the injury severity and mortality of pedestrians
increase exponentially with increased impact speed of the
offending vehicle [8, 9]. The number of sports utility
vehicles (SUVs) with a high pumper has been increasing.
The type of injuries caused by SUVs may be different from
those caused by small passenger cars [5, 8, 10].
Roudsari et al. [9] have found that severity of injury and
death is affected by the type and design of the offending
vehicle. Light truck vehicles were associated with triple
higher risk of severe injuries and double the mortality
compared with passenger vehicles [9]. Similarly, Ballesteros et al. [8] have shown that pedestrians hit by SUVs
have an odds ratio of death of 1.7 times compared with
pedestrians hit by small passenger cars. In this study, we
prospectively studied the effects of the offending vehicle
type and design on severity and pattern of pedestrian
injuries.
Results
Small
vehicle
(N = 80)
Sport utility
vehicle
(N = 21)
Age (yr)
28.5 (270)
P value
30 (450)
0.7
Gender (male)
60 (75 %)
20 (95.2 %)
0.04
Nationality
(Emirati/non-Emirati)
12 (17.6 %)/
68 (82.4 %)
3 (14.3 %)/
18 (85.7 %)
0.99
Operateda
31 (40 %)
8 (44 %)
0.79
ICU admission
15 (18.8 %)
2 (9.5 %)
0.51
5 (1127)
4 (1116)
0.35
1 (4.8 %)
0.99
Length of hospital
stay (days)
Mortality
GCS
3 (3.8 %)
15 (315)
15 (315)
0.7
TRS
12 (712)
12 (1112)
0.23
ISS
5.5 (145)
5 (134)
0.86
Data were missing for two patients in small vehicle group and three
patients for sport utility vehicle group
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138
Small vehicle
(N = 80)
Sport utility
vehicle (N = 21)
P value
Head
43 (53.8 %)
12 (57.1 %)
0.81
Face
32 (37.5 %)
6 (28.6 %)
0.45
Neck
2 (2.5 %)
Thorax
20 (25 %)
0.99
5 (23.8 %)
0.99
Abdomen
7 (8.6 %)
4 (19 %)
0.23
Spine
5 (6.3 %)
2 (9.5 %)
0.63
26 (32.5 %)
45 (56.3 %)
6 (28.6 %)
14 (66.7 %)
0.8
0.46
Upper extremity
Lower extremity
Small vehicle
(N = 80)
Sport utility
vehicle (N = 21)
P value
Head
2 (15)
2 (14)
0.56
Face
1 (12)
1 (12)
0.21
Neck
Thorax
2 (22)
3 (15)
0
1 (15)
0.19
Abdomen
1 (14)
1 (11)
0.26
Spine
2 (22)
2 (22)
0.99
Upper extremity
2 (13)
1 (12)
0.29
Lower extremity
2 (14)
2 (13)
0.7
Discussion
Our study has shown that there was no significant difference in anatomical distribution of pedestrian injuries and
their injury severity between small vehicle and SUV
groups. This may be explained by different reasons. The
sample size of the study may have been small. This
explanation is unlikely, because the data do not show
trends of difference between the two groups. In fact, our
study sample included all admitted pedestrians in our city
of a half million population during a period of 18 months.
Patients who died at the scene were not included in the
study. The traffic police records of Al-Ain City indicate
that the average annual RTC pedestrian deaths during the
years 20062008 was 21 deaths (personal communication,
Al-Shajrawi WS, Road Traffic Engineer, Al-Ain City
Traffic police, UAE). This indicates that, during the study
period, *85 % of pedestrian mortality in Al-Ain City
occurred in the prehospital setting and *15 % occurred in
the hospital. We do not know exactly which type of
vehicles caused these prehospital pedestrian deaths.
Assuming that the ratio of the SUV that hit pedestrians are
the same as other road traffic collisions indicates that SUVs
caused more mortality in the prehospital setting compared
with small cars. This suggestion is supported by others [8].
During 2009, 176,587 motor vehicles were licensed in
Al-Ain City; 90 % of these were categorized as light
vehicles, including small cars and SUVs. The exact percentage of SUVs licensed in Al-Ain City was not reported
[3]. During 2007 in UAE, 86 % of vehicles involved in
road traffic crashes were light vehicles [6]. Interestingly
88 % (95 % confidence interval (CI), 8690) of vehicles
involved in crashes in our Road Traffic Collision Registry
Table 4 Lower limb pedestrian injuries and their AIS in relation to the knee joint in offending vehicle groups
Region
Small vehicle
(N = 45)
P value
Small vehicle
AIS
P value
Above knee
n = 15 (33.3 %)
n = 5 (35.7 %)
0.76
3 (14)
2 (13)
0.22
Below knee
n = 26 (57.8 %)
n = 8 (57.1 %)
0.62
2 (13)
2 (13)
0.66
n = 4 (8.9 %)
n = 1 (7.1 %)
0.99
1 (11)
1 (N/A)
0.99
Knee
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139
Conclusions
The vehicle size and design did not affect the anatomical
distribution and severity of pedestrian injuries in our setting. Lower extremity was the most frequent injured region
followed by the head, face, and upper extremity. Impact
speed may be more important than the vehicle type when it
comes to pattern and severity of pedestrian injuries in our
setting. Our study highlights the importance of monitoring
the vehicle speed and enforcing the law to keep the speed
below the legal limit.
Acknowledgments The authors thank Road Traffic Engineer,
Wajih Al-Shajrawi, Head of Traffic Engineering and Statistics
Branch, Al-Ain police Department, Al-Ain, UAE, for supplying
the data on pedestrian prehospital mortality of Al-Ain city (years
20062008). This study was supported by an interdisciplinary UAE
University Grant No. 02-078-1/4.
Conflict of interest
References
1. Peden M, Scurfield R, Sleet D et al (2004) World report on road
traffic injury prevention 2004. World Health Organization,
Geneva
123
140
2. World Health Organization (2006) Country cooperation strategy
for WHO and the United Arab Emirates 20052009
3. Statistics Centre Abu Dhabi (2011) Statistical Yearbook of Abu
Dhabi 2011. www.scad.ae/Publications/YearBook/EBOOK_
English_SYB_2011.pdf. Accessed 10 June 2012
4. Hassan MN, Hawas YE, Maraqa MA (2012) A holistic approach
for assessing traffic safety in the United Arab Emirates. Accid
Anal Prev 45:554564
5. Bener A, Ghaffar A, Azab A, Sankaran-Kutty M, Toth F, Lovasz G
(2006) The impact of four-wheel drives on traffic disability and
deaths compared to passenger cars. J Coll Physicians Surg Pak
16:257260
6. World Health Organization (2009) Global status report on road
safety: time for action. Geneva. www.who.int/violence_injury_
prevention/road_safety_status/2009. Accessed 25 May 2010
7. Eid HO, Abu-Zidan FM (2007) Biomechanics of road traffic
collision injuries: a clinicians perspective. Singapore Med J
28:693700
8. Ballesteros MF, Dischinger PC, Langenberg P (2004) Pedestrian
injuries and vehicle type in Maryland, 19951999. Accid Anal
Prev 36:7381
9. Roudsari BS, Mock CN, Kaufman R et al (2004) Pedestrian
crashes: higher injury severity and mortality rate for light truck
vehicles compared with passenger vehicles. Inj Prev 10:154158
10. Matsui Y (2005) Effects of vehicle bumper height and impact
velocity on type of lower extremity injury in vehicle-pedestrian
accidents. Accid Anal Prev 37:633640
11. Abbreviated Injury Scale (AIS) produced by the Association of
the Advancement of Automotive Medicine (version 1998)
12. Maurer A, Morris JA Jr (2004) Injury severity scoring. In: Moore E,
Feliciano D, Mattox K (eds) Trauma, 5th edn. McGraw-Hill, New
York, pp 8791
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