O2017: Protecting the Most Vulnerable Road User: A Safe Systems Approach to Preventing Pediatric Pedestrian and Cyclist Severe Injuries and Deaths

Background: Motor vehicle collisions are a leading cause of preventable childhood death, severe injury and disability. Those traveling on roadways without the protection of a vehicle have experienced increasing death rates over the past decade, making pediatric pedestrians and cyclists particularly vulnerable. Mobility changes associated with the pandemic have the potential to increase pedestrian and cycling crash risk, intensifying the need for a safe and equitable transportation system that mitigates crash risk and protects all road users.

Methods: Fatal pedestrian and cyclist collision and injury data were collected from the Office of the Chief Coroner (2013-20), along with crash investigations including the collection of on-scene collision information, crash reconstruction from supporting police services, videos and media reports, where available (2013-21). Injury severity and patient kinematics were determined, and impact speeds estimated. Descriptive analysis was undertaken. Child (≤ 14 years) and adolescent (15-17 years) crashes were compared with Pearson chi square and t tests. Multivariate logistic regression modeling was performed with runover as the outcome variable, followed by an assessment of model fit and predictive accuracy. A review of collision avoidance safety features such as pedestrian detection systems with automatic emergency braking (AEB) to potentially prevent or reduce the injury severity in this series was undertaken.

Results: There were 48 pediatric fatalities, 38 (79%) pedestrians and 10 (21%) cyclists, comprised of 34 (71%) children and 14 (29%) adolescents. For cyclists, 22% wore a helmet (all ≤6 years) and 56% were crossing the street. Significant differences included impairment (0% vs. 31%; p=0.005), daylight collisions (87% vs. 8%, p< 0.001), low speed impacts (52% vs. 6%, p=0.004) with a median impact speed of 20 km/hr (IQR=41.25) and 60 km/hr (IQR=10), p=0.007, and runovers (70% vs. 21.4%, p=0.002) between children and adolescents, respectively. Logistic regression modeling found being ≤6 years of age (OR=48.96), struck by a light truck/van (LTV)/SUV/heavy truck (OR=29.68) and crossing with the right of way (OR=38.97) to be significantly associated with runover. Pedestrian detection systems with AEB may have been effective in 18 (38%) of the pediatric collisions involving 2 passenger cars, 15 LTVs and 1 transit bus.

Conclusion: Children will make mistakes when walking, playing and biking on the roadway. A safe systems approach is needed to prevent collisions or reduce the amount of energy transfer. Current generation pedestrian detection systems with front and rear AEB could have likely prevented or reduced the severity of 38% of these pediatric collisions. These systems have the potential to be very effective at reducing runover collisions that were found to involve young children, often occurring at low speed and in lighted areas. Higher rated vehicle headlight performance, reducing speeds, increased helmet use and decreased substance use were identified as prevention strategies to target adolescents.