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This report is an archived publication and may contain dated technical, contact, and link information
Publication Number: FHWA-RD-99-078
Date: 1999

Injuries to Pedestrians and Bicyclists: An Analysis Based on Hospital Emergency Department Data

 

Contact: Carol Tan Esse at Carol.Tan Esse@fhwa.dot.gov

ABSTRACT

Traditionally, the U.S. DOT has relied on State motor vehicle crash data as their primary source of information on events causing injury to pedestrians and bicyclists. These data have often been referred to as "the tip of the iceberg," however, because they are limited almost entirely to motor vehicle-related events that occur on public roadways. Specifically, they exclude: (1) many bicycle-motor vehicle and pedestrian-motor vehicle crashes that occur in non-roadway locations such as parking lots, driveways, and sidewalks, and (2) bicyclist and pedestrian falls or other non-collision events that do not involve a motor vehicle, regardless of whether they occur on a roadway or in a non-roadway location.

This report presents a descriptive analysis of data collected prospectively at eight hospital emergency departments over approximately a 1-year time period in three States: California, New York, and North Carolina. Information was gathered on 2,509 persons treated for injuries incurred while bicycling or walking. Results show that 70 percent of the reported bicycle injury events and 64 percent of the reported pedestrian injury events did not involve a motor vehicle. In addition, 31 percent of the bicyclists and 53 percent of the pedestrians were injured in non-roadway locations such as sidewalks, parking lots, or off-road trails. Alcohol was a factor in one-fourth of the pedestrian-motor vehicle injury events and 15 percent of the bicycle-motor vehicle injury events for those age 20 and older. The emergency department data were also examined in conjunction with statewide hospital discharge and motor vehicle crash data in an attempt to better define the overall scope and magnitude of the pedestrian and bicyclist injury problem.

 

TECHNICAL REPORT DOCUMENTATION

1. Report No.

FHWA-RD-99-078

2. Government Accession No. 3. Recipient's Catalog No.
4. Title and Subtitle

INJURIES TO PEDESTRIANS AND BICYCLISTS:
AN ANALYSIS BASED ON HOSPITAL EMERGENCY
DEPARTMENT DATA

5. Report Date
6. Performing Organization Code
7. Author(s)

Jane C. Stutts and William W. Hunter

8. Performing Organization Report No.
9. Performing Organization Name and Address

University of North Carolina
Highway Safety Research Center
730 Airport Road, CB #3430
Chapel Hill, NC 27599-3430

10. Work Unit No. (TRAIS)
11. Contract or Grant No.

DTFH61-92-C-00138

12. Sponsoring Agency Name and Address

Office of Safety Research, Development, and Technology
Federal Highway Administration
6300 Georgetown Pike
McLean, VA 22101-2296

13. Type of Report and Period Covered

Final Report
November 1993 - June 1997

14. Sponsoring Agency Code
15. Supplementary Notes

Contracting Officer's Technical Representative (COTR): Carol Tan Esse, HRDS

16. Abstract

Traditionally, the U.S. DOT has relied on State motor vehicle crash data as their primary source of information on events causing injury to pedestrians and bicyclists. These data have often been referred to as "the tip of the iceberg," however, because they are limited almost entirely to motor vehicle-related events that occur on public roadways. Specifically, they exclude: (1) many bicycle-motor vehicle and pedestrian-motor vehicle crashes that occur in non-roadway locations such as parking lots, driveways, and sidewalks, and (2) bicyclist and pedestrian falls or other non-collision events that do not involve a motor vehicle, regardless of whether they occur on a roadway or in a non-roadway location. This report presents a descriptive analysis of data collected prospectively at eight hospital emergency departments over approximately a 1-year time period in three States: California, New York, and North Carolina. Information was gathered on 2,509 persons treated for injuries incurred while bicycling or walking. Results show that 70 percent of the reported bicycle injury events and 64 percent of the reported pedestrian injury events did not involve a motor vehicle. In addition, 31 percent of the bicyclists and 53 percent of the pedestrians were injured in non-roadway locations such as sidewalks, parking lots, or off-road trails. Alcohol was a factor in one-fourth of the pedestrian-motor vehicle injury events and 15 percent of the bicycle-motor vehicle injury events for those age 20 and older. The emergency department data were also examined in conjunction with statewide hospital discharge and motor vehicle crash data in an attempt to better define the overall scope and magnitude of the pedestrian and bicyclist injury problem.

17. Key Words

Bicycle injury, pedestrian injury, bicycle fall, pedestrian fall, non-roadway, non-motor vehicle, alcohol.

18. Distribution Statement

No restrictions. This document is available to the public through the National Technical Information Service, Springfield, Virginia 22161.

19. Security Classif. (of this report)

Unclassified

20. Security Classif. (of this page)

Unclassified

21. No. of Pages

133

22. Price
From DOT F 1700.7 (8-72) Reproduction of form and completed page is authorized

 


SI* (Modern Metric) Conversion Factors


 

TABLE OF CONTENTS

CHAPTER 1 - INTRODUCTION

  • Background
  • Literature Review
  • Foreign Research Studies
  • U.S. Research Studies
  • Summary

CHAPTER 2 - METHODS

  • Overview
  • Data Collection Procedures
    • Emergency Department Data Collection
  • Hospital Discharge Data
  • State Motor Vehicle Crash Data
  • Description of the Data
  • Hospital Emergency Department Data
  • Hospital Discharge Data
  • State Motor Vehicle Crash Data

CHAPTER 3 - BICYCLIST INJURY EVENTS

  • Bicyclist Characteristics
  • Detailed Location and Event Characteristics
  • Injury Characteristics
  • Summary of Results

CHAPTER 4 - PEDESTRIAN INJURY EVENTS

  • Pedestrian Characteristics
  • Event Characteristics
  • Injury Characteristics
  • Summary of Results

CHAPTER 5 - ALCOHOL USE BY INJURED PEDESTRIANS AND BICYCLISTS

  • Results for Injured Pedestrians
  • Pedestrian-Motor Vehicle Events
  • Pedestrian-Only Events
  • Pedestrian-Bicycle Events
  • Results for Injured Bicyclists
  • Pedestrian-Motor Vehicle Events
  • Bicycle-Only Events
  • Bicycle-Bicycle Events
  • Summary of Results

CHAPTER 6 - INJURY ESTIMATES FROM THE COMBINED DATA

  • Estimates Based on Hospitalization Data
  • Estimates Based on Matched Emergency Department and Crash Data
  • Discussion

CHAPTER 7 - CONCLUSIONS AND RECOMMENDATIONS

  • Project Overview
  • Key Study Findings and Recommendations

APPENDIX A - Data Abstraction Form

APPENDIX B - Data Collection Guidelines for Pedestrian and Bicyclist Injury Study

APPENDIX C - Hospital Emergency Department Data Descriptive Tables

APPENDIX D - Hospital Discharge Data Descriptive Tables

APPENDIX E - State Motor Vehicle Crash File Data Descriptive Tables

REFERENCES

 


LIST OF TABLES

Table 1. E-code groupings for identification of pedestrian and bicyclist injury cases
Table 2. Comparison of reported pedestrian and bicyclist injury cases with total emergency department visits at the eight participating hospitals
Table 3. Distribution of pedestrian and bicyclist injury case types by reporting site
Table 4. Distribution of emergency department-reported pedestrian and bicyclist injury cases by location of injury event
Table 5. Distribution of pedestrian and bicyclist injury cases reported in hospital discharge datafiles
Table 6. Summary of State pedestrian- and bicyclist-motor vehicle crash data
Table 7. Distribution of bicyclist injury cases treated in hospital emergency departments by location and type of event
Table 8. Age distribution of bicyclists by type of injury event
Table 9. Gender distribution of bicyclists by type of injury event
Table 10. Race distribution of bicyclists by type of injury event
Table 11. Detailed location of bicycle collisions and falls occurring in non-roadway locations
Table 12. Detailed location distribution of non-roadway bicycle-only crashes, by age categories
Table 13. Time-of-day distribution by type of injury event 30
Table 14. Emergency department disposition of bicyclists by type of injury event
Table 15. Percentage of bicyclists with one or more injuries in specified locations
Table 16. Percentage of bicyclists with one or more injuries of specified types
Table 17. Most frequent injuries for each type of bicycle event, categorized by injury location and type
Table 18. Distribution of pedestrian injury cases treated in hospital emergency departments by location and type of event
Table 19. Age distribution of pedestrians by type of injury event
Table 20. Gender distribution of pedestrians by type of injury event
Table 21. Race distribution of pedestrians by type of injury event
Table 22. Pedestrian use of special equipment by event type
Table 23. Detailed location of pedestrian collisions and falls occurring in non-roadway locations
Table 24. Detailed location distribution of non-roadway pedestrian-motor vehicle crashes, by age categories
Table 25. Detailed location distribution of non-roadway pedestrian-only crashes, by age categories
Table 26. Time-of-day distribution by type of pedestrian injury event
Table 27. Emergency department disposition of pedestrians by type of injury event
Table 28. Percentage of pedestrians with one or more injuries in specified locations
Table 29. Percentage of pedestrians with one or more injuries of specified types
Table 30. Most frequent injuries for each type of pedestrian event, categorized by injury location and type
Table 31. Distribution of pedestrian and bicyclist injury event types by alcohol use
Table 32. Location where injury event occurred by alcohol use for pedestrian- motor vehicle events
Table 33. Age by alcohol use for pedestrian-motor vehicle events
Table 34. Gender by alcohol use for pedestrian-motor vehicle events
Table 35. Race by alcohol use for pedestrian-motor vehicle events
Table 36. Time of day by alcohol use for pedestrian-motor vehicle events
Table 37. Emergency department disposition by alcohol use for pedestrian-motor vehicle events
Table 38. Location where injury event occurred by alcohol use for pedestrian-only events
Table 39. Age by alcohol use for pedestrian-only events
Table 40. Gender by alcohol use for pedestrian-only events
Table 41. Race by alcohol use for pedestrian-only events
Table 42. Time of day by alcohol use for pedestrian-only events
Table 43. Emergency department disposition by alcohol use for pedestrian-only events
Table 44. Location where injury event occurred by alcohol use for bicycle-motor vehicle events
Table 45. Age by alcohol use for bicycle-motor vehicle events
Table 46. Gender by alcohol use for bicycle-motor vehicle events
Table 47. Race by alcohol use for bicycle-motor vehicle events
Table 48. Time of day by alcohol use for bicycle-motor vehicle events
Table 49. Emergency department disposition by alcohol use for bicycle-motor vehicle events
Table 50. Location where injury event occurred by alcohol use for bicycle-only events
Table 51. Age by alcohol use for bicycle-only events
Table 52. Gender by alcohol use for bicycle-only events
Table 53. Race by alcohol use for bicycle-only events
Table 54. Time of day by alcohol use for bicycle-only events
Table 55. Emergency department disposition by alcohol use for bicycle-only events
Table 56. Percentage of emergency department cases requiring hospitalization, by type of injury
Table 57. Number of injured bicyclists and pedestrians hospitalized, based on available statewide hospital discharge data
Table 58. Estimated number of bicyclists and pedestrians receiving hospital emergency department treatment, based on data in
Tables 56 and 57
Table 59. Percentage of cases reported by participating hospital emergency departments identified in State crash files
Table 60. Number of police-reported pedestrians and bicyclists injured, based on 1995 State motor vehicle crash file data
Table 61. Estimated number of bicyclists and pedestrians receiving hospital emergency department treatment, based on data in Tables 59 and 60
Table 62. Percentage of emergency department bicycle and pedestrian cases that involved a collision with a motor vehicle
Table 63. Overall estimates of bicycle and pedestrian emergency department cases
Table 64. Distribution of bicyclist injury cases by place of occurrence and motor vehicle involvement status
Table 65. Distribution of pedestrian injury cases by place of occurrence and motor vehicle involvement status
Table 66. Distribution of emergency department-reported pedestrian and bicyclist injury cases by age of victim
Table 67. Distribution of emergency department-reported pedestrian and bicyclist injury cases by gender of victim
Table 68. Distribution of emergency department-reported pedestrian and bicyclist injury cases by race of victim
Table 69. Distribution of emergency department-reported pedestrian and bicyclist injury cases by time of day injury occurred
Table 70. Distribution of emergency department-reported pedestrian and bicyclist injury cases by case disposition
Table 71. Pedestrian age distribution in hospital datafiles
Table 72. Pedestrian gender distribution in hospital datafiles
Table 73. Pedestrian race distribution in hospital datafiles
Table 74. Pedestrian length-of-stay (days) distribution in hospital datafiles
Table 75. Pedestrian disposition from hospital distribution in hospital datafiles
Table 76. Bicycle age distribution in hospital discharge datafiles
Table 77. Bicyclist gender distribution in hospital discharge datafiles
Table 78. Bicyclist race distribution in hospital discharge datafiles
Table 79. Bicyclist length-of-stay (days) distribution in hospital discharge datafiles
Table 80. Bicyclist disposition from hospital distribution in hospital discharge datafiles
Table 81. Bicyclist and pedestrian age distributions in 1995 State motor vehicle crash files
Table 82. Bicyclist and pedestrian gender distributions in 1995 State motor vehicle crash files
Table 83. Time-of-day distribution for bicyclist and pedestrian crashes in 1995 State motor vehicle crash files
Table 84. Bicyclist and pedestrian injury severity distributions for crashes in 1995 State motor vehicle crash files
Table 85. Bicyclist- and pedestrian-reported alcohol use in 1995 State motor vehicle crash files

 


LIST OF FIGURES

Figure 1. Types of events causing injury to pedestrians and bicyclists 2

Figure 2. Case identification definitions for emergency department data collection 11

Figure 3. Percentage of bicyclists injured in non-roadway locations or in events not involving a motor vehicle, by age of bicyclist 23

Figure 4. Percentage of bicyclists injured in non-roadway locations or in events not involving a motor vehicle, by gender of bicyclist 24

Figure 5. Percentage of bicyclists injured in non-roadway locations or in events not involving a motor vehicle, by race of bicyclist 26

Figure 6. Percentage of bicyclists wearing a helmet by type of bicyclist injury event 26

Figure 7. Percentage of bicyclists reported using alcohol by type of bicyclist injury event 27

Figure 8. Percentage of non-roadway or non-motor vehicle cases among injured bicyclists who were treated and released and among those hospitalized 31

Figure 9. Percentage of pedestrians injured in non-roadway locations in events not involving a motor vehicle, by age of pedestrian 42

Figure 10. Percentage of pedestrians injured in non-roadway locations or in events not involving a motor vehicle, by gender of pedestrian 43

Figure 11. Percentage of pedestrians injured in non-roadway locations or in events not involving a motor vehicle, by race of pedestrian 44

Figure 12. Percentage of pedestrians reported using alcohol by type of pedestrian injury event 45

FHWA-RD-99-078

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