Pediatric pedestrian versus motor vehicle patterns of injury: debunking the myth.

INTRODUCTION

Mechanism of injury has been widely used to enhance the ability of EMS providers to recognize predictable injury patterns. One such pattern, referred to as "Waddell's triad," identifies a triad of injuries associated with pedestrian/motor vehicle collision (MVC), including trauma to the head, abdomen, and lower extremities. We questioned this choice as a common injury pattern for this mechanism.

METHODS

A retrospective chart review of 4444 pediatric trauma patients admitted to a regional pediatric trauma center between 1992 and 1996. The source of this information was the medical center's trauma registry.

RESULTS

Four-hundred-sixty-five patients suffered a pedestrian/MVC and were included in the study; 231 suffered head injury, and 78 experienced a combination of head and leg injury. Only 11 patients (2.4%) suffered the predicted "triad" of head, leg, and abdominal injury as a result of pedestrian/MVCs. Two of these children suffered minor head injury, and only one patient (0.2%) suffered injury as originally described by Waddell.

CONCLUSION

Although the concept of Waddell's triad is logical, and a high index of suspicion should be maintained, the incidence of this predictable injury pattern is low. Educational emphasis should be placed on other aspects of mechanism of pedestrian injury.