Clinical outcomes of pediatric versus adult pedestrian motor vehicle traumas.

PURPOSE: Collisions between pedestrians and motor vehicles result in over 60,000 injuries annually in the United States. We hypothesized that pediatric patients would sustain more severe injuries than adults due to their shorter stature, which exposes their torsos to direct impact from vehicles. Therefore, we analyzed the outcomes of pediatric and adult patients involved in pedestrian motor vehicle trauma (PMVT).

METHODS

Utilizing data from the 2022 Trauma Quality Improvement Program (ACS-TQIP) database, we classified PMVT patients into pediatric (aged 1 to 17 years) and adult (aged 18 years and older) cohorts. Patients who experienced pre-hospital cardiac arrest were excluded from the analysis. Our primary and secondary outcomes focused on mortality and in-hospital complications. After conducting optimal propensity score matching (PSM), both cohorts contained 760 patients, with no significant differences in demographic and lifestyle factors.

RESULTS

The average injury severity score was 28.0 for adults and 26.4 for children (p = 0.002). Adults experienced higher rates of mortality (18.8 vs. 8.1 %; p < 0.001) and other complications, including unplanned operation (5.53 % vs. 1.71 %; p < 0.001) and cardiac arrest (5.26 vs. 2.63 %; p = 0.008). Multivariate logistic regression analysis confirmed that being an adult was independently associated with higher odds of mortality (OR = 2.8 [1.9, 4.1]) and unplanned operation (OR = 2.6 [1.4, 5.1]).

CONCLUSION

Among pedestrians struck by vehicles, adults face significantly higher rates of post-trauma complications and mortality. Contrary to our initial hypothesis, children had less severe injuries and overall better outcomes. This may be attributed to children having greater cardiopulmonary reserves, enhancing their adaptation and physiologic responses to PMVT.