Injury Severity and Mortality of Adult Zebra Crosswalk and Non-Zebra Crosswalk Road Crossing Accidents: A Cross-Sectional Analysis

Pfortmueller, Carmen A.; Marti, Mariana; Kunz, Mirco; Lindner, Gregor; Exadaktylos, Aristomenis K. · 2014 · OpenAlex-citations

DOI: 10.1371/journal.pone.0090835

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Summary

This retrospective cross-sectional study investigates the differences in injury severity and mortality between adult pedestrians struck by vehicles on zebra crosswalks versus those struck outside of marked crosswalks. Motivated by the global burden of road traffic injuries and the lack of systematic data comparing injury outcomes based on crossing location, the authors aimed to determine if the use of zebra crosswalks influences the severity of trauma sustained by pedestrians. The study analyzed data from 347 adult patients (aged 16 and older) admitted to a Level I emergency department in Switzerland between January 2000 and December 2012. Patients were identified via database search terms and matched with police and ambulance records. Injury severity was assessed using the Abbreviated Injury Score (AIS) and Injury Severity Score (ISS), with severe injury defined as an ISS greater than 15. Statistical analyses included chi-squared tests, t-tests, and multivariable logistic regression to identify predictors of severe injury, hospitalization, and mortality. The results indicated that accidents on zebra crosswalks were more frequent, accounting for 58.5% of cases, compared to 41.5% for non-zebra crosswalk accidents. However, injuries sustained in non-zebra crosswalk accidents were significantly more severe. The mean ISS for non-zebra crosswalk victims was 14.4, compared to 10.5 for zebra crosswalk victims (p=0.019). Vehicles involved in non-zebra crosswalk accidents traveled at higher average speeds (47.7 km/h vs. 41.4 km/h, p=0.027). Logistic regression revealed that using a zebra crosswalk was associated with a decreased risk of severe injury (OR 0.61, p=0.042). Conversely, accidents involving trucks were associated with a significantly increased risk of severe injury (OR 3.53, p=0.02), while bicycle accidents carried a lower risk. Patients in non-zebra crosswalk accidents were also more likely to require hospitalization (61.8% vs. 52.2%, p=0.048) and had higher in-hospital mortality rates (12.5% vs. 7.4%, p=0.034), although the difference in mean survival time was not statistically significant. The study concludes that while zebra crosswalk accidents are more common, likely due to higher pedestrian exposure, they result in significantly lower injury severity and mortality compared to non-zebra crosswalk accidents. The authors attribute this protective effect to reduced vehicle speeds at marked crossings. The findings highlight the critical role of vehicle type and speed in determining injury outcomes, noting that large vehicles like trucks pose a substantially higher risk of severe injury. The authors call for further prospective studies with larger sample sizes and more detailed data on vehicle characteristics and speed to validate these findings.

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• demographic disparities

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• Empirical Findings: crash risk outcomes