D. R. Fraser1, N. D. Fulkerson1, A. A. Chavez1, N. K. Ingalls1, E. A. Snavely2, B. S. Penalosa1, J. J. Fildes1, D. A. Kuhls1 2University Medical Center,Trauma,Las Vegas, NV, USA 1University Of Nevada School Of Medicine,Surgery/Trauma,Las Vegas, NV, USA
Introduction: Las Vegas is ranked the13th most dangerous metropolitan area for walking, according to Transportation for America. Approximately 5,000 pedestrians die each year on U.S. roadways, creating a public health concern for pedestrian safety. To effectively target injury prevention, we analyzed demographic, environmental, temporal and alcohol consumption factors associated with being struck by a vehicle while navigating the streets of Las Vegas on foot.
Methods: We conducted a retrospective analysis of injuries resulting from auto pedestrian crashes (APC) at our Level I Trauma Center in Las Vegas from 2009-2013 (n=1126). Demographic, injury, environmental and hospital utilization data were analyzed in SPSS 22 using chi square, Mann Whitney U and logistic regression tests with significance set at p<0.05.
Results: Overall, 29% of injured pedestrians were labeled as having suspected alcohol use on admission; this did not vary by racial groups and was reported higher during the weekdays. These patients with suspected alcohol use were 4.3 times more likely to be admitted at night and experienced a longer hospital length of stay (HLOS). Injury severity did not vary with the time of day or day of the week but injury patterns varied: severe extremity injury (Abbreviated Injury Scale (AIS) of 3+) occurred during weekdays (p<0.001) and more severe facial injuries occurred at night. Additionally, patients admitted at night had a lower Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) compared to those admitted during the day. Seasonal variation included more night admissions for spring, summer and fall. During the summer, APC patients were 2.2 times more likely to occur at night. Friday pedestrian injuries were higher compared to Sunday, Monday and Tuesday. Predictors of low GCS (3-8) included increased age, Asian and Other race groups. Compared to the White group, Asian and Other groups were 2.46 and 3.6 times more likely to have a low admission GCS. Older age, New Injury Severity Score (NISS) and suspected alcohol use were significant predictors of HLOS.
Conclusion: In Las Vegas, there are demographic, temporal and social factors that contribute to APCs. Pedestrians who engage in alcohol use during the summer months have an increased likelihood of being involved in a crash at night and during the weekdays. Patients injured during the night had a decreased Revised Trauma Score (RTS), indicating an initial assessment of more serious injury. Age, NISS and suspected alcohol use were associated with increased HLOS. Increased incidence of pedestrian injuries occurred on Friday compared with earlier days in the week. Injury prevention efforts should focus on alcohol consumption, seasonal and diurnal variations that contribute to pedestrian safety. A prospective study that analyzes pedestrian behaviors and other factors may help elucidate other factors that place pedestrians at risk and contribute to high rate of APCs in Las Vegas.