The pedestrian struck by a car presents challenges to trauma professionals for a number of reasons. Due to the size mismatch between the two, serious injuries are fairly common. And unfortunately, many injuries are occult, so it’s easy to dismiss patients who may be hiding serious problems.

The National Highway and Traffic Safety Administration (NHTSA) recently published its Traffic Safety Facts report for 2011. This 232 page tome contains a wealth of interesting and thought-provoking data. One of the more interesting tidbits that caught my eye had to do with pedestrians struck by cars.

Most normal people do not get hit by cars. There is nearly always some additional factor that allows this to occur:

• Don’t understand cars – this is a typical reason for small children, and I’ve also seen foreign visitors from countries with little auto traffic fall victim to this one. The developmentally disabled also fall into this category.
• Not paying attention – this category is growing rapidly due to smart phone use
• Can’t clear the intersection in time – this one gets the elderly. Due to physical constraints, they can’t move fast enough (4 ft/sec for most intersections) to get across in time
• Intoxicated – this basically puts an adult back into the first category above. These incidents tend to be clustered around bars, and the numbers peak at night, typically from midnight to 3am.

The NHTSA report has always detailed the age breakdown of pedestrians struck, but now they are reporting the number of “impaired walkers” as well.

• Overall, death by motor vehicle (occupants and pedestrians) involved alcohol 31% of the time (!!)
• 4,432 pedestrians were killed and about 69,000 were injured
• About one third of pedestrians killed tested positive for alcohol, and most were legally intoxicated!
• 14% of the nonintoxicated pedestrians were struck by an intoxicated driver vs 19% of intoxicated pedestrians

Bottom line: There are many reasons for getting hit by a car, and being intoxicated is an entirely avoidable one. These patients can be seriously injured, so don’t just shrug off complaints as being due to intoxication. Additional prevention efforts should be developed using the interesting patterns outlined in the NHTSA report.

Reference: NHTSA Traffic Safety Facts 2011