IMPACT OF PEDESTRIAN INJURY ON INNER-CITY TRAUMA SERVICES

This report describes the epidemiology of pedestrian injury in four in ner metropolitan local government areas of Sydney. These data were obt ained from the Roads and Traffic Authority of New South Wales. The spe ctrum of injury and clinical outcome was defined in patients with an I njury Severity Score (ISS) > 15 admitted from the study area, during a 1 year period, to the four inner metropolitan teaching hospitals. The incidence of pedestrian death was 3.3 times the state average of 32/1 0(6)/year. An average of 235 pedestrians, injured in the study area, w ere hospitalized each year during the period 1987-89. On average 24 pe destrians died each year, seven at the scene and 17 in hospital. Fifty patients (ISS > 15) were admitted to the four teaching hospitals duri ng a 1 year period 1990-91. Forty-five were adults and five children. Multiplicity of injury was seen in 68% of patients. The pelvis and low er extremities were involved in 70%, the head in 66% and chest in 42%. The hospital mortality rate was 30% with five patients dying on the f irst day from blood loss and nine dying during subsequent days from he ad injury. This study has important implications for trauma service de velopment. Successful clinical management of the severely injured pede strian requires close co-operation between pre-hospital and hospital c are providers. An integrated hospital trauma team response is mandator y to ensure appropriate management of what is often a shocked, hypoxic , head-injured patient.