Application of electronic surveillance and global information system mapping to track the epidemiology of pediatric pedestrian injury.

OBJECTIVE To compare the epidemiology of pediatric pedestrian injury in Jacksonville, FL to national trends, to analyze geographic distribution of these injuries, and to analyze pedestrian injury severity trends over time. METHODS Hospital emergency department and trauma registry data were analyzed for calendar year 2002 to define the incidence by age of vehicular pedestrian injury (Classification of Diseases--9th Revision--Clinical Modification E-code 814.7) in children less than 18 years old. The group was then stratified into the cohort living in the urban center (health zone 1-HZ1), and all other children in the region served by our state designated regional pediatric trauma referral center. To identify specific areas of cluster within and outside HZ1, FL Department of Highway Safety and Motor Vehicles (DHSMV) pedestrian crash data were analyzed for years 2002 to 2004. Global information system (GIS) mapping was performed based upon crash data geographic information. A recently deployed electronic injury surveillance system that combines both emergency department and trauma registry databases was then used to perform a similar analysis for calendar year 2006, which was the second of a 2-year program of enhanced prevention education specifically focused on the children and families of HZ1. This data were complied with 2006 DHSMV data to identify any decrease or change in GIS distribution of 2006 crashes compared with those of 2002. RESULTS The 71 total crashes encountered during the 2002 included 21 children (30%) with injury severity that required admission to the trauma service. Children from HZ1 represented 34% of the 2002 cohort (N = 24). Comparison of victim age distribution to a national sample recorded in the National Pediatric Trauma Registry demonstrated a statistically significantly higher proportion of adolescents injured in Jacksonville. Epidemiologic evaluation of a larger sample of DHSMV data for 2002 to 2004 identified 236 crashes, in which males constituted a majority (64.4%). Fall was the largest season with 30.9% of incidents. Most crashes occurred from 1 pm to 8 pm (61.4%) and were distributed predominantly during weekdays. A major portion of crashes occurred at nonintersections (40.3%). As indicated in the 2002, cohort adolescents aged 11 to 15 were the largest age group struck (35% for 2002, 48% for 2002-2004). GIS mapping revealed a high density of crashes in the urban core of northwest Jacksonville. Data from 2006 identified 74 children struck by vehicles, including only 9 (12%) who required admission to the trauma service. The proportion of HZ1 victims remained the same (35%); however no HZ1 child required admission to the trauma service. The overall incidence was unchanged either in age distribution or occurrence within HZ1. Comparison of 2006 GIS data to 2002 highlights a persistence of pedestrian incidents in north and west components of urban Jacksonville. Analysis of 2006 DHSMV data reveal similar epidemiologic trends to 2002 to 2004. CONCLUSIONS Although Jacksonville is similar to national trends in terms of gender, hour, day, and location of pedestrian injury, it differs from previous reports in terms of seasonality and the high proportion of adolescents struck. The effect of enhanced education appears to have diminished injury severity, although comparison of GIS plots clearly demonstrates that effective control will require changing environmental factors. Moreover, this report mandates further investigation and prevention efforts specifically targeting adolescents in urban areas.