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| Journal of the New Zealand Medical Association,
03-July-2009, Vol 122 No 1298
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Paediatric driveway run-over injuries: time to
redesign?
Kai Hsun Hsiao, Clinton Newbury, Nita Bartlett, Rangi
Dansey, Philip Morreau, James Hamill
A significant and often overlooked proportion of child
pedestrian injuries occur on domestic
driveways.1–3 These injuries typically
involve young children and most commonly occur in the child’s own home
driveway.1 Adding to the tragedy is the fact
that the driver of the vehicle is most often a parent or close
relative.1
Driveway injuries appear to be associated with higher
mortality and less favourable outcomes than other types of child pedestrian
trauma.4,5 In fatal cases, death usually occurs
at the scene of the accident.4
Given the severity of injuries and high mortality rate,
primary prevention would be desirable. Various prevention strategies have been
suggested including fencing, proximity sensors, visual aid devices and public
education.1,4,6–11
The purpose of the present study is to investigate the
demographic, accident and environmental characteristics associated with driveway
injuries in order to identify potentially modifiable factors and prevention
strategies that could lead to a safer driveway environment for children.
Materials and MethodsA retrospective review was undertaken of all children
less than 15 years old who were hospitalised or killed due to a driveway injury
in the Auckland region during the 50-month period from November 2001 to December
2005.
Driveway injury was defined as an injury caused by
contact with a non-stationary motor vehicle occurring on a driveway. A driveway
was defined as any passageway providing vehicle access between the road and the
adjoining property. This definition of ‘driveway’ excludes injuries
occurring in other off-road locations such as carparks, parks, reserves and
farms. Also excluded were cases transferred from outside the Auckland region and
cases not admitted into hospital, that is, cases seen only in the Emergency
Department then discharged.
Cases were identified from three sources: Starship
Children’s Hospital Trauma Registry, Middlemore Hospital Trauma Registry
and the Auckland City Coroner’s database. Starship Children’s
Hospital is the tertiary referral hospital and the paediatric trauma centre for
the region. Middlemore Hospital admits paediatric orthopaedic and burns cases.
These two units are responsible for all paediatric trauma admissions within the
greater Auckland region.
Data was collected on the demographics, accident and
environmental characteristics, and parental awareness. Data was obtained from
clinical records and telephone interviews with parents. Parents/caregivers of
the children in the identified cases were approached with an initial
introductory letter and after obtaining verbal consent, a structured telephone
interview was conducted. In selected cases where consent was granted, injury
sites were visited by the primary investigator to clarify the property
characteristics and driveway layout. Population data for the Auckland region was
obtained from Statistics New Zealand.12
Statistical analysis was performed using the
Pearson’s Chi-square test or Fisher’s exact test for categorical
variables and the Mann-Whitney U test for continuous variables.
The study received ethical approval from the Auckland
Regional Ethics Committee.
ResultsA total of 93 children were injured or killed over the
50-month period (Figure 1). Fifty-eight children initially presented to
Middlemore Hospital Emergency Department, but of these, 37 were transferred to
Starship Hospital for admission and one fatal case went to the coroner. Of the
93 cases, 7 were fatal. This equates to a mortality rate of 0.63/100 000
children per year, and an injury rate of 8.4.
Demographics—The 0–4 years age
group were over-represented, comprising 73% of cases versus 33% of the
paediatric population. The Pacific Island and Māori ethnic groups were
over-represented: Pacific Islanders represented 43% of driveway run-over cases,
significantly higher than their Auckland population of 14%, and Māori
represented 25% of cases compared to 10% of the population.
Injury location—The majority of
injuries (56%) occurred in South Auckland (which comprises 39% of the paediatric
population in the Auckland region).13 The
injury occurred at the child’s own home in 80% (n=74) of cases.
Figure 1. Patient numbers
 Middlemore: admissions to Middlemore
Hospital; Starship: admissions to Starship Children’s
Hospital; Coroner: fatal cases; † Injury occurred outside
the Auckland region.
Time: Accidents tended to occur in the
afternoon, especially between 4pm and 7pm, 37% (n=34) (Figure 2). There was also
a second peak around 11am. 43% (n=40) occurred in the summer months, correlating
with better weather and longer daylight hours, with peak frequency in December
(n=19).
Figure 2. Number of accidents by hour of
day†
 † Time of the accident could not be established
for two of the cases.
Driver and vehicle characteristics
(Table 1)—In about two-thirds
of cases, the driver was related to the child, most commonly the parent, 36%
(n=34). The type of vehicle most frequently involved was the car, 65% (n=60).
However, vans were over-represented in these accidents.
Table 1. Vehicle and driver characteristics
(N=93)
† Relative proportions of each vehicle type
registered to the Land Transport Safety Authority (LTSA) of New Zealand in
the Auckland region in 2005.
Interviewed subgroup—Of the 93 cases
identified, 45 (48%) were able to be contacted and gave consent for interview
(Figure 1). The characteristics of the interviewed subgroup did not differ
significantly from total study population (Table 2). The remaining results
presented below pertain to the interviewed subgroup (N=45).
Home ownership—The properties where
injuries occurred were predominantly rental houses (51%), of which 57% were
owned by the government housing agency, Housing Corporation New Zealand. Rental
accommodation comprises 36% of houses in the Auckland
region.12
Table 2. Characteristics of the total study
population compared to the interviewed subgroup
Age (Mann-Whitney U test); Gender (Pearson Chi-squared
test); Ethnicity (Fisher’s exact test, two-tailed); Injury location
(Fisher’s exact test, two-tailed); LQ: lower quartile; UQ: upper
quartile.
Scene characteristics (Table
3): Shared driveways (51%) and driveways which
extended through the length of the property (51%) predominated. A typical
driveway led up from the road past the front lawn and side of the house to the
garage/carport in the rear section, and was readily accessible from the front
lawn, back lawn and house. Only a small minority (13%) of driveways were fenced
or physically separated in any other way from the house and lawn.
Table 3. Driveway and property characteristics
(N=45)
Supervision—In nine cases (20%), the
driver actively checked that the child was in a safe location and that the
driveway was clear prior to moving the vehicle. In these cases the child was
able to easily gain access to the driveway and dart out into the path of the
moving vehicle: The drivers often reported that the child had suddenly darted
out into the path of their vehicle from inside the house or from a location out
of the driver’s view such as from behind another parked vehicle.
DiscussionStrategies in preventing driveway run-over injuries are
numerous, but largely fall into three groups: Modifying behaviour (driver and
parental education), modifying vehicles and modifying environment.
Education and public awareness campaigns, with messages
promoting awareness of driveway safety, parental supervision and driver care,
have been repeatedly suggested and have constituted the major thrust of efforts
in prevention.4,6,10,14,15 Further efforts in
this approach may yet have benefits, especially awareness campaigns targeted at
the high-risk groups, such as parents of preschool children, Māori and
Pacific Islanders, South Auckland parents and lower socioeconomic groups.
However, education alone has major limitations: Education requires significant
resources and sustained efforts to be effective, and the benefits are often
short-term. And even with the best parental supervision and driver care,
driveway accidents can still occur, as demonstrated by a few of the cases in our
study.
Strategies in the area of vehicular modifications have
largely focused on improving the rearward visibility of vehicles. The Motor
Accidents Authority (MAA) of New South Wales in Australia has conducted
extensive research into the effectiveness of various visual aids and
technologies, such as specialized mirrors, proximity sensors and cameras. The
MAA reported that any significant improvement to rearward visibility would
require the combination of a rear-mounted video camera and short-range proximity
sensor.15 Such a combination system is yet to
be developed commercially and requires further refinement. Even with currently
available technologies, the greatest limitation is the accessibility and
affordability in the current markets, particularly for lower socioeconomic
groups.
We believe that a more definitive and feasible solution in
addressing driveway run-over injuries lies in physical measures and
modifications that improve the safety of the driveway environment. The driveways
on which run-over injuries occur are characteristically shared, extend through
the property and function as a child play area. These factors maximise exposure
of children to vehicles.
The absence of physical separation between driveways and
children’s living areas is associated with a threefold increase in the
risk of driveway injuries.9 Physical separation
can be achieved through various means, including fencing off the driveway,
creating a physically separate outdoor play area and, for future developments,
changing the design or configuration of driveways.
Fencing is perhaps the most direct and basic form of
physical separation and has been frequently
recommended.1,6,7,9,10 Advantages include the
relatively low cost and flexibility of design, particularly for existing homes
and already developed properties where the options for change are more
restricted. However fencing is not always practical and, in some instances, may
be ineffective.
We believe that it is important to promote the concept of
physical separation in general: “Kids and cars don’t mix”.
This concept allows the flexibility to decide the most preferable means for each
property to achieve physical separation.
Who is responsible for ensuring safe driveway environment?
Parents, caregivers, landlords, developers and council planners could all
contribute. Driveway safety should be incorporated into the planning and design
of future residential developments. Placing the garage close to the front of a
property for example could limit the driveway’s accessibility to children,
decrease the driveway’s usefulness as a play area, and maximise use of the
land area for living purposes rather than for vehicles.
The present study is limited by its retrospective nature,
although it is based on two prospectively collected trauma registries and a
Coroner’s registry. It is an observational study of driveway injuries and
the residences at which they occurred but with no control group. It cannot be
confidently concluded from the presented data that driveway layout is
independently associated with risk of injury.
Further research should include a matched control group for
comparison. Investigation into the design aspects of driveways will be
beneficial, particularly questions addressing the ideal way to secure existing
driveways and the ideal layout for off-road parking for new residences.
Competing interests: None known.
Author information: Kai Hsun Hsiao, House
Officer, Starship Children’s Hospital, Auckland; Clinton Newbury, Medical
Student, University of Auckland; Nita Bartlett, Surgical Registrar, Auckland
Trauma Service; Rangi Dansey, Trauma Systems Co-ordinator, Auckland Trauma
Service; Philip Morreau, Paediatric Surgeon, Starship Children’s Hospital,
Auckland; James Hamill, Director, Children’s Trauma Service, Starship
Children’s Hospital, Auckland
Acknowledgements: This study was funded by
the University of Auckland. We also acknowledge the help and support of Julie
Chambers, Joy Gunn, Isabel Bird and the team at SafeKids New Zealand; the help
of Professor Tim Koelmeyer, Auckland Hospital Mortuary; the epidemiological and
statistical advice of Elizabeth Robinson and Shanthi Ameratunga, Section of
Epidemiology and Biostatistics, University of Auckland; and Helen Naylor, Trauma
Coordinator, Middlemore Hospital.
Correspondence: James Hamill,
Children’s Trauma Service, Department of Paediatric Surgery, Starship
Children’s Hospital, Private Bag 92024, Auckland, New Zealand. Fax: +64
(0)9 3078952; email: JamesH@adhb.govt.nz
References:
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