Patients and methods

Child pedestrians admitted to the Department of Pediatric Surgery, Graz for treatment of injuries related to a reversing vehicle/vehicle rolling backwards collision comprised the study group. The Department of Pediatric Surgery serves the County of Styria with a population of 193 806 children. The medical records of those children who attended the department between 16 April 1993 and 15 April 2001 were reviewed retrospectively, using a computerised trauma database for identification of pedestrian injuries.⁷ Age, gender, mechanism, type of injury, and injury severity score (ISS) were recorded.⁸ All injuries caused by motorized passenger vehicles or trucks reversing or rolling backwards were included. Injuries caused by agricultural machines or non-motorized vehicles were excluded. A “run-over” injury was assumed when a part of the child's body was crushed between vehicle and ground surface.

A questionnaire was sent to the parents inquiring about mode, location of the injury, and car type involved. Vehicle types were categorized as small, medium, executive, four wheel drive, or utility. The values presented are median and ranges.

Results

Over the eight years under consideration 32 children were injured by reversing vehicles or those that were rolling backwards. Their age and sex distribution is shown in table 1.

LOCATION OF THE INJURY

Over half of the injuries occurred in residential driveways (37.5%) or in farmyards (21.9%). The remainder occurred on sidewalks or car parks. In three cases the location had not been recorded.

DRIVERS

In nearly half of the cases (43.8%) the cars were driven by adult family members and in 37.5% by persons not related to the child. Three children were injured by a rolling car without a driver (9.4%). One child had knocked his father's car out of gear injuring his sister when she tried to stop the car from rolling downhill. The median ISS was 3 (1–27) and the main injuries are shown in table 2.

Twenty seven questionnaires were returned.

MODE OF INJURY

Altogether 70.4% were “run-over” by reversing vehicles or vehicles rolling backwards: 10 were injured by rear wheels, three by front wheels, five crushed by the car floor, and one was burned by the exhaust pipe. Of those hit by cars (29.6%), 63.0% by were hit by medium size and 22.2% by executive type cars.

Figure 1 shows a left hand drive car and child on the driver's (blind) right side.

Discussion

Nearly half of the injuries in our series were caused by adult family members. When comparing questionnaires to police reports we noted that 15.3% of these injuries had not been reported to the police. The analysis coroner's office datasets from 1989–99 revealed no fatalities among children up to age 14 related to reversing vehicles.

Toddlers playing in driveways or farmyards are at risk of a “run-over” injury caused by reversing vehicles. Physical barriers limiting the child's access to residential driveways may prevent some of these injuries.⁵ Greater use of infrasonic park distance monitoring systems installed at the rear bumper is a promising preventive strategy.^{2, 6}