The authors reviewed 369 consecutive pedestrian fatalities, which occurred from 1990 to 1994. This represented 28.5% (range 23.3 to 37.2; 95%CI 26% to 31%) of all road accident autopsies during that time.The mean and median ages of this population were 51 (95% CI 48.63 to 53.37) and 54 years, respectively. There were 160 (43.3%) who were in the economically productive ages of 20 to 59 years. Of the 369 victims, 224 (60.7%) were males and 145 (39.3%) females, there being a preponderance of males across all age groups. Most of these accidents occurred during the hours of daylight and in conditions of good weather and visibility. It was estimated that pedestrian behaviour contributed, in part, to at least three-quarters of these fatalities. The majority of these pedestrians died from multiple injuries (181; 49.1%) and closed head injury (146; 39.6%). The vast majority of subjects (357; 96.7%) had injury severity scores (ISS) ≥16. A total of 100 subjects (27.1%) died at the sites of the accidents. Of these, 99 had ISS ≥16, with 31 having had ISS = 75 (maximum score). Similarly, all 55 deaths that occurred in the A&E departments were associated with ISS ≥16, with 6 having ISS = 75. This would imply that most of the deaths that had occurred on site and at A&E departments were not unexpected. Interestingly, no pedestrian aged ≤12 years had an ISS ≤16, suggesting that they may be more vulnerable to serious or life-threatening injury than adults. There were 46 (12%) victims who had detectable levels of ethanol in their blood samples, of whom, 10 had ISS = 75. However, the difference between the latter proportion and that of the rest of the pedestrian population who had no alcohol detected in their blood samples (31/323), was only marginally significant (95% CI 0.002 to 0.245). There was a high prevalence of pre-existing and intercurrent diseases, such as ischaemic heart disease (58.8%), hypertensive heart disease (30.4%), chronic obstructive airways disease (47.4%), bronchopneumonia (18.2%) and evidence of systemic hypertension (40.7%). It is submitted that the existence of these underlying conditions should be anticipated, or suspected, in the management of injured pedestrians, particularly the elderly, as they may influence the outcome of their critical care.
Fatal road accidents are by no means uncommon in Singapore, a modern tropical metropolis with a population of approximately 3 million. Statistics provided by the Traffic Police Department show that, although the accident fatality rate had fallen sharply from 13.4 per 100,000 population in 1984, to 8.0 per 100,000 in 1987, it had remained between 8.7 and 9.0 from 1988 to 1994, before falling again to 7.5 in 1995.
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