Intended for healthcare professionals


Severe traffic injuries to children, Trent, 1992-7: time trend analysis

BMJ 2003; 327 doi: (Published 11 September 2003) Cite this as: BMJ 2003;327:593
  1. Carol Coupland, senior lecturer in medical statistics (carol.coupland{at},
  2. Julia Hippisley-Cox, senior lecturer in general practice1,
  3. Denise Kendrick, senior lecturer in general practice1,
  4. Lindsay Groom, research unit coordinator1,
  5. Elizabeth Cross, researcher in general practice1,
  6. Boki Savelyich, researcher in general practice1
  1. 1Division of Primary Care, University of Nottingham, Nottingham NG7 2RD
  1. Correspondence to: C Coupland
  • Accepted 1 July 2003


Unintentional injury is the leading cause of death in children aged 1 to 15, and two thirds of fatal injuries in schoolchildren result from road traffic crashes.1 More than 75% of children fatally or seriously injured in road traffic crashes are pedestrians or cyclists.

Socioeconomic gradients exist in children admitted with pedestrian and pedal cycle injuries,2 but little is known about trends in these gradients over time. We examined trends in admission rates and socioeconomic gradients for traffic injuries in children between 1992 and 1997.

Participants, methods, and results

We considered children aged 0-14 years who were admitted to hospital for pedal cycle, pedestrian, or other transport injuries in the 862 electoral wards in the old Trent NHS Executive Region, United Kingdom, between 1 April 1992 and 31 March 1997.2 An admission for fracture of a long bone needing an operation was a severe injury.3 We allocated each patient to their electoral ward using their postcode, aggregated the data at ward level for each year of the study, and calculated admission rates in each ward using population data.

We used random effects Poisson regression to find rate ratios for changes in admission rates and socioeconomic gradients over the study period. We categorised wards into fifths using the Townsend score for each ward. To assess whether the socioeconomic gradients had changed over the study period we conducted tests for interaction. Confounding variables were rurality, proportion of boys in the ward, proportion of black and Asian residents, and distance from the centre of the ward to the nearest acute hospital trust.

During the study period, admissions of children with severe injuries from road traffic crashes were 1061 pedal cyclists, 449 pedestrians, and 426 others. Admission rates for severe injuries among cyclists and pedestrians increased by 4.9% (95% confidence interval 0.6% to 9.5%) and 9.8% (2.9% to 17.3%) each year (table 1). Conversely, admission rates for other severe injuries decreased by 10.8% (4.6% to 16.7%) each year. Socioeconomic gradients did not change significantly during the study period.

Severe injuries in children aged 0-14 years, Trent, 1992-7*

View this table:

Admission rates for all traffic injuries in children increased by 8.1% (5.6% to 10.7%) for pedal cyclists, did not change for pedestrians, and decreased by 13.9% (11.0% to 16.7%) for others.


Admission rates for severe injuries to pedal cyclists and pedestrians increased in children in Trent between 1992 and 1997, but admission rates for other transport injuries fell; socioeconomic gradients among those admitted did not change.

Our findings are surprising, given the increasing number of journeys made by car in this period. Perhaps children's safety improved for car passengers but not for pedestrians or pedal cyclists between 1992 and 1997.

Our results relate only to long bone fractures, so maybe trends for other injuries differ, although trends were similar for all admissions for pedal cycle and other transport injuries. We need to analyse trends after 1997 to confirm our findings.

Injuries to pedestrians and cyclists can be reduced by area-wide engineering or traffic calming measures,4 and cycle helmets reduce head injuries.5 As national initiatives are promoting walking and cycling among schoolchildren, implementation of effective measures such as these should be a priority for local authorities and primary care groups and trusts.


We thank Andy Nicholson and Howard Chapman from Trent NHS Executive for help extracting data on hospital admissions and Maura Bell and April McCambridge for helping process ethical approval.


  • Contributors JH-C and DK initiated this analysis. CC analysed the data and produced the final draft of the paper. JH-C got ethical approval, designed the study, manipulated the data, interpreted the analysis, and drafted the paper. DK designed the study and drafted the paper. LG designed the study, managed the project, and manipulated the data. EC collected and manipulated the data. BS manipulated and interpreted the data. JH-C and CC are guarantors.

  • Funding Trent NHS Executive.

  • Competing interests None declared.