Halari Moheem Masumali, Shkrum Michael James
Acad Forensic Pathol. 2020 Dec;10(3-4):144-157. doi: 10.1177/1925362120986059. Epub 2021 Mar 17.
Injury patterns in pedestrians struck by motor vehicles were described in medical literature first published almost a half century ago. "Classical" triads of injury distribution were described for adults (skull-pelvis-extremity) and subsequently applied to children (head-hip or pelvis-distal femur/knee joint). Notably, these classical triads were derived from two publications reporting clinical observations of only 11 patients, all of whom were adults.
A systematic literature review was conducted using Medline, CINAHL, EMBASE, and Cochrane to determine the evidence-base for motor vehicle collision (MVC)-pedestrian injury "triads" and other trauma patterns described for pedestrians in the adult and pediatric age groups.
Of the 1540 full-text articles identified in the review, 56 articles published in English met the inclusion criteria, that is, motor vehicle-pedestrian collision resulting in specific, fatal injuries determined by postmortem examinations. There were variations in injury patterns that differed from the "classical" triads. These differences likely stem from advances in vehicle design and safety features which have affected the nature and distribution of injuries.
Further research on the correlation of specific injuries sustained by pedestrians of different ages with various types of vehicles and impacts are needed to assess the validity of previously observed injury patterns in relation to the current motor vehicle fleet. Delineation of injury patterns can assist health care teams in trauma management. Vehicle manufacturers and government regulators can better assess whether the introduction of advanced driver assistance features designed to protect pedestrians when struck will be effective in reducing severe injuries. In forensic pathology practice, knowledge of pedestrian injury patterns based on data representative of impacts involving modern vehicles can provide MVC death investigators the means to determine MVC dynamics and pedestrian kinematics.
机动车撞击行人的损伤模式最早在近半个世纪前发表的医学文献中有所描述。“经典”的损伤分布三联征被描述为成人（颅骨-骨盆-四肢），随后应用于儿童（头部-髋部或骨盆-股骨远端/膝关节）。值得注意的是，这些经典三联征源自两篇仅报告了11例患者临床观察结果的文献，所有患者均为成人。
使用Medline、CINAHL、EMBASE和Cochrane进行系统的文献综述，以确定机动车碰撞（MVC）-行人损伤“三联征”以及针对成人和儿童年龄组行人描述的其他创伤模式的证据基础。
在综述中确定的1540篇全文文章中，56篇英文发表的文章符合纳入标准，即机动车与行人碰撞导致通过尸检确定的特定致命损伤。损伤模式存在与“经典”三联征不同的差异。这些差异可能源于车辆设计和安全特性的进步，这些进步影响了损伤的性质和分布。
需要进一步研究不同年龄行人遭受的特定损伤与各种类型车辆及碰撞之间的相关性，以评估先前观察到的损伤模式与当前机动车车队的相关性的有效性。损伤模式的描绘可以帮助医疗团队进行创伤管理。车辆制造商和政府监管机构可以更好地评估旨在保护被撞行人的先进驾驶员辅助功能的引入是否能有效减少严重伤害。在法医病理学实践中，基于代表涉及现代车辆碰撞的数据的行人损伤模式知识，可以为MVC死亡调查人员提供确定MVC动力学和行人运动学的方法。
