Factors influencing the severity of road traffic accident injuries among pedestrians in Thailand: a national-level analysis.

OBJECTIVES: Road traffic accidents are one of the leading causes of injury and death compared to other causes. Pedestrians are highly vulnerable when they use the roads. When involved in road traffic accidents, pedestrians may experience dangerous, potentially fatal impacts when they are involved in road traffic accidents. Therefore, identifying risk factors and ways to prevent these accidents involving pedestrians is extremely important. We sought to identify the factors influencing the severity of road traffic accident injuries among pedestrians in Thailand according to the Safe System Approach framework. METHODS: We conducted a cross-sectional study using secondary data from the Highway Accident Information Management System (HAIMS) database of the Department of Highways, Ministry of Transport, Thailand. We analyzed data for pedestrians from 2012 to 2021 involved in traffic accidents (n = 1,728) using descriptive statistics and binary logistic regression analysis. RESULTS: Among the 1,820 pedestrian road traffic injury cases identified, 1,728 cases with complete data were included in the descriptive analysis. The majority of pedestrians (60.76%) sustained fatal injuries, followed by injuries (39.24%). Binary logistic regression analysis revealed that vehicle-related factors, crash causes, and environmental factors were significantly associated with pedestrian injury severity. Regarding vehicle types, motorcycle-involved crashes were associated with significantly lower odds of severe pedestrian injury compared to agricultural and other vehicles (OR = 0.083, 95% CI: 0.024-0.288, p < 0.001). For crash causes, alcohol intoxication-related crashes showed significantly lower odds of severe injury than drowsy-driving crashes (OR = 0.235, 95% CI: 0.060-0.917, p = 0.037). Furthermore, environmental lighting conditions played a critical role; crashes during daylight were associated with lower odds of severe injury compared to those under dark conditions with street lighting (OR = 0.498, 95% CI: 0.317-0.781, p = 0.002). Conversely, crashes occurring under dark conditions without street lighting significantly increased the risk, with 2.078 times higher odds of severe injury (OR = 2.078, 95% CI: 1.066-4.053, p = 0.032). CONCLUSION: Grounded in the Safe System Approach, reducing severe pedestrian injuries requires tripartite interventions: expanding street lighting networks to eradicate dark-spot hazards, strengthening enforcement against high-risk alcohol intoxication-related crashes, and implementing pedestrian segregation measures that safeguard vulnerable road users from other vehicles.