Look right! A retrospective study of pedestrian accidents involving overseas visitors to London

Introduction: Research within the European Union has shown international visitors to have a higher injury mortality than residents. Traffic accidents are the leading cause of injury-related death among overseas visitors and evidence suggests overseas visitors are at a greater risk of being involved in road traffic accidents than the resident population. Little information looks specifically at pedestrian injuries to overseas visitors. Pedestrian deaths account for 21% of all UK road deaths. Methods: A retrospective database review of London helicopter emergency medical service (HEMS) missions was undertaken to examine the number and type of missions to overseas visitors, specifically examining pedestrian incidents. Results: Of 121 missions to overseas visitors, 74 (61%) involved the visitor as a pedestrian struck by a vehicle. Thirty-five pedestrians (47%) were struck by a bus and 20 by a car (27%). Fourteen patients (19%) had an initial Glasgow coma scale score of 3–8, suggesting severe head injury and half of all patients required prehospital intubation (38/74, 51%). Mortality was 16% (12/74%) and 62 patients (84%) survived to hospital discharge. Of 39 patients admitted to the Royal London Hospital, the average injury severity score (ISS%) was 23.0 (ISS >15 denotes severe trauma) with a mean inpatient stay of 17.9 days. Conclusion: During the 7-year period studied, 61% of HEMS missions to overseas visitors involved a pedestrian being struck by a vehicle, compared with 16% of missions to UK residents. For HEMS missions, serious trauma to pedestrians is disproportionally more common among the visitor population to London.