The walking dead

The Walking Dead is a popular American horror-drama television show based on a comic book series of the same name. The TV show debuted in 2010 and is now in its seventh season. The show is set in a post-apocalyptic world overrun with zombies. Over the years, the so-called walking dead have been portrayed as mindless creatures wandering the earth.

Today, real-life “smombies” (smartphone zombies) walk face down, eyes glued to their smartphones while navigating city streets.

Attack of the smombies

Smombies are seen walking and texting, checking Facebook, tweeting, or looking at maps on GPS apps, often while stepping off the curb into traffic.

According to a survey conducted in several European cities, including Berlin, approximately 20 percent of pedestrians are distracted by their cell phone.1 Fortunately for smombies in Germany, a new type of pedestrian warning system is being installed, with traffic lights embedded in the pavement. Hence, German smombies can continue to look down and text while waiting for the ground-level traffic lights to turn green, signaling that it is safe to cross the street. This system offers a new level of attention to traffic signals, adapted to the modern age.2

The U.S. has its fair share of smombies as well. A 2012 study on the impact of social and technological distraction on pedestrian behavior when crossing streets indicated that at 20 high-risk intersections in Seattle, WA, nearly one-third of the pedestrians were engaged in a distracted activity—such as listening to music, text messaging, and using a handheld phone—while crossing the road. The study also revealed that it took 18 percent longer for them than for undistracted pedestrians to cross the intersection and that texting pedestrians were 3.9 times more likely than undistracted pedestrians to display at least one unsafe crossing behavior (that is, disobeying the lights, crossing in the middle of the intersection, or failing to look both ways before stepping off the curb).3

An unhealthy distraction

According to several additional studies cited in a 2015 report Everyone Walks from the Governors Highway Safety Association, the risk of injury and death to “petextrians” (pedestrians who text while walking) has increased over the last 10 years. The number of pedestrians killed while using a cell phone rose from 1 percent in 2004 to 3.6 percent in 2010. The U.S. Consumer Products Safety Commission estimated that as many as 2 million pedestrian injuries related to cell phone use occurred in 2010 alone.4 With smartphone use on the rise, these numbers will only increase if nothing is done to mitigate this risky behavior.

To examine the occurrence of distracted pedestrian versus motor vehicle injuries contained in the National Trauma Data Bank® (NTDB®) research dataset admissions for 2014, medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Specifically searched were records that contained the external cause of injury code (E-code) E814.7 (Motor vehicle traffic accident involving collision with pedestrian, injuring pedestrian), which includes the subset of distracted pedestrians. A total of 24,918 records were found, of which 20,339 contained a discharge status, including 13,647 patients discharged to home, 3,266 to acute care/rehab, and 2,140 sent to skilled nursing facilities; 1,286 died. Of these patients, 63.6 percent were male, on average 39.8 years of age, had an average hospital length of stay of 7.5 days, an intensive care unit length of stay of 6.9 days, an average injury severity score of 14.1, and were on the ventilator for an average of seven days (see Figure 1).

Figure 1. Hospital discharge status

Figure 1. Hospital discharge status

Our society has become increasingly dependent on technology, and it is amazing what one can do with a metal and glass device the size of a 3″ x 5″ index card. One can be in constant communication with friends, loved ones, employers, and employees; almost any contact or information is in reach from your smart device. However, aside from getting a stiff neck from looking down while being a petextrian, one could join the walking dead as a result of being a smombie while trying to cross the street. For safety tips on preventing pedestrian injuries, go to the American Academy of Orthopaedic Surgeons website.

Throughout the year, we will be highlighting these data through brief reports that will be found monthly in the Bulletin. The National Trauma Data Bank Annual Report 2015 is available on the ACS website. In addition, information is available on our website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at


Statistical support for this article was provided by Chrystal Caden-Price, Data Analyst, NTDB.


  1. Noack R. This city embedded traffic lights in the sidewalks so that smartphone users don’t have to look up. Washington Post. April 25, 2016. Available at: Accessed April 30, 2016.
  2. Whitten S. Germany installs ground-level traffic lights for distracted cellphone users. Available at: Accessed on April 30, 2016.
  3. Thompson LL, Rivara FP, Ayyagari RC, Ebel BE. Impact of social and technological distraction on pedestrian crossing behaviour: An observational study. Inj Prev. 2013;19(4):232-237. Accessed May 23, 2016.
  4. Everyone Walks. Understanding & Addressing Pedestrian Safety. Governors Highway Safety Association. August 2015. Available at: Accessed April 30, 2016.

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