The rise of the smombies and fall of the pedestrians

Last month, this column addressed the cultural phenomena of “smombies”—short for smartphone zombies—and distracted pedestrian injuries resulting from collisions with motor vehicles.* Many of us have seen smombies in action, and some of us, at one time or another, have been guilty of being one. Unfortunately, walking head down with eyes focused on a smartphone screen is a recipe for disaster. In last month’s column, the disturbing 10-year upward trend in pedestrian injuries and fatalities from texting was discussed.* This month, we look at the pedestrian case fatality rate over the last several National Trauma Data Bank® (NTDB®) dataset years.

A growing problem

According to a preliminary press release from the annual Governors Highway Safety Association Spotlight on Highway Safety Report, the number of pedestrians killed in traffic crashes in 2015—the year under investigation at press time—will likely increase by 10 percent from the prior year. This projected increase will be the largest annual increase reported. Pedestrians currently account for a larger share of all motor vehicle crash-related deaths, numbering around 15 percent, up from 11 percent just a decade ago.

The number of pedestrian fatalities recorded for the first half of 2015 varies widely from state to state. A total of 21 states reported decreases, 26 states along with the District of Columbia reported increases, while three states reported no change. Pedestrian fatalities tended to occur in larger states with large urban areas such as California, Florida, Texas, and New York. These four states accounted for 42 percent of all pedestrian fatalities but are home to only 33 percent of the population. In 2014, 72 percent of all pedestrian fatalities occurred in the dark.

Contributing factors

Many factors may have contributed to this spike in pedestrian fatalities. Motor vehicle use has increased as a result of lower gas prices and an improved economy. In addition, cell phone use has increased among pedestrians as well as drivers. Although automobile engineers have created safer vehicles that ensure more occupants will survive a crash, pedestrians remain just as susceptible to injuries as in the past.

Another contributing factor is the increase in the number of pedestrians as a result of more Americans walking for health, environmental, and economic reasons. With this increase in pedestrian traffic comes the need for safer walkways. In addition to engineering improvements is the need to educate the public about the importance of following the rules of the road—not only as a driver but as a pedestrian.

NTDB findings

To examine the trend of pedestrian fatalities from motor vehicle traffic crashes in the NTDB research dataset admission years 2009–2014, medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Specifically searched were records that contained the following external cause of injury code (E-code): E814.7 (Motor vehicle traffic accident involving collision with pedestrian, injuring pedestrian). A total of 152,551 records were found for this six-year period; of these injured patients, 11,188 died. The motor vehicle-related pedestrian fatality rate by year is displayed in Figure 1.

Figure 1. Pedestrian case fatality rate by year

Figure 1. Pedestrian case fatality rate by year

An upward trend in the pedestrian case fatality rate is demonstrated over the six-year period from 2009 to 2014. The one-year, 10 percent spike mentioned previously is projected to appear in the 2015 data. Will the preliminary 2015 data bear out? With an increase in the number of petextrians (texting pedestrians) roaming the streets, that is a good possibility. We may see a day when the rise of the smombies results in the fall of the pedestrians.

Throughout the year, we will highlight these data through brief monthly reports published in the Bulletin. The NTDB 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.

*Fantus RJ. The walking dead. Bull Am Coll Surg. 2016;101(7): 57-58. Available at: Accessed July 15, 2016.

Governors Highway Safety Association. Pedestrian fatalities projected to spike 10% in 2015. Available at: Accessed May 13, 2016.

Governors Highway Safety Association. Pedestrian fatalities by state: 2015 preliminary data. Available at: Accessed May 13, 2016.

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