Changes in severe injuries of child and adolescent pedestrians in child protection zones after the revision of the Road Traffic Act in Korea: a retrospective nationwide observational study

초록

Purpose: This study aimed to analyze changes in injury severity among child pedestrians following the implementation of the revised Road Traffic Act (the "Minsik Law") in Korea’s child protection zones on March 25, 2020. Methods: We conducted a retrospective analysis using the nationwide Emergency Department-based Injury In-depth Surveillance (EDIIS) database. The pre-amendment period (January 2018 to February 2020; n=1,480) was compared with the post-amendment period (March 2021 to December 2023; n=1,085) for pedestrian accident patients under 13 years of age, applying a 1-year washout period to mitigate the effects of the COVID-19 pandemic. The primary outcome was severe injury, defined as an Injury Severity Score (ISS) of ≥15. Multivariate logistic regression was used for the assessment. Results: A total of 2,565 patients were included. The proportion of severe injuries (ISS ≥15) decreased from 63.1% to 53.6% after the amendment, although this trend did not reach statistical significance (P=0.085). However, after adjustment for age, sex, and other variables, multivariate analysis showed that the post-amendment period was independently associated with a significant 38.4% reduction in the odds of severe injury (adjusted odds ratio, 0.616; P<0.001). A significant shift in the distribution of injury sites was also noted (P<0.005). Conclusions: The revision of the Road Traffic Act was significantly associated with reduced injury severity among child pedestrians in Korea. These findings provide strong evidence supporting the policy’s effectiveness in improving clinical outcomes and strengthening child safety.

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