Do sports utility vehicles (SUVs) and light truck vehicles (LTVs) cause more severe injuries to pedestrians and cyclists than passenger cars in the case of a crash? A systematic review and meta-analysis

Questions In the case of a road traffic crash, do sports utility vehicles (SUVs) and light truck vehicles (LTVs) cause more severe injuries to pedestrians and cyclists than passenger cars? Does any effect differ between adults and children? Design Systematic review and meta-analysis. Data sources MEDLINE, TRID and Global Index Medicus were searched up to September 2024, with no restrictions by setting or language. Inclusion criteria Eligible studies had to compare injury severity between pedestrians and/or cyclists hit by an SUV or LTV versus a passenger car. Only sources using real-world crash data were included. Main outcome measure Injury severity, defined either as ‘fatal versus non-fatal injury’ or as ‘killed or seriously injured (KSI) versus slight injury’. Results 24 studies were included in the meta-analysis. The results were similar between pedestrians and cyclists. When combining pedestrians and cyclists, the pooled odds of KSI versus slight injury if hit by an SUV/LTV versus a passenger car were higher among adults/all-age samples by 1.24 (95% CI 1.15, 1.34) and higher among children by 1.28 (95% CI 1.19, 1.37). The odds of fatal versus non-fatal injury if hit by an SUV/LTV versus a passenger car increased among adults/all-age samples by 1.44 (95% CI 1.33, 1.56) and among children by 1.82 (95% CI 1.57, 2.11; p=0.006 for heterogeneity by age). Conclusion In the case of a crash, SUVs and LTVs cause more severe injuries to pedestrians and cyclists than passenger cars. This effect is larger for fatalities than for KSIs, and the fatality effect is particularly large for children. PROSPERO registration number CRD42024597283. Data are available upon reasonable request. Extracted data and analytical code are available on request from the corresponding author.