INTRODUCTION

Background

A child protection zone (commonly referred to as a school zone) is a designated section of roadway near facilities with frequent child foot traffic, including kindergartens, elementary schools, private educational institutes (hagwons), and other childcare facilities defined by ordinance. These zones are established to protect children from the risk of traffic accidents [1]. Within these areas, the Road Traffic Act in Korea permits restrictions on vehicle speeds to 30 km/hr or less, and parking and stopping are prohibited in marked sections. However, these regulations were often applied without consistent enforcement. According to a survey on the conditions of child protection zones, 38.7% of drivers were found to be violating these rules [2]. Moreover, fines for violations were equivalent to those on general roads, and the duty of care at crosswalks without traffic signals lacked clear definition.

The Road Traffic Act related to child protection zones was revised after a tragic incident in 2019 in which a 9-year-old child was killed in a traffic accident within a school zone in Chungnam-do. The revised bill was promulgated on December 24, 2019, and took effect on March 25, 2020. Widely known as the "Minsik Law," the amended Act was introduced to prevent child traffic accidents and enhance child safety by reducing fatalities and improving driver awareness.

The amendment consists of two major components. The first is the Partial Amendment to the Road Traffic Act, which includes strengthened enforcement of speed limits, stricter regulation of illegal parking and stopping, and tripled fines compared to those for violations on regular roads. The second is the Amendment to the Act on the Aggravated Punishment, etc. of Specific Crimes, which mandates aggravated punishment for perpetrators who cause death or injury through negligent driving within a child protection zone.

However, since the implementation of the revised law, few studies have examined its impact on the frequency and severity of child pedestrian accidents. Therefore, in this study, we sought to analyze changes in both the frequency and severity of child pedestrian injuries after the amendment.

Objectives

We aimed to compare child pedestrian traffic accidents that occurred before the law’s enforcement (January 1, 2018–February 28, 2020) with those after enforcement (March 1, 2021–December 31, 2023), using data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) database, managed by the Korea Disease Control and Prevention Agency (KDCA).

METHODS

Ethics statement

The study was exempted from deliberation by the Institutional Review Board of Gachon University Gil Medical Center (No. GCIRB2025-283). Informed consent was waived due to the use of deidentified data and the retrospective nature of the study.

Study design and setting

This study utilized data from the EDIIS database, a hospital-based injury surveillance system operated by the KDCA. This retrospective study reviewed medical records of patients under 13 years of age who were registered in the database. The study population consisted of children who visited the emergency room because of a traffic accident involving a collision with a car or motorcycle while walking, during two time periods: before the law’s implementation (January 1, 2018–February 28, 2020) and after the law’s implementation (March 1, 2021–December 31, 2023). Because the academic year in Korea begins in March and ends in February of the following year, and student mobility decreases markedly during school breaks, the washout period was set from March to February to align with the school calendar.

Data collection and measurement

Data were collected for 3,803 patients under 13 years who visited 23 emergency rooms nationwide due to pedestrian traffic accidents. From this total, we excluded 644 cases in which the injury did not occur on a public road and 574 cases in which the other party involved was not a car or motorcycle. An additional 20 cases with unclear injury sites or diagnoses were excluded. Ultimately, 2,565 patients were included and classified into a pre-amendment group (n=1,480) and a post-amendment group (n=1,085) for analysis (Fig. 1).

General characteristics were recorded by sex, age, time of injury, injury severity, whether surgery was performed, emergency room disposition, and injury site. The time of injury was categorized into two groups based on school commute patterns: “school time” (07:00–09:00, 14:00–16:00) and other [3]. Emergency room disposition was classified as discharged, transferred, admitted to a general ward, admitted to an intensive care unit, deceased, or other. Injury sites were categorized as head and neck, chest, abdomen, upper extremities, lower extremities, and other.

To assess injury severity in each group, the Injury Severity Score (ISS) was used. The ISS divides the body into six regions (head/neck, face, chest, abdomen, extremities, external). Injury severity in each region is assigned according to the Abbreviated Injury Scale (AIS), which ranges from 1 (minor) to 6 (maximal). The ISS is calculated by summing the squares of the highest AIS scores from the three most severely injured regions, producing a score from 1 to 75. Patients with an ISS of 15 or higher are classified as having major trauma [4].

Statistical analysis

For statistical analysis, the general characteristics of the pre- and post-amendment groups were compared, and changes in accident frequency and severity were described. Univariate logistic regression was performed, and variables that were statistically significant or considered clinically important were selected for multivariate logistic regression. This analysis examined whether there was a statistically significant change in injury severity among child pedestrian traffic accidents after the legal revision, while adjusting for potential confounders. Variables with a P-value of <0.1 in univariate analysis, as well as variables deemed clinically meaningful by the researchers, were included in the multivariate model. Odds ratios and 95% confidence intervals were calculated, with statistical significance set at P<0.05. IBM SPSS ver. 24.0 (IBM Corp) was used for all analyses.

RESULTS

Table 1 compares the demographic and clinical characteristics of the two groups, comprising a total of 2,565 patients: the pre-amendment group (n=1,480) and the post-amendment group (n=1,085). No statistically significant differences were observed in major demographic variables, including sex distribution, mean age (pre-amendment, 7.08 years vs. post-amendment, 7.34 years), or time of accident (P>0.05). Likewise, no significant differences were identified in the rates of surgical intervention or short-term clinical outcomes such as discharge or hospital admission from the emergency room (P>0.05).

The proportion of major trauma cases, defined as an ISS of ≥15, showed a decreasing trend from 63.1% in the pre-amendment period to 53.6% in the post-amendment period. However, this difference did not reach statistical significance (P=0.085). A statistically significant difference was found in the distribution of injury sites (P<0.005). In particular, the proportion of lower extremity injuries decreased from 41.0% to 34.3% after the law’s revision, whereas the proportion of injuries classified as “other” increased from 4.7% to 11.4%.

Table 2 presents the results of the univariate logistic regression used to evaluate the independent effect of each variable on the outcome. Most variables, including sex, age, time of accident, and primary injury site, did not show a statistically significant association with the outcome (P>0.05). In contrast, the post-amendment period variable demonstrated a highly significant association with the outcome (P<0.001), with an odds ratio calculated at 0.676.

Multivariate logistic regression was conducted to more precisely determine the net effect of the post-amendment period variable while adjusting for potential confounding variables (Table 3). The findings confirmed that even after controlling for key covariates such as age and sex, the post-amendment period variable retained a statistically significant independent association with the outcome (P<0.001). These results indicate that after adjusting for confounding factors, the incidence of major trauma decreased by approximately 38.4% following the law’s revision.

DISCUSSION

The 30 km/hr speed limit in school zones is based on scientific analyses examining the relationship between vehicle speed and the likelihood of severe pedestrian injury. Before the amendment, the speed limit in child protection zones was not uniformly mandated and could range from 30 to 50 km/hr depending on local government guidelines. The revision standardized this limit to 30 km/hr nationwide. Research by the Korea Transportation Safety Authority in 2018 showed that the probability of severe injury for a pedestrian decreases sharply as vehicle speed decreases: 92.6% at 60 km/hr, 72.2% at 50 km/hr, and 15.4% at 30 km/hr [5]. Furthermore, a 2019 international study demonstrated that for every 1 km/hr increase in estimated impact speed, the risk of pedestrian death increases by an average of 11%. That study also reported fatality probabilities of 90% at 80 km/hr, 75% at 69 km/hr, 50% at 59 km/hr, 10% at 37 km/hr, and 5% at 30 km/hr [6]. In Canada, reducing the school zone speed limit from 50 to 30 km/hr resulted in a 12.2 km/hr decrease in mean driving speed and an 11.6 km/hr reduction in the 85th percentile speed. Each 1 km/hr reduction in average speed corresponded to an approximate 4% decrease in deaths and injuries [7]. Korea’s school zone speed limit is grounded in this body of evidence.

Following the 2020 revision of the Road Traffic Act, expectations arose regarding reductions in accident frequency and decreases in injury severity and mortality in child protection zones. However, one earlier study comparing road traffic outcomes in school zones found no significant decrease in child traffic mortality, injury rates, severe injury rates, minor injury rates, or accident incidence after the law’s revision [8]. Another study reported contrasting results, identifying a statistically significant decline in child traffic accidents, especially severe injuries, after the law came into effect [9]. The monthly average number of incidents dropped from 11 before the law to 8 after (P=0.017), and a time-series analysis revealed a statistically significant decrease in the relative risk of all child traffic accidents following the revision (relative risk, 0.987; P=0.002). The total number of child injuries decreased from 40,091 before the law to 32,867 after, and fatalities declined from 116 to 65 [10]. These findings suggest that the revised law contributed to a reduction in child traffic accidents, particularly those involving severe injuries. Nevertheless, the study could not precisely determine injury severity, and its conclusions are considered limited because they were largely based on decreases in incidence.

In our study, the proportion of major trauma patients (ISS ≥15) showed a downward trend from 63.1% before the amendment to 53.6% after the amendment. Although this difference did not reach statistical significance (P=0.085), the trend suggests that the legal revision may have contributed to reducing injury severity. In the multivariate analysis conducted to more accurately clarify the causal relationship, the post-amendment period variable remained statistically significant after adjusting for all key variables that could influence the outcome, including sex, age, and time of accident (P<0.001). This finding indicates that the effect of the legal revision was not restricted to a specific subgroup but was broadly observed across the entire patient population. Notably, the adjusted odds ratio for the post-amendment group was 0.616, which was lower than the value observed in the univariate analysis (0.676). This means that when all other variables are controlled, the probability of major trauma in the post-amendment group is approximately 38.4% lower than in the pre-amendment group. This result suggests that the beneficial impact of the legal revision became more apparent after accounting for confounding factors.

In this study, the time of accident was selected as an important variable associated with pedestrian traffic accidents in school zones. Numerous previous studies have consistently shown that accidents tend to cluster during school commute hours (07:00–09:00 and 14:00–16:00) [11,12]. Statistical data from the Korea Road Traffic Authority and the Korean Ministry of the Interior and Safety indicate that child pedestrian traffic accidents begin increasing around 14:00, when schools dismiss students, and peak around 16:00, with approximately 27% of all casualties occurring in this period [13]. Additionally, 36.9% of traffic accidents involving children aged 12 years and under occurred between 15:00 and 18:00, the hours when both school and private educational institutes typically end, representing the highest proportion. This was followed by evening hours (18:00–21:00) at 26.4%. A study on the Safe Routes to School (SRTS) program specifically analyzed the effectiveness of traffic safety facility improvements during commute times (07:00–09:00, 14:00–16:00). In areas where the program was implemented, the child pedestrian accident rate during these hours significantly decreased from 40.9 per 10,000 in 2001 to 27.4 per 10,000 in 2010 [14]. A recent Korean study further expanded the traditional focus on commute times to examine accident patterns during after-school hours [15]. It emphasized accident risks not only near schools but also around private educational facilities, suggesting that safety policies designed for the home-school route should be broadened to include after-school activity spaces.

In our study, the analysis of accidents by time of day before and after the revision did not show statistically significant differences. In contrast to other countries, many students in Korea attend private educational institutes (hagwons) for educational activities outside standard school commute hours, which may not have been fully accounted for in our analysis. Furthermore, the results may be limited by the lack of adjustment for differences in commute times by age group and for variations in pedestrian traffic patterns between weekdays and holidays.

Children exhibit distinct patterns of injury sites depending on age, reflecting differences in body proportions and center of gravity at various stages of development. Previous research indicates that head and facial injuries are most common among infants and toddlers (1–3 years old) [16,17]. In school-aged children (4 years and older), as height increases, the point of impact with a vehicle shifts to the lower body, resulting in a marked rise in lower extremity fractures (e.g., femur, tibia) and pelvic injuries. In our study, head injuries and lower extremity fractures did not show a statistically significant change in relation to the legal amendment. However, it is notable that the proportion of lower limb injuries in the post-amendment group decreased from 41.0% to 34.3%, while the proportion of injuries categorized as “other,” which are not classified under a specific anatomical site, more than doubled from 4.7% to 11.4%. This shift suggests that the legal revision may have influenced not only the accident rate but also accident patterns or mechanisms of impact. It may be hypothesized that strengthened safety regulations reduced certain types of accidents while increasing other, more minor types of incidents, although this interpretation requires further in-depth research.

Limitations

This study has several limitations. During the study period, the COVID-19 pandemic led to restrictions on school attendance and the widespread adoption of remote learning, significantly reducing overall accident volume. This represents a limitation, as it altered the characteristics of the pre- and post-amendment populations. Additionally, COVID-19 influenced general traffic flow. Reports indicate an approximately 5.6% reduction in overall traffic volume compared with the previous year [18], which may have reduced the student traffic accident rate independently of the “Minsik Law” by decreasing the number of vehicles on the road. Another limitation is the lack of information regarding whether a guardian accompanied the child at the time of the accident. This factor is important because a guardian’s protective actions could influence injury severity, yet it could not be assessed in our dataset. Investigation of the accident location also posed limitations. The data did not clearly differentiate between accidents occurring strictly within child protection zones and those occurring on general roads, which limited the precision of our analysis.

Several follow-up measures have recently been implemented, including the widespread installation of speed enforcement cameras in school zones and the creation of additional no-stopping/no-parking areas. Moreover, pedestrian safety regulations were strengthened in January 2023 with the introduction of a new rule requiring drivers to exercise greater caution when making right turns at intersections. To ensure the stable establishment and sustained effectiveness of these new regulations within school zones, further research will be required. It is essential to conduct studies evaluating the effectiveness of these additional regulations and safety devices. Furthermore, research is needed to determine whether the reduction in traffic accidents is limited to school zones or reflects a broader improvement in driver safety awareness. This will require supplementary analyses comparing changes in traffic accident rates between general roads and child protection zones.

Conclusions

The analysis conducted in this study identified a statistically significant change in the distribution of injury sites among patients before and after the legal revision. More importantly, the multivariate analysis demonstrated that the legal revision itself was an independent and significant factor that reduced the probability of a specific outcome by approximately 38.4%, even after controlling for other variables such as sex and age. These findings provide strong statistical evidence that the amendment had a beneficial effect on patient prognosis and offer important support for the policy’s overall effectiveness.

ARTICLE INFORMATION

Author contributions

Conceptualization: JHJ, SYH; Data curation: JHJ; Formal analysis: SYH, WSC; Methodology: ESR, JYC; Writing–original draft: ESR; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Conflicts of interest

The authors have no conflicts of interest to declare.

Funding

The authors received no financial support for this study.

Data availability

Data analyzed in this study were obtained from the Emergency Department-based Injury In-depth Surveillance (EDIIS) database and are available from the corresponding author upon reasonable request with the permission of the Korea Disease Control and Prevention Agency.

Fig. 1.

Flowchart of the patient selection.

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Figure & Data

References

Citations

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