BACKGROUND: Pedestrian-vehicle crashes are a significant problem in public health. Understanding contributing factors within a specific community helps recognize and target key intervention points. METHODS: Trauma registry analysis included all of the patients treated at a Level I trauma center following pedestrian-motor vehicle collisions from January 1, 2000 to December 31, 2010. Variables examined included patient demographics, timing of collision, abbreviated injury scale score, injury severity score (ISS), hospital and intensive care unit (ICU) length of stay (LOS), and emergency department and hospital disposition. RESULTS: A total of 945 pedestrians were reviewed within the study period. Average age was 46.4+/-19.4 years. One hundred seventy-seven (18.7%) patients were elderly and of the elderly group, 69 (39%) were 80 years of age or greater. The median ISS score was 12, average hospital LOS was 10.8 days and average ICU length of stay was 6.0+/-7.5 days. More elderly patients required admission to the ICU than the nonelderly (61.6% vs 40.2%; P<0.001), and more elderly patients required admission to a skilled nursing facility than nonelderly (42.1% vs. 9%; P< 0.001). The mortality rate for elderly patients was more than double that of nonelderly patients (20.9% vs 9.1%; P<0.001). Pedestrian-motor vehicle collisions occurred disproportionately between the hours of 6 PM and midnight (P< 0.0001). CONCLUSION: Elderly patients struck by a motor vehicle have a mortality rate twice that of the nonelderly and a higher rate of discharge to a skilled nursing facility, despite having a similar injury severity score on admission. This highlights the need for aggressive prevention efforts targeted at the elderly population.