The number of traffic deaths in Japan was 4,612 in 2011. Looking at the road accident fatalities, it revealed that pedestrians accounted for the highest number in 2011 (1,686, 36.6%). To develop safety countermeasures to decrease the severity of injuries and to reduce the number of deaths in traffic accidents, the detailed characteristics of pedestrian injury in vehicle-to-pedestrian crashes are necessary. The purpose of this study is to understand the scenarios of vehicle accidents in which pedestrians suffer fatal injuries. In the present study, we investigated the characteristics of pedestrian injuries in fatal crashes from accident analyses and compared them to head injury severity levels in impact tests against a road pavement and vehicle contact surfaces. In the accident analyses, we investigated the main body regions injured, that is, the most serious extent of injuries over the whole body of pedestrians by using macro vehicle-pedestrian accident data from database of the Institute for Traffic Accident Research and Data Analysis (ITARDA) of Japan. In comparing the differences in injury frequencies for various body regions between 1999 and 2009, it is noted that the frequencies of pedestrian fatalities due to head injuries were significantly reduced. The result indicated that even though head injuries were the most frequent cause of pedestrian fatalities in traffic accidents, the introduction of pedestrian head protection regulation in Japan in 2005 could be considered effective in reducing fatal head injuries. On the other hand, the frequencies of pedestrian fatalities due to hip injuries increased significantly in sedans, light passenger cars, and light cargo vans.Using the macro accident data in 2009, we investigated the frequency of pedestrian fatalities by gender, age group, vehicle travel speed, and fatal head injuries due to vehicle impacts or road pavement impacts. The results also indicated that the frequencies of female pedestrian fatalities due to hip injuries were significantly higher than those of males. Additionally, the results showed that the frequency of pedestrian fatalities due to hip injuries for the age group of over 65 years was significantly higher than that of the industrial age group (aged 13-59). Focusing on the frequency of pedestrian fatalities due to hip injuries in all age groups, vehicle travel speed appeared likely not to be an extremely important factor in increasing fatal hip injuries. In examining the differences in the frequency of fatal head injuries due to contacts with vehicles or road pavements, it is noted that injury frequency in crashes involving vehicles travelling at high speeds were significantly higher than those at lower speeds for pedestrians over 60 years of age.Focusing on head injury severity levels in impact tests against a road and vehicle surfaces using an adult pedestrian headform impactor, the impacts against a road pavement (HIC 6525) was considered to be more severe than those against vehicle front components with high stiffness (HIC from 2600 to 4032).