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Background: Allowing contraflow cycling on one-way streets has been reported to reduce crash risks in Belgium and the United Kingdom. Similarly, walking against traffic on roadways without sidewalks substantially improves pedestrian safety. This study examined fatalities and head injuries sustained by pedestrians in against-traffic and with-traffic crashes.Methods: Using police-reported crash data in Taiwan between 2011 and 2016, fatalities and head injuries were compared for pedestrians involved in against-traffic and with-traffic crashes.Results: Of the 14,382 pedestrians involved in crashes, 10,749 and 3633 pedestrians in with-traffic and against-traffic crashes, respectively, were reported. Compared with pedestrians involved in against-traffic crashes, those in with-traffic crashes were more likely to sustain fatalities and head injuries. Results of logistic regression models revealed several influential factors on pedestrian fatalities and head injuries, including elderly pedestrians, male drivers, intoxicated drivers, rural roadways, unlit streets in darkness, limited sight distance, adverse weather conditions, midnight hours, and a heavy vehicle as the crash partner.Conclusions: Pedestrians in with-traffic crashes were more likely to sustain fatalities and head injuries compared with those in against-traffic crashes. Furthermore, the negative effect of walking with traffic on injuries was more pronounced in reduced-visibility conditions. [ABSTRACT FROM AUTHOR]