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Some New Car Assessment Programs (NCAPs) include pedestrian safety ratings based on crash tests. We compared 2,682 real-world Australasian pedestrian injury outcomes with pedestrian safety ratings provided by the Australasian NCAP within the speed limit areas where the collisions occurred. We found that the risk of a pedestrian fatal or severe (involving hospital treatment) injury was considerably reduced for the safest rated vehicles studied, but only in speed limit areas of 40km/h or less. From the perspective of promoting a safer system for pedestrians, these results imply that both lowered speed limits and a safer vehicle fleet are required.