Sex-related disparities in vehicle crash injury and hemodynamics.

Objective: Multiple studies evaluate relative risk of female vs. male crash injury; clinical data may offer a more direct injury-specific evaluation of sex disparity in vehicle safety. This study sought to evaluate trauma injury patterns in a large trauma database to identify sex-related differences in crash injury victims. Methods: Data on lap and shoulder belt wearing patients age 16 and up with abdominal and pelvic injuries from 2018 to 2021 were extracted from the National Trauma Data Bank for descriptive analysis using injuries, vital signs, International Classification of Disease (ICD) coding, age, and injury severity using AIS (Abbreviated Injury Scale) and ISS (Injury Severity Score). Multiple linear regression was used to assess the relationship of shock index (SI) and ISS, sex, age, and sex*age interaction. Regression analysis was performed on multiple injury regions to assess patient characteristics related to increased shock index. Results: Sex, age, and ISS are strongly related to shock index for most injury regions. Women had greater overall SI than men, even in less severe injuries; women had greater numbers of pelvis and liver injuries across severity categories; men had greater numbers of injury in other abdominal/pelvis injury regions. Conclusions: Female crash injury victims' tendency for higher (AIS) severity of pelvis and liver injuries may relate to how their bodies interact with safety equipment. Females are entering shock states (SI > 1.0) with lesser injury severity (ISS) than male crash injury victims, which may suggest that female crash patients are somehow more susceptible to compromised hemodynamics than males. These findings indicate an urgent need to conduct vehicle crash injury research within a sex-equity framework; evaluating sex-related clinical data may hold the key to reducing disparities in vehicle crash injury.

Small Female Occupant Response in Reclined and Upright Seated Postures in Frontal Impacts.

The objective of this study was to compare the kinematics of the head-neck, torso, pelvis, and lower extremities and document injuries and their patterns to small female occupants in frontal impacts with upright and reclined postures using an experimental model. Six postmortem human surrogates (PMHS) with a mean stature of 154 ± 9.0 cm and mass of 49 ± 12 kg were equally divided between upright and reclined groups (seatback: 25 deg and 45 deg), restrained by a three-point integrated belt, positioned on a semirigid seat, and exposed to low and moderate crash velocities (15 km/h and 32 km/h respectively). The response between the upright and reclined postures was similar in magnitude and curve morphology. While none of the differences were statistically significant, the thoracic spine demonstrated increased downward (+Z) displacement, and the head demonstrated an increased horizontal (+X) displacement for the reclined occupants. In contrast, the upright occupants showed a slightly increased downward (+Z) displacement at the head, but the torso displaced primarily along the +X direction. The posture angles between the two groups were similar at the pelvis and different at the thorax and head. At 32 km/h, both cohorts exhibited multiple rib failure, with upright specimens having a greater number of severe fractures. Although MAIS was the same in both groups, the upright specimens had more bi-cortical rib fractures, suggesting the potential for pneumothorax. This preliminary study may be useful in validating physical (ATDs) and computational (HBMs) surrogates.

Pelvis-Sacrum-Lumbar Spine Injury Characteristics From Underbody Blast Loading.

INTRODUCTION: Combat-related injuries from improvised explosive devices occur commonly to the lower extremity and spine. As the underbody blast impact loading traverses from the seat to pelvis to spine, energy transfer occurs through deformations of the combined pelvis-sacrum-lumbar spine complex, and the time factor plays a role in injury to any of these components. Previous studies have largely ignored the role of the time variable in injuries, injury mechanisms, and warfighter tolerance. The objective of this study is to relate the time or temporal factor using a multi-component, pelvis-sacrum-lumbar spinal column complex model. MATERIALS AND METHODS: Intact pelvis-sacrum-spine specimens from pre-screened unembalmed human cadavers were prepared by fixing at the superior end of the lumbar spine, pelvis and abdominal contents were simulated, and a weight was added to the cranial end of the fixation to account for torso effective mass. Prepared specimens were placed on the platform of a custom vertical accelerator device and aligned in a seated soldier posture. An accelerometer was attached to the seat platen of the device to record the time duration to peak velocity. Radiographs and computed tomography images were used to document and associate injuries with time duration. RESULTS: The mean age, stature, weight, body mass index, and bone density of 12 male specimens were as follows: 65 ± 11 years, 1.8 ± 0.01 m, 83 ± 13 kg, 27 ± 5.0 kg/m2, and 114 ± 21 mg/cc. They were equally divided into short, medium, and long time durations: 4.8 ± 0.5, 16.3 ± 7.3, and 34.5 ± 7.5 ms. Most severe injuries associated with the short time duration were to pelvis, although they were to spine for the long time duration. CONCLUSIONS: With adequate time for the underbody blast loading to traverse the pelvis-sacrum-spine complex, distal structures are spared while proximal/spine structures sustain severe/unstable injuries. The time factor may have implications in seat and/or seat structure design in future military vehicles to advance warfighter safety.

Analysis of experimental injuries to obese occupants with different postures in frontal impact.

The objective of the present study was to analyze injuries and their patterns to obese occupants in frontal impacts with upright and reclined postures using experimental data. Twelve obese post-mortem human subjects (PMHS) were positioned on a sled buck with seatback angles of 250 or 450 from the vertical, termed as upright and reclined postures. They were restrained with a seat belt and pretensioner. Frontal impact tests were conducted at 8.9 or 13.9 m/s, termed as low and high velocities. After the test, x-rays and CTs were taken, and an autopsy was conducted. The Maximum AIS (MAIS) and Injury Severity Score (ISS) were calculated, and injury patterns were analyzed. The mean age, stature, total body mass, and body mass indexes were 67 years, 112 kg, and 1.7 m, and 38 kg/m2. None of these parameters were statistically significantly different between any groups. The mean thickness of the soft tissues in the left anterior lateral, central, and right anterior lateral aspects were 44 mm, 24 mm, and 46 mm. In the low-velocity tests, the ISS data were 9, 18, and 9 for the upright, and 9, 9, and 4 for the reclined specimens, and in the high velocity tests, they were 29, 17, and 27 for the upright, and 27, 13, and 27 for the reclined postures. Other data are given in the paper. For both postures at the low velocity, injuries were concentrated at one body region, and the ISS data were in the mild category; in contrast, at the high velocity, other body regions also sustained injuries, and the ISS data were in the major trauma category. From MAIS perspectives, injuries to obese occupants did not change between postures and were independent of the energy input to the system. The association of chest with pelvis injuries in upright and reclined postures to obese occupants may have additional consequences following the initial injury to this group of our population.

Comparison of Axial Force Attenuation Characteristics in Two Different Lower Extremity Anthropomorphic Test Devices.

INTRODUCTION: Any type of boot or footwear is designed to attenuate and distribute loading to the bottom of the foot. Anthropomorphic test device (ATDs) are used to assess potential countermeasures against these loads. The specific aims of this study were to compare and quantify force attenuation characteristics as a function of input energy for Hybrid-III and Mil-Lx ATD human surrogates. MATERIALS AND METHODS: Two lower leg ATD surrogates (Mil-Lx and Hybrid-III) were tested to investigate the influence of a commercially available military boot on lower extremity force response and assess such differences against previously published postmortem human surrogate studies. The testing apparatus impacted the bottom of the foot using a rigid plate at velocities from 2 to 10 m/s. Tests were conducted on each ATD to obtain axial force response with and without boots as a function of input energy. RESULTS: Peak forces ranged from 1 to 16.4 kN for the Hybrid-III, and 1 to 8.4 kN for the Mil-Lx for similar input conditions. The average force attenuation for the Hybrid-III at upper and lower load cells was 71% (59%-80%) and 70% (58%-78%). The average attenuation for the Mil-Lx at upper and lower load cells was 20% (13%-28%) and 37% (36%-37%), respectively. At the knee load cell, the attenuated peak loads ranged from 62% to 81% for the Hybrid-III and 16% to 30% for the Mil-Lx. CONCLUSIONS: Force attenuation characteristics in the booted vs unbooted configuration of the Mil-Lx were significantly different than force attenuation characteristics of the H3 and may better represent in vivo forces during vertical impact injuries, such as IED blasts. Hence for military relevant applications where boots are used, the Mil-Lx may provide a more conservative evaluation of lower extremity protection systems.

Effect of muscle activation scheme in human head-neck model on estimating cervical spine ligament strain from military volunteer frontal impact data.

Cervical spine (c-spine) injuries are a common injury during automobile crashes. The objective of this study is to verify an existing head-neck (HN) finite element model with military volunteer frontal impact kinematics by varying the muscle activation scheme from previous literature. Proper muscle activation will allow for accurate percent elongation (strain) of the c-spine ligaments and will serve to establish ligamentous response during non-injury frontal impacts. Previous human research volunteer (HRV) frontal impact sled tests reported kinematic data that served as the input for HN model simulation. Peak sled acceleration (PSA) was varied between 10G and 30G for HRVs. Muscle activation was shifted to begin at 0 ms at start of impact to allow for proper muscle contraction in the HN model. Then, extensor muscle activation magnitude was varied between 20 and 100% to determine the proper activation necessary to match kinematic outputs from the model with experimental results. The model was validated against 10G test recorded response. Ligament strain was measured from multiple ligaments along the c-spine once the model was verified. The 40% activated extensor muscle scheme was deemed the most biofidelic, with CORA scores of 0.743 and 0.686 for head X linear acceleration and angular Y acceleration for 10G pulse. All PSA groups scored well with this muscle activation. Most ligaments were buffered well by the active simulation, with only the interspinous ligament nearing physiologic injury. With the HN model verified against additional kinematic data, simulations with higher accelerations to predict areas of injury in real life crash scenarios are possible.

Temporal corridors of forces and moments, and injuries to pelvis-lumbar spine in vertical impact simulating underbody blast.

Pelvis and lumbar spine fractures occur in falls, motor vehicle crashes, and military combat events. They are attributed to vertical impact from the pelvis to the spine. Although whole-body cadavers were exposed to this vector and injuries were reported, spinal loads were not determined. While previous studies determined injury metrics such as peak forces using isolated pelvis or spine models, they were not conducted using the combined pelvis-spine columns, thereby not accounting for the interaction between the two body regions. Earlier studies did not develop response corridors. The study objectives were to develop temporal corridors of loads at the pelvis and spine and assess clinical fracture patterns using a human cadaver model. Vertical impact loads were delivered at the pelvic end to twelve unembalmed intact pelvis-spine complexes, and pelvis forces and spinal loads (axial, shear and resultant and bending moments) were obtained. Injuries were classified using clinical assessments from post-test computed tomography scans. Spinal injuries were stable in eight and unstable in four specimens. Pelvis injuries included ring fractures in six and unilateral pelvis in three, sacrum fractures in ten, and two specimens did not sustain any injuries to the pelvis or sacrum complex. Data were grouped based on time to peak velocity, and ± one standard deviation corridors about the mean of the biomechanical metrics were developed. Time-history corridors of loads at the pelvis and spine, hitherto not reported in any study, are valuable to assess the biofidelity of anthropomorphic test devices and assist validating finite element models.

Surface wave analysis of the skin for penetrating and non-penetrating projectile impact in porcine legs.

Secondary blast injuries may result from high-velocity projectile fragments which ultimately increase medical costs, reduce active work time, and decrease quality of life. The role of skin penetration requires more investigation in energy absorption and surface mechanics for implementation in computational ballistic models. High-speed ballistic penetration studies have not considered penetrating and non-penetrating biomechanical properties of the skin, including radial wave displacement, resultant surface wave speed, or projectile material influence. A helium-pressurized launcher was used to accelerate 3/8″ (9.525 mm) diameter spherical projectiles toward seventeen whole porcine legs from seven pigs (39.53 ± 7.28 kg) at projectile velocities below and above V50. Projectiles included a mix of materials: stainless steel (n = 26), Si3N4 (n = 24), and acetal plastic (n = 24). Tracker video analysis software was used to determine projectile velocity at impact from the perpendicular view and motion of the tissue displacement wave from the in-line view. Average radial wave displacement and surface wave speed were calculated for each projectile material and categorized by penetrating or non-penetrating impacts. Two-sample t-tests determined that non-penetrating projectiles resulted in significantly faster surface wave speeds in porcine skin for stainless steel (p = 0.002), plastic (p = 0.004), and Si3N4 ball bearings (p = 0.014), while ANOVA determined significant differences in radial wave displacement and surface wave speed between projectile materials. Surface wave speed was used to quantify mechanical properties of the skin including elastic modulus, shear modulus, and bulk modulus during ballistic impact, which may be implemented to simulate accurate deformation behavior in computational impact models.

Occupant Injury and Response on Oblique-Facing Aircraft Seats: A Computational Study.

Increased interest in the airline industry to enhance occupant comfort and maximize seating density has prompted the design and installation of obliquely mounted seats in aircraft. Previous oblique whole-body sled tests demonstrated multiple failures, chiefly distraction-associated spinal injuries under oblique impacts. The present computational study was performed with the rationale to examine how oblique loading induces component level responses and associated injury occurrence. The age-specific human body model (HBM) was simulated for two oblique seating conditions (with and without an armrest). The boundary conditions consisted of a 16 g standard aviation crash pulse, 45 deg seat orientation, and with restrained pelvis and lower extremities. The overall biofidelity rating for both conditions ranged from 0.5 to 0.7. The validated models were then used to investigate the influence of pulse intensity and seat orientation by varying the pulse from 16 g to 8 g and seat orientation from 0 deg to 90 deg. A total of 12 parametric simulations were performed. The pulse intensity simulations suggest that the HBM could tolerate 11.2 g without lumbar spine failure, while the possibility of cervical spine failure reduced with the pulse magnitude <9.6 g pulse. The seat orientation study demonstrated that for all seat angles the HBM predicted failure in the cervical and lumbar regions at 16 g; however, the contribution of the tensile load and lateral and flexion moments varied with respect to the change in seat angle. These preliminary outcomes are anticipated to assist in formulating safety standards and in designing countermeasures for oblique seating configurations.

Influence of bending pre-load on the tensile response of the lumbar spine.

Previous full body cadaver testing has shown that both obliquely oriented seats in survivable aircraft crashes and far-side oblique crashes in vehicles present distinctive occupant kinematics that are not yet well understood. Knowledge surrounding how these loading scenarios affect the lumbar spine is particularly lacking as there exists minimal research concerning oblique loading. The current study was created to evaluate a novel experimental method through comparison with existing literature, and to examine the impact of a static bending pre-load (posture) on the load-displacement response for the whole lumbar spine loaded in non-destructive axial distraction. T12-S1 lumbar spines were tested in tension to 4 mm of displacement while positioned in one of three pre-load postures. These postures were: the spine's natural, unloaded curvature (neutral), flexed forward (flexed), and combined flexion and lateral bending (oblique). Deviations from a neutral spine position were shown to significantly increase peak loads and tensile stiffness. The presence of a flexion pre-load caused statistically significant increases in tensile stiffness, tensile force, and bending moments. The addition of a lateral bending pre-load to an already flexed spine did not significantly alter the tensile response. However, the flexion moment response was significantly affected by the additional postural pre-load. This work indicates that the initial conditions of distraction loading significantly affect lumbar spine load response. Therefore, future testing that seeks to emulate crash dynamics of obliquely seated occupants must account for multi-axis loading.

Comparison of small female occupant model responses with experimental data in a reclined posture.

Objective: The objective of the current study was to compare the GHBMC female model responses with in-house sled test data for three small female post mortem human surrogates (PMHS) at 32 km/h and a seatback recline angle of 45 degrees. The kinematics and the seatbelt forces were used to compare the female PMHS and model responses. The study aimed to identify updates that may be needed to the model.Methods: In-house experimental sled test kinematic and seatbelt response data for the small females were obtained. The 5th female GHBMC was simulated with the same boundary conditions as in the experiments. In addition, using the PMHS computed tomography (CT) and test environment scans, the female model geometry was updated to a subject-specific model for one of the specimens, and the models were simulated to obtain 5th female and subject-specific model responses. The kinematic response and the seatbelt forces for the two models were compared with the average of the three experimental data.Results: The head, T8 and L4 excursions, head and pelvis accelerations and seatbelt forces for the two female models were compared with the experimental data. The model responses were in agreement with the PMHS; however, the subject-specific model showed a closer agreement with the kinematic response. The subject-specific model did not submarine as in the experiments, whereas the 5th female model submarined. However, the subject-specific model showed 20% higher seatbelt forces than the PMHS.Conclusion: This study showed that anthropometric differences may significantly alter occupant kinematics in reclined posture and need to be incorporated to investigate kinematics and injury mechanisms. The next step of the study involves incorporating age-specific material changes and investigating the subject-specific injury mechanisms. The results will be useful to develop countermeasures for autonomous vehicles.

Loading rate effect on tradeoff of fractures from pelvis to lumbar spine under axial impact loading.

Objectives: The transmission of impact loading from the seat-to-pelvis-to-lumbar spine in a seated occupant in automotive and military events is a mechanism for fractures to these body regions. While postmortem human subject (PMHS) studies have replicated fractures to the pelvis or lumbar spine using isolated/component models, the role of the time factor that manifests as a loading rate issue on injuries has not been fully investigated in literature. The objective of this study was to explore the hypothesis that short duration pulses fracture the pelvis while longer pulses fracture the spine, and intermediate pulses involve both components.Methods: Unembalmed PMHS thoracolumbar spine-pelvis specimens were fixed at the superior end, and a six-axis load cell was attached. The specimens were mounted on a vertical accelerator, and noninjury and injury tests were conducted by applying short, medium, or long pulses with 5, 15, or 35 ms durations, respectively. Peak axial, shear and resultant forces were obtained. Injuries were documented using posttest x-ray and computed tomography images and scaled using the AIS (2015).Results: The mean age, stature, weight, body mass index, and BMD of twelve specimens were 64.8 ± 11.4 years, 1.8 ± 0.01 m, 83 ± 13 kg, 26.7 ± 5.0 kg/m2, and 114.5 ± 21.3 mg/cc, respectively. For the short, long, and medium duration pulses, the mean resultant forces were 5.6 ± 0.9 kN, 5.9 ± 0.94 kN, and 5.4 ± 1.8 kN, and time durations were 4.8 ± 0.5 ms, 16.3 ± 7.3 ms, and 34.5 ± 7.5 ms, respectively. For the short pulse, pelvis injuries were more severe in 3 out 4 specimens, for the medium pulse, they were distributed between the pelvis and spine, and for the long pulse, spine injuries were more severe in 3 out of 4 specimens.Conclusions: While acknowledging the limitations of the sample size, the results of this study support the hypothesis of the time variable in the tradeoff between pelvis and spine injuries with pulse duration. The tradeoff pattern is attributed to mass recruitment: short pulse biases injuries to pelvis while limiting spinal injuries, and the opposite is true for the longer pulse, thus supporting the hypothesis. It is important to account for the time variable in injury analysis.

Calcaneus fracture pattern and severity: Role of local trabecular bone density.

Calcaneus fracture is the most common tarsal bone fracture and is associated with external loads resulting from vehicle crashes, under body blasts, or sports. Almost 50% of weight bearing by the foot occurs through the calcaneus and its surgical fixation remains a challenging procedure. Postmortem human subjects were used to measure the regional trabecular BMD of the calcaneus. Mean age, height and weight of the included 14 specimens was 69 years, 177 cm and 80 kg respectively. Using a custom mode within Quantitative Computed Tomography clinical software; calcaneal trabecular BMD in the anterior and posterior regions was quantified. Tolerance data and calcaneus fracture patterns were also available for these specimens from previous tests. The posterior region of the calcaneus had a higher mean BMD (114 mg/cc) than the anterior region (81 mg/cc). These BMD differences also paralleled injury outcome of specimens from axial loading with 50% of specimens resulting in high severity anterior region calcaneal fractures and 36% of specimens resulting in low severity posterior calcaneal fractures. These findings may be reflective of the lower BMD in the anterior region, although the load was uniformly distributed across the plantar surface of the foot. Severity of fracture was greater (intraarticular/crush) in the anterior region as compared to fractures of the posterior region. The BMD ratio between anterior and posterior was significant (p = 0.02) between anterior region fractures and posterior region fractures. The ratio parameter may indicate that the disparity in trabecular BMD between anterior and posterior calcaneus regions is more important in predicting injury outcome than the absolute BMD value of each region.

Repeated measures analysis of projectile penetration in porcine legs as a function of storage condition.

Buried blast explosions create small projectiles which can become lodged in the tissue of personnel as far away as hundreds of meters. Without appropriate treatment, these lodged projectiles can become a source of infection and prolonged injury to soldiers in modern combat. Human cadavers can be used as surrogates for living humans for ballistic penetration testing, but human cadavers are frozen during transport and storage. The process of freezing and thawing the tissue before testing may change the biomechanical properties of the tissue. The goal of the current study was to understand penetration threshold differences between fresh, refrigerated, and frozen tissue and investigate factors that may contribute to these differences. A custom-built pneumatic launcher was used to accelerate 3/16″ stainless steel ball bearings toward porcine legs that were either tested fresh, following refrigerated storage, or following frozen storage. A generalized linear mixed model, accounting for within-animal dependence, owing to repeated observations, was found to be the most appropriate for these data and was used for analysis. The "generalized" model accommodated non-continuous observations, provided a straight-forward way to implement the repeated measures, and provided a risk estimate for projectile penetration. Both storage condition (p = 0.48) and leg (p = 0.07) were shown to be not significant and the confidence intervals for those variables were overlapping. As all covariates were found to be non-significant, a single model containing all impacts was used to develop a V50, or velocity at which 50% of impacts are expected to penetrate. From this model, 50% probability of penetration occurs at 137.3 m/s with 95% confidence intervals at 132.0 and 144.0 m/s. In this study, the fresh legs and previously frozen legs allowed penetration at similar velocities indicating that previously frozen legs were acceptable surrogates for fresh legs. This study only compared the penetration threshold in tissues that had been stored in differing conditions. To truly study penetration, more conditions will need to be studied including the effects of projectile mass and material, the effects of projectile shape, and the effects of clothing or protective layers on penetration threshold.

Cervical spine degeneration specific segmental angular rotational and displacements: A quantitative study.

BACKGROUND: The objective of the present isolated spine study was to evaluate the kinematic differences between groups of normal and degenerated cervical spine specimens. Previous studies on cervical spine degeneration support the existence of the unstable phase during the degeneration process; however, there is a lack of quantitative data available to fully characterize this early stage of degeneration. METHOD: For this effort five degenerated and eight normal cervical spines (C2-T1) were isolated and were subject to pure bending moments of flexion, extension, axial rotation and lateral bending. The specimen quality was assessed based on the grading scale. In the present study, the degeneration was at the C5-C6 level. A four-camera motion analysis system was used to measure the overall primary and segmental motions. FINDING: In the extension mode, the degenerated group demonstrated a significant larger angular rotation as well as antero-posterior displacement at the degenerated level (C5-C6). In contrast, in flexion mode, the degenerated group measured a drastic decrease in angular rotation, at the adjacent level (C6-C7). In other modes of loading as well as in other segmental levels, the degenerated group had similar segmental motion as the normal group. INTERPRETATION: These preliminary results provide single level degeneration specific cervical spine kinematics. The finding demonstrates the influence of degeneration on the kinematics of the normal sub adjacent segment. The degenerated group observed larger translation displacement in the extension mode, which would potentially be a critical parameter in assisting early detection of cervical spine spondylosis with just a functional X-ray scan.

Obese Occupant Response in Reclined and Upright Seated Postures in Frontal Impacts.

The American population is getting heavier and automated vehicles will accommodate unconventional postures. While studies replicating mid-size and upright fore-aft seated occupants are numerous, experiments with post-mortem human subjects (PMHS) with obese and reclined occupants are sparse. The objective of this study was to compare the kinematics of the head-neck, torso and pelvis, and document injuries and injury patterns in frontal impacts. Six PMHS with a mean body mass index of 38.2 ± 5.3 kg/m2 were equally divided between upright and reclined groups (seatback: 23°, 45°), restrained by a three-point integrated belt, positioned on a semi-rigid seat, and exposed to low and moderate velocities (15, 32 km/h). Data included belt loads, spinal accelerations, kinematics, and injuries from x-rays, computed tomography, and necropsy. At 15 km/h speed, no significant difference in the occupant kinematics and evidence of orthopedic failure was observed. At 32 km/h speed, the primary difference between the cohorts was significantly larger Z displacements in the reclined occupant at the head (190 ± 32 mm, vs. 105 ± 33 mm p < 0.05) and femur (52 ± 18 mm vs. 30 ± 10 mm, p < 0.05). All the moderate-speed tests produced at least one thorax injury. Rib fractures were scattered around the circumference of the rib-cage in the upright, while they were primarily concentrated on the anterior aspect of the rib-cage in two reclined specimens. Although MAIS was the same in both groups, the reclined specimens had more bi-cortical rib fractures, suggesting the potential for pneumothorax. While not statistical, these results suggest enhanced injuries with reclined obese occupants. These results could serve as a data set for validating the response of restrained obese anthropometric test device (ATDs) and computational human body models.

Belt-induced abdominal injuries in recent frontal impact CIREN cases.

OBJECTIVE: The objective is to report sex-related variation in 3-point belt-related abdominal injuries in Crash Injury Research Engineering Network (CIREN) cases. METHODS: A query of CIREN cases was made for those with the highest ranked Collision Deformation Classification (CDC) to the front plane, a principal direction of force (PDOF) ±20° from 0°, and Abbreviated Injury Scale (AIS) 2+ abdomen injuries attributed to the seat belt. Patterns of injury were categorized as above the crest of the ilium, injuries below the crest of the ilium, and injuries above and below the ilium. This was done in the context of autonomous vehicle occupant kinematics testing results. Twelve 5th and 95th percentile 3-point belt-restrained postmortem human subjects were subjects; test speeds and recline angles varied. Abdomen injuries were anticipated; none were observed. RESULTS: Thirty-five occupants with belt-related abdominal injuries were identified. Seventeen case occupants sustained an injury only within the pelvic contents: 5 women and 12 men. Nine of the 17 were at or above the 81st percentile for height, 13 were between the 62nd and 80th percentile for height, and 4 were less than the 50th percentile for height. CONCLUSIONS: The stature component of the body mass index (BMI) appears to be a plausible candidate for an independent variable that is a contributing factor explaining the incidence of pelvic contents injuries when a 3-point belt-restrained occupant is involved in a frontal impact.

Importance of neural foraminal narrowing in lumbar spine fractures of low AIS severity.

OBJECTIVE: In recent years, based on injuries predicted using machine learning, there have been efforts to reduce imaging performed on trauma patients. While useful, such efforts do not incorporate results from studies investigating the pathophysiology of traumatic events. The objective of this study was to identify potentially symptomatic vertebral foramen narrowing in the presence of minor to moderate (AIS ≤ 2 levels of severity) thoracolumbar fractures sustained in motor vehicle crashes (MVCs). METHODS: Hospital records and images of patients admitted to a Level One trauma center between the years 2014 and 2018 with the diagnosis of thoracolumbar fracture were reviewed. Spinal injuries were scored using the AIS v2015. In addition, the geometry of the neural foramina, particularly the height of the foramina and intervertebral disk at the posterior region, were measured using reconstructed sagittal computed tomography (CT) images. The criteria for foraminal narrowing were associated with <15 mm for the foraminal height and <4 mm for the height of the posterior disk. RESULTS: 24 patients with MVCs associated thoracolumbar fractures, who met both the clinical and imaging criteria for radiculopathy and foraminal narrowing without spinal cord injury, were considered for the present clinical study. 54% of the total lumbar fracture cases reported were rated as AIS 2 injuries. AIS ≥ 3 cases reported 50% narrowing of foramen, which was expected. However, it was surprising to note that the AIS 2 cases also sustained foraminal stenosis, narrowing ranging from 13% to 20%. CONCLUSIONS: Low severity (AIS ≤ 2) injuries were often found to be associated with foraminal narrowing leading to clinical complaints. While the present clinical study cannot determine if narrowing existed prior to the trauma, they were certainly asymptomatic prior to the trauma. The present findings emphasize the need for detailed imaging in all instances of thoracolumbar trauma, as clinically significant nerve compression may occur even with modest vertebral body injury.

Delta-v slope as an indicator of injury.

OBJECTIVE: This study's objective was to examine a crash severity characteristic and the relationship as an indicator of abdominal injury causation. METHODS: Data were analyzed from 23 CIREN case vehicles involved in a frontal type collision, had an AIS 2+ abdominal injury, and contained an electronic data recorder (EDR) download. Data was downloaded from the NHTSA and IIHS crash test databases for comparison. Data was run through a MATLAB algorithm calculating the maximum velocity-time profile slope. This data was compared to the available crash tests. RESULTS: The CIREN vehicle EDR velocity-time slopes ranged from 233 m/s2 to 434 m/s2 for crashes with a delta-v range of 42 km/h to 77 km/h. NHTSA NCAP comparable data was available for all cases, and the slopes ranged from 263 m/s2 to 405 m/s2 calculated from the collected accelerometer. Three comparable tests were available from the IIHS database and the calculated slopes ranged from 252 m/s2 to 298 m/s2. Four test vehicles had EDR data, two each from NHTSA and IIHS and slopes ranged from 245 m/s2 to 281 m/s2. The crash test EDRs slope calculations were lower than the accelerometer data. Nine of the 12 case vehicles had slope values lower than the comparable NCAP accelerometer velocity-time slopes. CONCLUSIONS: Vehicle velocity-time profile can be beneficial to examine the characteristics of crash severity and potential injury. This small sample of field crashes did not indicate a clear relationship of abdominal injury related to crash severity measured by the EDR delta-v slope. EDR results can be considered when determining crash severity, but the limitations need to be understood.