Examination of Crash Injury Risk as a Function of Occupant Demographics.

The objectives of this study were to provide insights on how injury risk is influenced by occupant demographics such as sex, age, and size; and to quantify differences within the context of commonly-occurring real-world crashes. The analyses were confined to either single-event collisions or collisions that were judged to be well-defined based on the absence of any significant secondary impacts. These analyses, including both logistic regression and descriptive statistics, were conducted using the Crash Investigation Sampling System for calendar years 2017 to 2021. In the case of occupant sex, the findings agree with those of many recent investigations that have attempted to quantify the circumstances in which females show elevated rates of injury relative to their male counterparts given the same level bodily insult. This study, like others, provides evidence of certain female-specific injuries. The most problematic of these are AIS 2+ and AIS 3+ upper-extremity and lower-extremity injuries. These are among the most frequently observed injuries for females, and their incidence is consistently greater than for males. Overall, the odds of females sustaining MAIS 3+ (or fatality) are 4.5% higher than the odds for males, while the odds of females sustaining MAIS 2+ (or fatality) are 33.9% higher than those for males. The analyses highlight the need to carefully control for both the vehicle occupied, and the other involved vehicle, when calculating risk ratios by occupant sex. Female driver preferences in terms of vehicle class/size differ significantly from those of males, with females favoring smaller, lighter vehicles.

A comparison of injuries, crashes, and outcomes for pediatric rear occupants in traffic motor vehicle collisions.

BACKGROUND: This study was initiated was initiated to describe pediatric rear-occupant motor vehicle collision (MVC) injuries, including injury patterns and outcomes as well as characteristics associated with severe injury to the head and abdomen. METHODS: A retrospective cohort of severely injured (Injury Severity Score [ISS] > 12) pediatric (age <18 years) patients involved in a traffic MVC as a rear occupant and treated at one of two Ontario trauma centers (2001-2010) was studied was studied. Demographic, injury, crash and outcome data were obtained from the trauma registries. Data were statistically compared by two pediatric age groups: children (0-8 years; requiring a child or booster seat) versus adolescents (9-17 years; requiring a lap-shoulder belt). RESULTS: There were 36 children (34%) and 70 adolescents (66%) severely injured as rear occupants in MVCs. Despite similar ISS (p = 0.716) and mortality rates (p = 0.680) between age groups, there were significant differences in injury patterns and risk factors. Children were more likely to have severe head injuries (78% vs. 39%, p < 0.001) associated with a lack of an age-appropriate child restraints (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1-10.8; p = 0.029), middle seating (OR, 6.2; 95% CI, 1.5-26.1; p = 0.013), and side-impact crashes (p = 0.007). Adolescents were more likely to have severe abdominal injuries (23% vs. 6%, p < 0.001) associated with the use of lap-shoulder belts (OR, 3.8; 95% CI, 1.1-13.3; p = 0.034), single-vehicle MVCs (p = 0.007), and vehicle extrications (p = 0.035). CONCLUSION: While safer than the front seat for children, additional study is needed on the restraint systems and the potential for injury to pediatric rear occupants in an MVC. Our data suggest that pediatric age groups differ in injuries, risk factors, and MVC impacts. Recommendations for improved protection of child occupants and preferred seating positions are required. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Children in side-impact motor vehicle crashes: seating positions and injury mechanisms.

BACKGROUND: This study aimed to describe the injury mechanisms of children involved in side-impact car crashes, particularly as these relate to seating position, and to estimate the danger of the near-side seating position. METHODS: A prospective two-center study of children involved in severe car crashes in Canada was conducted as well as a retrospective cohort study of children involved in crashes reported in the Fatality Analysis Reporting System (FARS) and the National Automotive Sampling System: Crashworthiness Data System (NASS CDS). RESULTS: Children sitting at the side the car was struck (near-side position) sustained severe head, trunk, and limb injuries. Many of these injuries were attributable to direct intrusion, but some occurred without direct damage to the occupant compartment. Center-seat and far-side occupants had severe injuries only when unrestrained. Injury severity scores were higher for children seated on the near side, and this was statistically significant (p = 0.024) The analysis of Fatality Analysis Reporting System data showed that the risk of fatality was higher for children seated in the near-side position than for those in the center-seat position. The fatality risk ratio was 2.53 (95% confidence interval [CI], 2.08-3.07) for restrained children and 1.84 (95% CI, 1.57-2.17) for unrestrained children. Analysis of the NASS-CDS data showed that for restrained children, severe injury (ISS > or = 16) was more common among those on the near side (7 per 1,000 children) than among those in the center seat (2 per 1,000) or on the far-side seat (1 per 1,000) (p < 0.001). CONCLUSIONS: Severe injuries to near-side occupants occurred in both the presence and absence of compartment intrusion. A typical pattern of head, chest, and extremity injury similar to that seen among child pedestrians was observed among near-side child occupants in side-impact crashes. The center seat was statistically safer than the near-side seat, particularly for restrained child occupants. Scene information may be useful to trauma teams for the prediction of injury type and location. Avoiding intrusion and preventing the occupant from striking the vehicle wall are both important to side-impact protection for children. Improvement of the vehicle safety cage may protect against intrusion injuries. Seating two child occupants in inboard seating positions may provide additional protection against intrusion injuries, and also may protect against nonintrusion injuries.

Ejections of young children in motor vehicle crashes.

PURPOSE: The purpose of this study was to report the incidence of ejection from the vehicle among children involved in motor vehicle crashes, and to describe a novel mode of ejection from child safety seats. METHODS: The U.S. National Automotive Sampling System General Estimates System and the Fatality Analysis Reporting System databases from 1995 through 1999 were analyzed. A prospective two-center study of children involved in severe car crashes in Canada was performed. RESULTS: Only 0.2% of 5.5 million children involved in crashes experienced ejection, but 1924 (29%) of 6570 child fatalities involved ejections. Only 2.2% of children experienced rollover crashes, but these contributed 1832 (28%) of 6570 child passenger fatalities. Among 56 crashes, 5 restrained young children were ejected, 4 in rollover crashes. Ejection of a toddler through the shoulder straps of a forward-facing child safety seat was the mechanism of ejection in three of the five cases. CONCLUSION: Ejection from the vehicle is common (29%) among fatally injured children. Shoulder straps alone (as found in T-shield or overhead shield child seats) may not prevent the ejection of toddlers from child safety seats during rollovers.