Epidemiology of moderate-to-severe injury patterns observed in rollover crashes.

BACKGROUND: Previous epidemiological studies have highlighted the high risk of injury to the head, thorax, and cervical spine in rollover crashes. However, such results provide limited information on whole-body injury distribution and multiple region injury patterns necessary for the improvement and prioritization of rollover-focused injury countermeasures. METHODS: Sampled cases representing approximately 133,000 U.S. adult occupants involved in rollover crashes (between 1995 and 2013) sustaining moderate-to-severe injuries were selected from the National Automotive Sampling System Crashworthiness Data System database. A retrospective cohort study, based on a survey of population-based data, was used to identify relevant whole body injury patterns. RESULTS: Among belted occupants injured in rollover crashes, 79.2% sustained injuries to only one body region. The three most frequently injured (AIS2+) body regions were head (42.1%), upper extremity (28.0%), and thorax (27.1%). The most frequent multi-region injury pattern involved the head and upper extremity, but this pattern only accounted for 2.3% of all of occupants with moderate or worse injuries. CONCLUSIONS: The results indicated that for rollover-dominated crashes, the frequently observed injury patterns involved isolated body regions. In contrast, multi-region injury patterns are more frequently observed in rollovers with significant planar impacts. Identification of region-specific injury patterns in pure rollover crashes is essential for clarifying injury mitigation targets and developing whole-body injury metrics specifically applicable to rollovers.

Thoraco-abdominal deflection responses of post mortem human surrogates in side impacts.

The objective of the present study was to determine the thorax and abdomen deflections sustained by post mortem human surrogate (PMHS) in oblique side impact sled tests and compare the responses and injuries with pure lateral tests. Oblique impact tests were conducted using modular and non-modular load-wall designs, with the former capable of accommodating varying anthropometry. Tests were conducted at 6.7 m/s velocity. Deflection responses from chestbands were analyzed from 15 PMHS tests: five each from modular load-wall oblique, non-modular load-wall oblique and non-modular load- wall pure lateral impacts. The thorax and abdomen peak deflections were greater in non-modular load-wall oblique than pure lateral tests. Peak abdomen deflections were statistically significantly different while the upper thorax deflections demonstrated a trend towards significance. Deflection angulations were statistically significantly different between pure lateral and oblique tests at all regions indicating that it is important to characterize not only the amplitude but also the angle of the vector. Injuries were confined to skeletal regions in pure lateral tests and this was in contrast to the occurrence of both skeletal and soft tissue/organ injury in oblique loading tests, again emphasizing the role of obliqueness in side impacts. Furthermore, injuries in oblique tests were primarily unilateral, paralleling real-world trauma and confirming the applicability of the experimental design to field environments. Potential injury mechanisms are discussed based on anatomical considerations. These findings, albeit from a limited sample size, underscore the need for additional studies to derive human injury tolerance and criteria in oblique side impacts.

Incorporation of CPR Data into ATD Chest Impact Response Requirements.

Pediatric and adult ATD's are key tools for the development of motor vehicle crash safety systems. Previous researchers developed size-based scaling methods to adapt blunt chest impact data from adult post-mortem human subjects (PMHS) for pediatric ATD chests design requirements, using skull or femur elastic modulus ratios to estimate the change in whole chest stiffness during maturation. Recently, the mechanics of chest compression during cardiopulmonary resuscitation (CPR) of patients spanning the pediatric and elderly ages have been reported. Our objective was to integrate these pediatric and adult chest stiffness data from CPR into the established scaling methods to 1) compare new CPR-based and existing pediatric ATD chest biofidelity response requirements and 2) develop new CPR-based corridors for ages 12 and 20 years, which do not currently exist. Compared to the current 6-year-old ATD corridor, the maximum force of the CPR-based 6-year-old corridor was 7% less and the maximum displacement was 8% greater, indicating a softer chest. Compared to the current 10-year-old corridor, the new 10-year-old corridor peak force was 12% higher and the peak displacement was 11% smaller, suggesting a stiffer chest. The 12-year-old corridor developed in this paper was 10% higher in maximum force and 4% lower in maximum displacement compared with the adult 5(th) percentile female (AF05). Finally, the 20-year-old 50(th) percentile male (AM50(20)) corridor was 24% higher in maximum force and 19% lower in maximum displacement than 63-year old 50(th) percentile adult male (AM50(63)) corridor, suggesting a stiffer chest. We consider all the new corridors preliminary, as data collection is ongoing for CPR subjects under age 8 years and in the young and middle adult age ranges.

Severe-to-fatal head injuries in motor vehicle impacts.

Severe-to-fatal head injuries in motor vehicle environments were analyzed using the United States Crash Injury Research and Engineering Network database for the years 1997-2006. Medical evaluations included details and photographs of injury, and on-scene, trauma bay, emergency room, intensive care unit, radiological, operating room, in-patient, and rehabilitation records. Data were synthesized on a case-by-case basis. X-rays, computed tomography scans, and magnetic resonance images were reviewed along with field evaluations of scene and photographs for the analyses of brain injuries and skull fractures. Injuries to the parenchyma, arteries, brainstem, cerebellum, cerebrum, and loss of consciousness were included. In addition to the analyses of severe-to-fatal (AIS4+) injuries, cervical spine, face, and scalp trauma were used to determine the potential for head contact. Fatalities and survivors were compared using nonparametric tests and confidence intervals for medians. Results were categorized based on the mode of impact with a focus on head contact. Out of the 3178 medical cases and 169 occupants sustaining head injuries, 132 adults were in frontal (54), side (75), and rear (3) crashes. Head contact locations are presented for each mode. A majority of cases clustered around the mid-size anthropometry and normal body mass index (BMI). Injuries occurred at change in velocities (DeltaV) representative of US regulations. Statistically significant differences in DeltaV between fatalities and survivors were found for side but not for frontal impacts. Independent of the impact mode and survivorship, contact locations were found to be superior to the center of gravity of the head, suggesting a greater role for angular than translational head kinematics. However, contact locations were biased to the impact mode: anterior aspects of the frontal bone and face were involved in frontal impacts while temporal-parietal regions were involved in side impacts. Because head injuries occur at regulatory DeltaV in modern vehicles and angular accelerations are not directly incorporated in crashworthiness standards, these findings from the largest dataset in literature, offer a field-based rationale for including rotational kinematics in injury assessments. In addition, it may be necessary to develop injury criteria and evaluate dummy biofidelity based on contact locations as this parameter depended on the impact mode. The current field-based analysis has identified the importance of both angular acceleration and contact location in head injury assessment and mitigation.

Association of contact loading in diffuse axonal injuries from motor vehicle crashes.

BACKGROUND: Although studies have been conducted to analyze brain injuries from motor vehicle crashes, the association of head contact has not been fully established. This study examined the association in occupants sustaining diffuse axonal injuries (DAIs). METHODS: The 1997 to 2006 motor vehicle Crash Injury Research Engineering Network database was used. All crash modes and all changes in velocity were included; ejections and rollovers were excluded; injuries to front and rear seat occupants with and without restraint use were considered. DAI were coded in the database using Abbreviated Injury Scale 1990. Loss of consciousness was included and head contact was based on medical- and crash-related data. RESULTS: Sixty-seven occupants with varying ages were coded with DAI. Forty-one adult occupants (mean, 33 years of age, 171-cm tall, 71-kg weight; 30 drivers, 11 passengers) were analyzed. Mean change in velocity was 41.2 km/h and Glasgow Coma Scale score was 4. There were 33 lateral, 6 frontal, and 2 rear crashes with 32 survivors and 9 were fatalities. Two occupants in the same crash did not sustain DAI. Although skull fractures and scalp injuries occurred in some impacts, head contact was identified in all frontal, rear, and far side, and all but one nearside crashes. CONCLUSIONS: Using a large sample size of occupants sustaining DAI in 1991 to 2006 model year vehicles, DAI occurred more frequently in side than frontal crashes, is most commonly associated with impact load transfer, and is not always accompanied by skull fractures. The association of head contact in >95% of cases underscores the importance of evaluating crash-related variables and medical information for trauma analysis. It would be prudent to include contact loading in addition to angular kinematics in the analysis and characterization of DAI.

Impact response of restrained PMHS in frontal sled tests: skeletal deformation patterns under seat belt loading.

This study evaluated the response of restrained post-mortem human subjects (PMHS) in 40 km/h frontal sled tests. Eight male PMHS were restrained on a rigid planar seat by a custom 3-point shoulder and lap belt. A video motion tracking system measured three-dimensional trajectories of multiple skeletal sites on the torso allowing quantification of ribcage deformation. Anterior and superior displacement of the lower ribcage may have contributed to sternal fractures occurring early in the event, at displacement levels below those typically considered injurious, suggesting that fracture risk is not fully described by traditional definitions of chest deformation. The methodology presented here produced novel kinematic data that will be useful in developing biofidelic human models. Additional analysis of the data produced by the reported tests as well as additional tests with a variety of loading conditions are required to fully characterize torso response including ribcage fracture tolerance.

Investigation of traumatic brain injuries using the next generation of simulated injury monitor (SIMon) finite element head model.

The objective of this study was to investigate potential for traumatic brain injuries (TBI) using a newly developed, geometrically detailed, finite element head model (FEHM) within the concept of a simulated injury monitor (SIMon). The new FEHM is comprised of several parts: cerebrum, cerebellum, falx, tentorium, combined pia-arachnoid complex (PAC) with cerebro-spinal fluid (CSF), ventricles, brainstem, and parasagittal blood vessels. The model's topology was derived from human computer tomography (CT) scans and then uniformly scaled such that the mass of the brain represents the mass of a 50th percentile male's brain (1.5 kg) with the total head mass of 4.5 kg. The topology of the model was then compared to the preliminary data on the average topology derived from Procrustes shape analysis of 59 individuals. Material properties of the various parts were assigned based on the latest experimental data. After rigorous validation of the model using neutral density targets (NDT) and pressure data, the stability of FEHM was tested by loading it simultaneously with translational (up to 400 g) combined with rotational (up to 24,000 rad/s2) acceleration pulses in both sagittal and coronal planes. Injury criteria were established in the manner shown in Takhounts et al. (2003a). After thorough validation and injury criteria establishment (cumulative strain damage measure--CSDM for diffuse axonal injuries (DAI), relative motion damage measure--RMDM for acute subdural hematoma (ASDH), and dilatational damage measure--DDM for contusions and focal lesions), the model was used in investigation of mild TBI cases in living humans based on a set of head impact data taken from American football players at the collegiate level. It was found that CSDM and especially RMDM correlated well with angular acceleration and angular velocity. DDM was close to zero for most impacts due to their mild severity implying that cavitational pressure anywhere in the brain was not reached. Maximum principal strain was found to correlate well with RMDM and angular head kinematic measures. Maximum principal stress didn't correlate with any kinematic measure or injury metric. The model was then used in the investigation of brain injury potential in NHTSA conducted side impact tests. It was also used in parametric investigations of various "what if" scenarios, such as side versus frontal impact, to establish a potential link between head kinematics and injury outcomes. The new SIMon FEHM offers an advantage over the previous version because it is geometrically more representative of the human head. This advantage, however, is made possible at the expense of additional computational time.

Chest deflections and injuries in oblique lateral impacts.

A majority of laboratory-driven side-impact injury assessments are conducted using postmortem human subjects (PMHS) under the pure lateral mode. Because real-world injuries occur under pure and oblique modes, this study was designed to determine chest deflections and injuries using PMHS under the latter mode. Anthropometrical data were obtained and x-rays were taken. Specimens were seated on a sled and lateral impact acceleration corresponding to a change in velocity of 24 km/h was applied such that the vector was at an angle of 20 or 30 degrees. Chestbands were fixed at the level of the axilla (upper), xyphoid process (middle), and tenth rib (lower) location. Deflection contours as a function of time at the levels of the axilla and mid-sternum, representing the thorax, and at the tenth rib level, representing the abdomen, were evaluated for peak magnitudes. All data were normalized using mass-scaling procedures. Injuries were identified following the test at autopsy. Trauma graded according to the Abbreviated Injury Score, 1990 version, indicated primarily unilateral rib fractures and soft tissue abnormalities such as lung contusion and diaphragm laceration occurred. Mean peak deflections at the upper, middle, and lower levels of the chest for the 30-degree tests were 96.2, 78.5, and 76.8 mm. For the 20-degree tests, these magnitudes were 77.5, 89.9, and 73.6 mm. Statistical analysis indicated no significant (p > 0.05) differences in peak chest deflections at all levels between the two obliquities although the metric was significantly greater in oblique than pure lateral impacts at the mid and lower thoracic levels. These response data are valuable in oblique lateral impact assessments.