Census Study of Real-Life Near-Side Crashes with Modern Side Airbag-Equipped Vehicles in the United States

Objective: This study aimed to investigate the crash characteristics, injury distribution, and injury mechanisms for Maximum Abbreviated Injury Score (MAIS) 2+ injured belted, near-side occupants in airbag-equipped modern vehicles. Furthermore, differences in injury distribution for senior occupants compared to non-senior occupants was investigated, as well as whether the near-side occupant injury risk to the head and thorax increases or decreases with a neighboring occupant.

Method: National Automotive Sampling System's Crashworthiness Data System (NASS-CDS) data from 2000 to 2012 were searched for all side impacts (GAD L&R, all principal direction of force) for belted occupants in modern vehicles (model year > 1999). Rollovers were excluded, and only front seat occupants over the age of 10 were included. Twelve thousand three hundred fifty-four MAIS 2+ injured occupants seated adjacent to the intruding structure (near-side) and protected by at least one deployed side airbag were studied. To evaluate the injury risk influenced by the neighboring occupant, odds ratio with an induced exposure approach was used.

Result: The most typical crash occurred either at an intersection or in a left turn where the striking vehicle impacted the target vehicle at a 60 to 70° angle, resulting in a moderate change of velocity (delta-V) and intrusion at the B-pillar. The head, thorax, and pelvis were the most frequent body regions with rib fracture the most frequent specific injury. A majority of the head injuries included brain injuries without skull fracture, and non-senior rather than senior occupants had a higher frequency of head injuries on the whole. In approximately 50% of the cases there was a neighboring occupant influencing injury outcome.

Conclusion: Compared to non-senior occupants, the senior occupants sustained a considerably higher rate of thoracic and pelvis injuries, which should be addressed by improved thorax side airbag protection. The influence on near-side occupant injury risk by the neighboring occupant should also be further evaluated. Furthermore, side airbag performance and injury assessments in intersection crashes, especially those involving senior occupants in lower severities, should be further investigated and side impact dummy biofidelity and injury criteria must be determined for these crash scenarios.     

Factors contributing to serious and fatal injuries in belted rear seat occupants in frontal crashes

Abstract

Objectives: Earlier research has shown that the rear row is safer for occupants in crashes than the front row, but there is evidence that improvements in front seat occupant protection in more recent vehicle model years have reduced the safety advantage of the rear seat versus the front seat. The study objective was to identify factors that contribute to serious and fatal injuries in belted rear seat occupants in frontal crashes in newer model year vehicles.

Methods: A case series review of belted rear seat occupants who were seriously injured or killed in frontal crashes was conducted. Occupants in frontal crashes were eligible for inclusion if they were 6 years old or older and belted in the rear of a 2000 or newer model year passenger vehicle within 10 model years of the crash year. Crashes were identified using the 2004–2015 National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and included all eligible occupants with at least one Abbreviated Injury Scale (AIS) 3 or greater injury. Using these same inclusion criteria but split into younger (6 to 12 years) and older (55+ years) cohorts, fatal crashes were identified in the 2014–2015 Fatality Analysis Reporting System (FARS) and then local police jurisdictions were contacted for complete crash records.

Results: Detailed case series review was completed for 117 rear seat occupants: 36 with Maximum Abbreviated Injury Scale (MAIS) 3+ injuries in NASS-CDS and 81 fatalities identified in FARS. More than half of the injured and killed rear occupants were more severely injured than front seat occupants in the same crash. Serious chest injury, primarily caused by seat belt loading, was present in 22 of the injured occupants and 17 of the 37 fatalities with documented injuries. Nine injured occupants and 18 fatalities sustained serious head injury, primarily from contact with the vehicle interior or severe intrusion. For fatal cases, 12 crashes were considered unsurvivable due to a complete loss of occupant space. For cases considered survivable, intrusion was not a large contributor to fatality.

Discussion: Rear seat occupants sustained serious and fatal injuries due to belt loading in crashes in which front seat occupants survived, suggesting a discrepancy in restraint performance between the front and rear rows. Restraint strategies that reduce loading to the chest should be considered, but there may be potential tradeoffs with increased head excursion, particularly in the absence of rear seat airbags. Any new restraint designs should consider the unique needs of the rear seat environment.     

Driver and front passenger injury in frontal crashes: Update on the effect of unbelted rear occupants

Purpose: This is a study of the influence of an unbelted rear occupant on the risk of severe injury to the front seat occupant ahead of them in frontal crashes. It provides an update to earlier studies.

Methods: 1997–2015 NASS-CDS data were used to investigate the risk for severe injury (Maximum Abbreviated Injury Score [MAIS] 4+F) to belted drivers and front passengers in frontal crashes by the presence of a belted or unbelted passenger seated directly behind them or without a rear passenger. Frontal crashes were identified with GAD1 = F without rollover (rollover ≤ 0). Front and rear outboard occupants were included without ejection (ejection = 0). Injury severity was defined by MAIS and fatality (F) by TREATMNT = 1 or INJSEV = 4. Weighted data were determined. The risk for MAIS 4+F was determined using the number of occupants with known injury status MAIS 0+F. Standard errors were determined.

Results: The risk for severe injury was 0.803 ± 0.263% for the driver with an unbelted left rear occupant and 0.100 ± 0.039% with a belted left rear occupant. The driver's risk was thus 8.01 times greater with an unbelted rear occupant than with a belted occupant (P <.001). With an unbelted right rear occupant behind the front passenger, the risk for severe injury was 0.277 ± 0.091% for the front passenger. The corresponding risk was 0.165 ± 0.075% when the right rear occupant was belted. The front passenger's risk was 1.68 times greater with an unbelted rear occupant behind them than a belted occupant (P <.001). The driver's risk for MAIS 4+F was highest when their seat was deformed forward. The risk was 9.94 times greater with an unbelted rear occupant than with a belted rear occupant when the driver's seat deformed forward. It was 13.4 ± 12.2% with an unbelted occupant behind them and 1.35 ± 0.95% with a belted occupant behind them.

Conclusions: Consistent with prior literature, seat belt use by a rear occupant significantly lowered the risk for severe injury to belted occupants seated in front of them. The reduction was greater for drivers than for front passengers. It was 87.5% for the driver and 40.6% for the front passenger. These results emphasize the need for belt reminders in all seating positions.     

Injuries in Full-Scale Vehicle Side Impact Moving Deformable Barrier and Pole Tests Using Postmortem Human Subjects

Objective: To conduct near-side moving deformable barrier (MDB) and pole tests with postmortem human subjects (PMHS) in full-scale modern vehicles, document and score injuries, and examine the potential for angled chest loading in these tests to serve as a data set for dummy biofidelity evaluations and computational modeling.

Methods: Two PMHS (outboard left front and rear seat occupants) for MDB and one PMHS (outboard left front seat occupant) for pole tests were used. Both tests used sedan-type vehicles from same manufacturer with side airbags. Pretest x-ray and computed tomography (CT) images were obtained. Three-point belt-restrained surrogates were positioned in respective outboard seats. Accelerometers were secured to T1, T6, and T12 spines; sternum and pelvis; seat tracks; floor; center of gravity; and MDB. Load cells were used on the pole. Biomechanical data were gathered at 20 kHz. Outboard and inboard high-speed cameras were used for kinematics. X-rays and CT images were taken and autopsy was done following the test. The Abbreviated Injury Scale (AIS) 2005 scoring scheme was used to score injuries.

Results: MDB test: male (front seat) and female (rear seat) PMHS occupant demographics: 52 and 57 years, 177 and 166 cm stature, 78 and 65 kg total body mass. Demographics of the PMHS occupant in the pole test: male, 26 years, 179 cm stature, and 84 kg total body mass. Front seat PMHS in MDB test: 6 near-side rib fractures (AIS = 3): 160–265 mm vertically from suprasternal notch and 40–80 mm circumferentially from center of sternum. Left rear seat PMHS responded with multiple bilateral rib fractures: 9 on the near side and 5 on the contralateral side (AIS = 3). One rib fractured twice. On the near and contralateral sides, fractures were 30–210 and 20–105 mm vertically from the suprasternal notch and 90–200 and 55–135 mm circumferentially from the center of sternum. A fracture of the left intertrochanteric crest occurred (AIS = 3). Pole test PMHS had one near-side third rib fracture. Thoracic accelerations of the 2 occupants were different in the MDB test. Though both occupants sustained positive and negative x-accelerations to the sternum, peak magnitudes and relative changes were greater for the rear than the front seat occupant. Magnitudes of the thoracic and sternum accelerations were lower in the pole test.

Conclusions: This is the first study to use PMHS occupants in MDB and pole tests in the same recent model year vehicles with side airbag and head curtain restraints. Injuries to the unilateral thorax for the front seat PMHS in contrast to the bilateral thorax and hip for the rear seat occupant in the MDB test indicate the effects of impact on the seating location and restraint system. Posterolateral locations of fractures to the front seat PMHS are attributed to constrained kinematics of occupant interaction with torso side airbag restraint system. Angled loading to the rear seat occupant from coupled sagittal and coronal accelerations of the sternum representing anterior thorax loading contributed to bilateral fractures. Inward bending initiated by the distal femur complex resulting in adduction of ipsilateral lower extremity resulted in intertrochanteric fracture to the rear seat occupant. These results serve as a data set for evaluating the biofidelity of the WorldSID and federalized side impact dummies and assist in validating human body computational models, which are increasingly used in crashworthiness studies.     

Side impact crashes--factors affecting incidence and severity: review of the literature

Many traffic crashes are side impact collisions resulting in significant death and injury. A review was conducted of the evidence of driver, road, and vehicle characteristics affecting either the risk of occurrence or the severity of injury in such crashes for papers published from 1996 to early 2003. For drivers, evidence was found of increased crash risk or injury severity only for age and age-related medical conditions (e.g., dementia). Traffic roundabouts and other traffic control devices--stop signs, traffic lights, and so on--had mixed results; traffic controls were better than no controls, but their effectiveness varied with circumstance. Most vehicle characteristics have had little or no effect on crash occurrence. Antilock braking systems (ABS) in the striking vehicle had been anticipated to reduce the risk of crashes, but so far have demonstrated little effect. The primary emphasis in vehicle design has been on protective devices to reduce the severity of injury. Disparity in the size of the two vehicles, especially when the struck vehicle is smaller and lighter, is almost a consistent risk factor for occupant injury. The occupants of light trucks, however, when struck by passengers cars on the opposite side, were at higher risk of injury. Wearing seat belts had a consistently protective effect; airbags did not, but there were few studies, and no field studies, of lateral airbags found. Of all the characteristics examined, vehicle design, including occupant restraints, is the most easily modified in the short term, although road design, traffic control, and the monitoring of older drivers may also prove effective in reducing side impact crashes in the longer term.     

The risk of whiplash injury in the rear seat compared to the front seat in rear impacts

One hundred ninety-five rear impacts with both front- and rear-seat occupants in the struck car, where at least one occupant sustained permanent disability, were selected for study. There was a significantly higher disability risk for the female rear-seat occupant compared with the male driver. Furthermore, a higher risk was found for female rear-seat occupants compared with female front-seat passengers. The disability risk for occupants of the driver's seat was three times higher for females than for males, and four times higher for females in the rear seat. In the future, test methods should consider the risk of whiplash injury in both the front and the rear seat.     

Improving the Chest Protection of Elderly Occupants in Frontal Crashes Using SMART Load Limiters

Objective: To determine whether varying the seat belt load limiter (SBL) according to crash and occupant characteristics could have real-world injury reduction benefits in frontal impacts and, if so, to quantify those benefits.

Methods: Real-world UK accident data were used to identify the target population of vehicle occupants and frontal crash scenarios where improved chest protection could be most beneficial. Generic baseline driver and front passenger numerical models using a 50th percentile dummy were developed with MADYMO software. Simulations were performed where the load limiter threshold was varied in selected frontal impact scenarios. For each SBL setting, restraint performance, dummy kinematics, and injury outcome were studied in 5 different frontal impact types. Thoracic injury predictions were converted into injury probability values using Abbreviated Injury Scale (AIS) 2+ age-dependent thoracic risk curves developed and validated based on a methodology proposed by Laituri et al. (2005). Real-world benefit was quantified using the predicted AIS 2+ risk and assuming that an appropriate adaptive system was fitted to all the cars in a real-world sample of recent frontal crashes involving European passenger cars.

Results: From the accident data sample the chest was the most frequently injured body region at an AIS 2+ level in frontal impacts (7% of front seat occupants). The proportion of older vehicle front seat occupants (>64 years) with AIS 2+ injury was also greater than the proportion of younger occupants. Additionally, older occupants were more likely to sustain seat belt–induced serious chest injury in low- and moderate-speed frontal crashes. In both front seating positions, the low SBL provided the best chest injury protection, without increasing the risk to other body regions. In severe impacts, the low SBL allowed the driver to move dangerously close to the steering wheel. Compared to the driver side, greater ride-down space on the passenger side gave a higher potential for using the low SBLs. When applying the AIS 2+ risk reduction findings to the weighted accident data sample, the risk of sustaining an AIS 2+ seat belt injury changed to 0.9, 4.9, and 8.1% for young, mid, and older occupants, respectively, from their actual injury risk of 1.3, 7.6, and 13.1%.

Conclusions: These results suggest the potential for improving the safety of older occupants with the development of smarter restraint systems. This is an important finding because the number of older users is expected to increase rapidly over the next 20 years. The greatest benefits were seen at lower crash severities. This is also important because most real-world crashes occur at lower speeds.     

Rollover injury: effects of near- and far-seating position, belt use, and number of quarter rolls

PURPOSE: Vehicle and occupant responses in rollovers are complex since many factors influence both. This study analyzes the following factors: 1) belt use, 2) seated position with respect to the lead side in the rollover, 3) another front occupant in the crash, and 4) number of quarter rolls. The aim was to improve our understanding of rollover injury mechanisms. METHOD: Rollover accidents were analyzed using 1992-2004 NASS-CDS data. The sample included adult drivers and right-front passengers. All occupants were evaluated and then a subset of non-ejected occupants was analyzed. Using roll direction and seating position, the sample was divided into near- and far-seated occupants. Injury and fatality risks were determined by seatbelt use, occupancy, rollover direction, and number of quarter rolls. Risk was defined as the number of injured (e.g., MAIS 3+) divided by the number of exposed occupants (MAIS 0-6). Significance in differences was determined. A matched-pair analysis was used to determine the risk of serious injury for near- and far-seated occupants who were either belted or unbelted in the same crash. RESULTS: For all occupants, serious injury risks were highest for far-seated, unbelted occupants at 18.1% +/- 4.8%, followed by near-seated unbelted occupants at 12.0% +/- 3.5%. However, the difference was not statistically significant. Belted near- and far-seated occupants had a similar injury risk of 4.3% +/- 1.2% and 4.0% +/- 1.2%, respectively. For non-ejected occupants, serious injury risk was 9.5% +/- 3.2% for far-seated unbelted occupants and 4.9% +/- 2.1% for near-seated unbelted occupants, not a statistically significant difference. Serious injury risk was similar for belted near- and far-seated non-ejected occupants, at 3.6% +/- 1.1%. Seatbelts were 64.2%-77.9% effective in preventing serious injury for all occupants and 62.1%-26.5% for far- and near-seated, non-ejected occupants, respectively. Based on the matched pairs, seatbelts were less effective for near-seated (5.0%) compared to far-seated (2.8%) occupant MAIS 3+F risks. This was similar for non-ejected occupants. An unbelted near-seated occupant increased the risk for a belted far-seated occupant by 2.2 times, whereas an unbelted far-seated occupant increased the risk for a belted near-seated occupant by 10.2 times. For all occupants, the risk of serious injury increased with the number of quarter rolls, irrespective of seated position. For near-seated occupants, seatbelt effectiveness was higher in < or =1 roll than 1+ roll, at 72.3% compared to 28.3%. For far-seated occupants, seatbelt effectiveness was similar in < or =1 and 1+ roll samples at 78.3% and 76.8%, respectively. Near-seated occupants had the lowest serious injury risk when they were the sole occupant in the vehicle. This was also true for non-ejected occupants. However, far-seated occupants had a lower injury risk when another occupant was involved in the crash. CONCLUSIONS: The effect of carrying another occupant appears to reduce the risk of serious injury to far-seated occupants. However, near-seated occupants are better off being the sole occupant in the vehicle. Seatbelt effectiveness was lowest at 28.3% for non-ejected, near-seated occupants in 1+ rolls. This finding deserves further evaluation in an effort to improve seatbelt effectiveness in rollovers. For belted drivers alone in a rollover, fatality risks are 2.24 times higher for the far- versus near-seated position. Analysis of rollovers by quarter turns indicates that occupants are both far-side and near-side in rollovers. The extent to which this confounds the relationship between roll direction, seating position, and injury risk is unknown.     

Association Between NCAP Ratings and Real-World Rear Seat Occupant Risk of Injury

Objective: Several studies have evaluated the correlation between U.S. or Euro New Car Assessment Program (NCAP) ratings and injury risk to front seat occupants, in particular driver injuries. Conversely, little is known about whether NCAP 5-star ratings predict real-world risk of injury to restrained rear seat occupants. The NHTSA has identified rear seat occupant protection as a specific area under consideration for improvements to its NCAP. In order to inform NHTSA's efforts, we examined how NCAP's current 5-star rating system predicts risk of moderate or greater injury among restrained rear seat occupants in real-world crashes.

Methods: We identified crash-involved vehicles, model year 2004–2013, in NASS-CDS (2003–2012) with known make and model and nonmissing occupant information. We manually matched these vehicles to their NCAP star ratings using data on make, model, model year, body type, and other identifying information. The resultant linked NASS-CDS and NCAP database was analyzed to examine associations between vehicle ratings and rear seat occupant injury risk; risk to front seat occupants was also estimated for comparison. Data were limited to restrained occupants and occupant injuries were defined as any injury with a maximum Abbreviated Injury Scale (AIS) score of 2 or greater.

Results: We linked 95% of vehicles in NASS-CDS to a specific vehicle in NCAP. The 18,218 vehicles represented an estimated 6 million vehicles with over 9 million occupants. Rear seat passengers accounted for 12.4% of restrained occupants. The risk of injury in all crashes for restrained rear seat occupants was lower in vehicles with a 5-star driver rating in frontal impact tests (1.4%) than with 4 or fewer stars (2.6%, P =.015); results were similar for the frontal impact passenger rating (1.3% vs. 2.4%, P =.024). Conversely, side impact driver and passenger crash tests were not associated with rear seat occupant injury risk (driver test: 1.7% for 5-star vs. 1.8% for 1–4 stars; passenger test: 1.6% for 5 stars vs 1.8% for 1–4 stars).

Conclusions: Current frontal impact test procedures provide some degree of discrimination in real-world rear seat injury risk among vehicles with 5 compared to fewer than 5 stars. However, there is no evidence that vehicles with a 5-star side impact passenger rating, which is the only crash test procedure to include an anthropomorphic test dummy (ATD) in the rear, demonstrate lower risks of injury in the rear than vehicles with fewer than 5 stars. These results support prioritizing modifications to the NCAP program that specifically evaluate rear seat injury risk to restrained occupants of all ages.     

Potential of a Precrash Lateral Occupant Movement in Side Collisions of (Electric) Minicars

Objective: In minicars, the survival space between the side structure and occupant is smaller than in conventional cars. This is an issue in side collisions. Therefore, in this article a solution is studied in which a lateral seat movement is imposed in the precrash phase. It generates a pre-acceleration and an initial velocity of the occupant, thus reducing the loads due to the side impact.

Methods: The assessment of the potential is done by numerical simulations and a full-vehicle crash test. The optimal parameters of the restraint system including the precrash movement, time-to-fire of head and side airbag, etc., are found using metamodel-based optimization methods by minimizing occupant loads according to European New Car Assessment Programme (Euro NCAP).

Results: The metamodel-based optimization approach is able to tune the restraint system parameters. The numerical simulations show a significant averaged reduction of 22.3% in occupant loads.

Conclusion: The results show that the lateral precrash occupant movement offers better occupant protection in side collisions.     

The safety implications of vehicle seat adjustments

INTRODUCTION: The goal of this study was to gather information on the preferred front seat position of vehicle occupants and to determine the impact of variation in seat position on safety during crashes. METHOD: The study evaluated the relationship between seat position and occupant size using the chi-square test and compared the risk of severe injury for small females and large males with regard to forward and rearward seat position using logistic regression. RESULTS: While smaller drivers sat closer to the steering wheel than larger drivers, front passengers of all sizes used similar seat positions. Additionally, the risk of injury was higher for small, unbelted females in rearward seat positions and large males (belted and unbelted) in forward seat positions. CONCLUSIONS: Occupants who adjust their seats to positions that are not consistent with required federal tests are at a greater risk for severe injury in a crash.     

Occurrence of Serious Injury in Real-World Side Impacts of Vehicles with Good Side-Impact Protection Ratings

Objective: The Insurance Institute for Highway Safety (IIHS) introduced its side impact consumer information test program in 2003. Since that time, side airbags and structural improvements have been implemented across the fleet and the proportion of good ratings has increased to 93% of 2012–2014 model year vehicles. Research has shown that drivers of good-rated vehicles are 70% less likely to die in a left-side crash than drivers of poor-rated vehicles. Despite these improvements, side impact fatalities accounted for about one quarter of passenger vehicle occupant fatalities in 2012. This study is a detailed analysis of real-world cases with serious injury resulting from side crashes of vehicles with good ratings in the IIHS side impact test.

Methods: NASS-CDS and Crash Injury Research and Engineering Network (CIREN) were queried for occupants of good-rated vehicles who sustained an Abbreviated Injury Scale (AIS) ≥ 3 injury in a side-impact crash. The resulting 110 cases were categorized by impact configuration and other factors that contributed to injury. Patterns of impact configuration, restraint performance, and occupant injury were identified and discussed in the context of potential upgrades to the current IIHS side impact test.

Results: Three quarters of the injured occupants were involved in near-side impacts. For these occupants, the most common factors contributing to injury were crash severities greater than the IIHS test, inadequate side-airbag performance, and lack of side-airbag coverage for the injured body region. In the cases where an airbag was present but did not prevent the injury, occupants were often exposed to loading centered farther forward on the vehicle than in the IIHS test. Around 40% of the far-side occupants were injured from contact with the struck-side interior structure, and almost all of these cases were more severe than the IIHS test. The remaining far-side occupants were mostly elderly and sustained injury from the center console, instrument panel, or seat belt. In addition, many far-side occupants were likely out of position due to events preceding the side impact and/or being unbelted.

Conclusion: Individual changes to the IIHS side impact test have the potential to reduce the number of serious injuries in real-world crashes. These include impacting the vehicle farther forward (relevant to 28% of all cases studied), greater test severity (17%), the inclusion of far-side occupants (9%), and more restrictive injury criteria (9%). Combinations of these changes could be more effective.     

Case study: 128 injured in rollover coach crashes in Sweden—Injury outcome,mechanisms and possible effects of seat belts

The risk for injuries in rollover coach crashes are dependent on whether the occupants are belted or not. However, the influence of the different belt systems for reducing injuries has remained unclear. Since many injuries sustained are caused by impacts with the interior, passenger interactions or ejection through a window, the advantages by proper seat belt systems are evident. In this study, representing the most common serious crash scenario for serious injury, 128 injured in rollover cases were analysed with regard to the injury outcome, mechanisms and the possible injury reduction for occupants when using a safety belt. Furthermore, the different belt systems were compared to explain their contribution to increased safety. Based on medical reports and questioning of the passengers, the injuries sustained are recorded according to the AIS classification. The next step was the identification of the injury mechanisms, using the passenger statements as well as results from numerical occupant simulations. It is important to mention that this study was purely focused on detection of the injury mechanism to avoid the reported injuries. The possibility of additional injuries due to the wearing of a belt were not taken into account. However, the analysis of the 128 injured showed a considerable increase in safety for belted occupants through limiting interior contacts, minimising passenger interaction and reducing the possibility of ejection.     

Motor vehicle restraint system use and risk of spine injury

OBJECTIVE: Motor vehicle collision (MVC)-related spinal injury is a severe and often permanently disabling injury. In addition, strain injuries have been reported as a common outcome of MVCs. Although advances in automobile crashworthiness have reduced both fatalities and severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on thoracolumbar spine injuries is unknown. This study examined the relationship between the occurrence of mild to severe cervical and thoracolumbar spine injury and occupant restraint systems among front seat occupants involved in frontal MVCs. METHODS: A retrospective cohort study was conducted among subjects obtained from the 1995-2004 National Automotive Sampling System. Cases were identified based on having sustained a spine injury of >/=1 on the Abbreviated Injury Scale (AIS), 1990 Revision. Risk risks (RRs) and 95% confidence intervals (CIs) were computed comparing occupant restraint systems with unrestrained occupants. RESULTS: We found an overall incidence of AIS1 cervical (11.8%) and thoracolumbar (3.7%) spinal injury. Seatbelt only restraints were associated with increased cervical AIS1 injury (RR = 1.40, 95% CI 1.04-1.88). However, seatbelt only restraints showed the greatest risk reduction for AIS2 spinal injuries. Airbag only restraints reduced thoracolumbar AIS1 injuries (RR = 0.29, 95% CI 0.08-1.04). Seatbelt combined with airbag use was protective for cervical AIS3+ injury overall (RR = 0.29, 95% CI 0.14-0.58), cervical neurological injury (RR = 0.19, 95% CI 0.05-0.81), and thoracolumbar AIS3+ injury overall (RR = 0.20, 95% CI 0.05-0.70). CONCLUSIONS: The results of this study suggest that seatbelts alone or in combination with an airbag increased the incidence of AIS1 spinal injuries, but provide protection against more severe injury to all regions of the spine. Airbag deployment without seatbelt use did not show increased protection relative to unrestrained occupants.     

Reducing primary and secondary impact loads on the pelvis during side impact

OBJECTIVE: The objective of the study was to determine which vehicle factors are significantly related to pelvic injury in side impact collisions. Identification of relevant parameters could aid in the reduction of these injuries. METHOD: Side impact crashes from the CIREN database were separated into those in which the occupant sustained a pelvic fracture and those in which no pelvic fracture occurred, although all occupants had serious injuries. A multibody MADYMO model was created of a USDOT SINCAP (U.S. Department of Transportation Side Impact New Car Assessment Program) test of a vehicle with a large center console. RESULTS: From a study of 113 side impact crashes in the ciren database, nearside occupants with pelvic fractures (n = 78) had (i) more door intrusion (mean, 37 vs. 32 cm, p = 0.02) than those who had serious injuries, but not pelvic fractures (ii) a greater likelihood that the lower border of the door intruded more than the upper part (40% vs. 18%, p < 0.025); and (iii) a greater likelihood that their vehicle had a center console (47 vs. 17%, p < 0.005). Other parameters such as occupant age, weight, gender, vehicle weight, and struck vehicle speed change were not significantly different. MADYMO modeling showed that with a center console, an initial positive pelvic acceleration occurred at about 30 msec, followed at about 45 msec by a second acceleration peak in the opposite direction. Reducing console stiffness reduced the second acceleration but not the initial peak. Allowing the seat to translate laterally when contacted by the door reduced the initial pelvic acceleration by 50% and eliminated the second acceleration peak. CONCLUSIONS: Redesigning the center console using less stiff materials and allowing some lateral translation of the seat could aid in reducing pelvic injuries in side impact collisions.     

Real-World Rib Fracture Patterns in Frontal Crashes in Different Restraint Conditions

Objective: The purpose of this study was to use the detailed medical injury information in the Crash Injury Research and Engineering Network (CIREN) to evaluate patterns of rib fractures in real-world crash occupants in both belted and unbelted restraint conditions. Fracture patterns binned into rib regional levels were examined to determine normative trends associated with belt use and other possible contributing factors.

Methods: Front row adult occupants with Abbreviated Injury Scale (AIS) 3+ rib fractures, in frontal crashes with a deployed frontal airbag, were selected from the CIREN database. The circumferential location of each rib fracture (with respect to the sternum) was documented using a previously published method (Ritchie et al. 2006) and digital computed tomography scans. Fracture patterns for different crash and occupant parameters (restraint use, involved physical component, occupant kinematics, crash principal direction of force, and occupant age) were compared qualitatively and quantitatively.

Results: There were 158 belted and 44 unbelted occupants included in this study. For belted occupants, fractures were mainly located near the path of the shoulder belt, with the majority of fractures occurring on the inboard (with respect to the vehicle) side of the thorax. For unbelted occupants, fractures were approximately symmetric and distributed across both sides of the thorax. There were negligible differences in fracture patterns between occupants with frontal (0°) and near side (330° to 350° for drivers; 10° to 30° for passengers) crash principal directions of force but substantial differences between groups when occupant kinematics (and contacts within the vehicle) were considered. Age also affected fracture pattern, with fractures tending to occur more anteriorly in older occupants and more laterally in younger occupants (both belted and unbelted).

Conclusions: Results of this study confirmed with real-world data that rib fracture patterns in unbelted occupants were more distributed and symmetric across the thorax compared to belted occupants in crashes with a deployed frontal airbag. Other factors, such as occupant kinematics and occupant age, also produced differing patterns of fractures. Normative data on rib fracture patterns in real-world occupants can contribute to understanding injury mechanisms and the role of different causation factors, which can ultimately help prevent fractures and improve vehicle safety.     

Driver injury in near- and far-side impacts: Update on the effect of front passenger belt use

Purpose: This is a study that updates earlier research on the influence of a front passenger on the risk for severe driver injury in near-side and far-side impacts. It includes the effects of belt use by the driver and passenger, identifies body regions involved in driver injury, and identifies the sources for severe driver head injury.

Methods: 1997–2015 NASS-CDS data were used to investigate the risk for Maximum Abbreviated Injury Scale (MAIS) 4 + F driver injury in near-side and far-side impacts by front passenger belt use and as a sole occupant in the driver seat. Side impacts were identified with GAD1 = L or R without rollover (rollover ≤ 0). Front-outboard occupants were included without ejection (ejection = 0). Injury severity was defined by MAIS and fatality (F) by TREATMNT = 1 or INJSEV = 4. Weighted data were determined. The risk for MAIS 4 + F was determined using the number of occupants with known injury status MAIS 0 + F. Standard errors were determined.

Results: Overall, belted drivers had greater risks for severe injury in near-side than far-side impacts. As a sole driver, the risk was 0.969 ± 0.212% for near-side and 0.313 ± 0.069% for far-side impacts (P < .005). The driver's risk was 0.933 ± 0.430% with an unbelted passenger and 0.596 ± 0.144% with a belted passenger in near-side impacts. The risk was 2.17 times greater with an unbelted passenger (NS). The driver's risk was 0.782 ± 0.431% with an unbelted passenger and 0.361% ± 0.114% with a belted passenger in far-side impacts. The risk was 1.57 times greater with an unbelted passenger (P < .10). Seat belt use was 66 to 95% effective in preventing MAIS 4 + F injury in the driver. For belted drivers, the head and thorax were the leading body regions for Abbreviated Injury Scale (AIS) 4+ injury. For near-side impacts, the leading sources for AIS 4+ head injury were the left B-pillar, roof, and other vehicle. For far-side impacts, the leading sources were the other occupant, right interior, and roof (8.5%).

Conclusions: Seat belt use by a passenger lowered the risk of severe driver injury in side impacts. The reduction was 54% in near-side impacts and 36% in far-side impacts. Belted drivers experienced mostly head and thoracic AIS 4+ injuries. Head injuries in the belted drivers were from contact with the side interior and the other occupant, even with a belted passenger.     

Estimated Injury Risk for Specific Injuries and Body Regions in Frontal Motor Vehicle Crashes

Objective: Injury risk curves estimate motor vehicle crash (MVC) occupant injury risk from vehicle, crash, and/or occupant factors. Many vehicles are equipped with event data recorders (EDRs) that collect data including the crash speed and restraint status during a MVC. This study's goal was to use regulation-required data elements for EDRs to compute occupant injury risk for (1) specific injuries and (2) specific body regions in frontal MVCs from weighted NASS-CDS data.

Methods: Logistic regression analysis of NASS-CDS single-impact frontal MVCs involving front seat occupants with frontal airbag deployment was used to produce 23 risk curves for specific injuries and 17 risk curves for Abbreviated Injury Scale (AIS) 2+ to 5+ body region injuries. Risk curves were produced for the following body regions: head and thorax (AIS 2+, 3+, 4+, 5+), face (AIS 2+), abdomen, spine, upper extremity, and lower extremity (AIS 2+, 3+). Injury risk with 95% confidence intervals was estimated for 15–105 km/h longitudinal delta-Vs and belt status was adjusted for as a covariate.

Results: Overall, belted occupants had lower estimated risks compared to unbelted occupants and the risk of injury increased as longitudinal delta-V increased. Belt status was a significant predictor for 13 specific injuries and all body region injuries with the exception of AIS 2+ and 3+ spine injuries. Specific injuries and body region injuries that occurred more frequently in NASS-CDS also tended to carry higher risks when evaluated at a 56 km/h longitudinal delta-V. In the belted population, injury risks that ranked in the top 33% included 4 upper extremity fractures (ulna, radius, clavicle, carpus/metacarpus), 2 lower extremity fractures (fibula, metatarsal/tarsal), and a knee sprain (2.4–4.6% risk). Unbelted injury risks ranked in the top 33% included 4 lower extremity fractures (femur, fibula, metatarsal/tarsal, patella), 2 head injuries with less than one hour or unspecified prior unconsciousness, and a lung contusion (4.6–9.9% risk). The 6 body region curves with the highest risks were for AIS 2+ lower extremity, upper extremity, thorax, and head injury and AIS 3+ lower extremity and thorax injury (15.9–43.8% risk).

Conclusions: These injury risk curves can be implemented into advanced automatic crash notification (AACN) algorithms that utilize vehicle EDR measurements to predict occupant injury immediately following a MVC. Through integration with AACN, these injury risk curves can provide emergency medical services (EMS) and other patient care providers with information on suspected occupant injuries to improve injury detection and patient triage.     

Comparison of mid-block and intersection-related left turn collisions

OBJECTIVES: To evaluate the factors that might influence an occupant's injury severity during a left turn movement. METHODS: We used the National Automotive Sampling System Crashworthiness Data System (1995-2005) to compare crash characteristics and injury outcome between intersection and midblock left turn collisions. RESULTS: A total of 7,396 collisions were evaluated. Traffic control devices were present in 82% of intersection and 10% of mid-block collisions. After adjustment for potential confounding variables, drivers' injury severity was not significantly associated with the crash location. However, front seat passengers in mid-block collisions had 72% higher odds of experiencing an injury with injury severity score > or =9 (odds ratio: 1.72, 95% confidence interval: 1.09-2.69). Our analysis did not show that drivers or passengers in larger vehicles, e.g., sport utility vehicles and mini-vans, were at lower risk of more severe injuries in comparison to the car occupants in sedans. CONCLUSION: We found that in comparison to intersection-related left turn collisions, mid-block crashes are associated with more severe injuries for front seat passengers. Furthermore, size of the turning vehicle was not significantly associated with injury severity for drivers or front seat passengers.