Small female rib cage fracture in frontal sled tests

Objectives: The 2 objectives of this study are to (1) examine the rib and sternal fractures sustained by small stature elderly females in simulated frontal crashes and (2) determine how the findings are characterized by prior knowledge and field data.

Methods: A test series was conducted to evaluate the response of 5 elderly (average age 76 years) female postmortem human subjects (PMHS), similar in mass and size to a 5th percentile female, in 30 km/h frontal sled tests. The subjects were restrained on a rigid planar seat by bilateral rigid knee bolsters, pelvic blocks, and a custom force-limited 3-point shoulder and lap belt. Posttest subject injury assessment included identifying rib cage fractures by means of a radiologist read of a posttest computed tomography (CT) and an autopsy. The data from a motion capture camera system were processed to provide chest deflection, defined as the movement of the sternum relative to the spine at the level of T8.

?A complementary field data investigation involved querying the NASS-CDS database over the years 1997–2012. The targeted cases involved belted front seat small female passenger vehicle occupants over 40 years old who were injured in 25 to 35 km/h delta-V frontal crashes (11 to 1 o'clock).

Results: Peak upper shoulder belt tension averaged 1,970 N (SD = 140 N) in the sled tests. For all subjects, the peak x-axis deflection was recorded at the sternum with an average of ?44.5 mm or 25% of chest depth. The thoracic injury severity based on the number and distribution of rib fractures yielded 4 subjects coded as Abbreviated Injury Scale (AIS) 3 (serious) and one as AIS 5 (critical). The NASS-CDS field data investigation of small females identified 205 occupants who met the search criteria. Rib fractures were reported for 2.7% of the female occupants.

Conclusions: The small elderly test subjects sustained a higher number of rib cage fractures than expected in what was intended to be a minimally injurious frontal crash test condition. Neither field studies nor prior laboratory frontal sled tests conducted with 50th percentile male PMHS predicted the injury severity observed. Although this was a limited study, the results justify further exploration of the risk of rib cage injury for small elderly female occupants.     

Assessment of Bilateral Thoracic Loading on the Near-Side Occupant Due to Occupant-to-Occupant Interaction in Vehicle Crash Tests

Objective: This study aims, by means of the WorldSID 50th percentile male, to evaluate thoracic loading and injury risk to the near-side occupant due to occupant-to-occupant interaction in combination with loading from an intruding structure.

Method: Nine vehicle crash tests were performed with a 50th percentile WorldSID male dummy in the near-side (adjacent to the intruding structure) seat and a THOR or ES2 dummy in the far-side (opposite the intruding structure) seat. The near-side seated WorldSID was equipped with 6 + 6 IR-Traccs (LH and RH) in the thorax/abdomen enabling measurement of bilateral deflection. To differentiate deflection caused by the intrusion, and the deflection caused by the neighboring occupant, time history curves were analyzed. The crash tests were performed with different modern vehicles, equipped with thorax side airbags and inflatable curtains, ranging from a compact car to a large sedan, and in different loading conditions such as car-to-car, barrier, and pole tests. Lateral delta V based on vehicle tunnel acceleration and maximum residual intrusion at occupant position were used as a measurement of crash severity to compare injury measurements.

Result: In the 9 vehicle crash tests, thoracic loading, induced by the intruding structure as well as from the far-side occupant, varied due to the size and structural performance of the car as well as the severity of the crash. Peak deflection on the thoracic outboard side occurred during the first 50 ms of the event. Between 70 to 150 ms loading induced by the neighboring occupant occurred and resulted in an inboard-side peak deflection and viscous criterion. In the tests where the target vehicle lateral delta V was below 30 km/h and intrusion less than 200 mm, deflections were low on both the outboard (20–40 mm) and inboard side (10–15 mm). At higher crash severities, delta V 35 km/h and above as well as intrusions larger than 350 mm, the inboard deflections (caused by interaction to the far-side occupant) were of the same magnitude or even higher (30–70 mm) than the outboard deflections (30–50 mm).

Conclusion: A WorldSID 50th percentile male equipped with bilateral IR-Traccs can detect loading to the thorax from a neighboring occupant making injury risk assessment feasible for this type of loading. At crash severities resulting in a delta V above 35 km/h and intrusions larger than 350 mm, both the inboard deflection and VC resulted in high risks of Abbreviated Injury Scale (AIS) 3+ injury, especially for a senior occupant.     

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.     

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.     

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.     

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.     

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.     

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.     

Chest injuries of elderly postmortem human surrogates (PMHSs) under seat belt and airbag loading in frontal sled impacts: Comparison to matching THOR tests

Abstract

Objective: The goal of the study was to develop experimental chest loading conditions that would cause up to Abbreviated Injury Scale (AIS) 2 chest injuries in elderly occupants in moderate-speed frontal crashes. The new set of experimental data was also intended to be used in the benchmark of existing thoracic injury criteria in lower-speed collision conditions.

Methods: Six male elderly (age >63) postmortem human subjects (PMHS) were exposed to a 35?km/h (nominal) frontal sled impact. The test fixture consisted of a rigid seat, rigid footrest, and cable seat back. Two restraint conditions (A and B) were compared. Occupants were restrained by a force-limited (2.5?kN [A] and 2?kN [B]) seat belt and a preinflated (16?kPa [A] and 11?kPa [B]; airbag). Condition B also incorporated increased seat friction. Matching sled tests were carried out with the THOR-M dummy. Infra-red telescoping rod for the assessment of chest compression (IRTRACC) readings were used to compute chest injury risk. PMHSs were exposed to a posttest injury assessment. Tests were carried out in 2 stages, using the outcome of the first one combined with a parametric study using the THUMS model to adjust the test conditions in the second. All procedures were approved by the relevant ethics board.

Results: Restraint condition A resulted in an unexpected high number of rib fractures (fx; 10, 14, 15 fx). Under condition B, the adjustment of the relative airbag/occupant position combined with a lower airbag pressure and lower seat belt load limit resulted in a reduced pelvic excursion (85 vs. 110?mm), increased torso pitch and a substantially lower number of rib fractures (1, 0, 4 fx) as intended.

Conclusions: The predicted risk of rib fractures provided by the THOR dummy using the C_max and PC Score injury criteria were lower than the actual injuries observed in the PMHS tests (especially in restraint condition A). However, the THOR dummy was capable of discriminating between the 2 restraint scenarios. Similar results were obtained in the parametric study with the THUMS model.     

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.     

The Importance of Non-struck Side Occupants in Side Collisions

Current occupant protection assessment for side impact is focused on struck side occupants sitting alone. In a representative sample of tow-away side collisions from the UK, only one-third of front seat occupants in side collisions were alone, on the struck side of the car. The other two-thirds were either a non-struck side occupant alone or a situation where the adjacent seat was also occupied. In terms of restraint protection for non-struck side occupants, belts appeared to be less effective in perpendicular compared to oblique side crashes. Front seat occupancy had bearing on injury outcome. With both front seats occupied, there was a reduction in AIS 27+ injury to belted non-struck side occupants due to a reduction in chest and lower limb injuries. Struck side occupants sustained increased injury rates to the extremities when accompanied by a belted non-struck side occupant but no notable increases in moderate to serious injury to the head, chest, abdomen or pelvis.     

Differences in Long-term Medical Consequences Depending on Impact Direction Involving Passenger Cars

Objective: There is limited knowledge of the long-term medical consequences for occupants injured in car crashes in various impact directions. Thus, the objective was to evaluate whether injuries leading to permanent medical impairment differ depending on impact direction.

Methods: In total, 36,743 injured occupants in car crashes that occurred between 1995 and 2011 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. Injured car occupants were followed for at least 3 years to assess permanent medical impairment. The data were divided into different groups according to impact direction and levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to AIS.

Results: It was found that almost 12% of all car occupants sustained a permanent medical impairment. Given an injury, car occupants involved in rollover crashes had the highest overall risk to sustain a permanent medical impairment. Half of the head injuries leading to long-term consequences occurred in frontal impacts. Far-side occupants had almost the same risk as near-side occupants. Occupants who sustained a permanent medical impairment from cervical spine injuries had similar risk in all impact directions (13%) except from rollover (17%). However, these injuries occurred more often in rear crashes. Most of the injuries leading to long-term consequences were classified as minor injuries by AIS for all impact directions.

Conclusions: Studying crash data from a perspective of medical impairment is important to identify injuries that might not be prioritized only considering the AIS but might lead to lower quality of life for the occupant and also costs for society. These results can be used for road transport system strategies and for making priority decisions in vehicle design.     

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.     

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.     

The safest seat: effect of seating position on occupant mortality

INTRODUCTION: This study investigated the survival rates of occupants of passenger cars involved in a fatal crash between 2000 and 2003. METHODS: The information from every fatal crash in the United States between 2000 and 2003 was analyzed. Variables such as seat position, point of impact, rollover, restraint use, vehicle type, vehicle weight, occupant age, and injury severity were extracted from the Fatality Analysis Reporting System (FARS). Univariate and a full logistic multivariate model analyses were performed. RESULTS: The data show that the rear middle seat is safer than any other occupant position when involved in a fatal crash. Overall, the rear (2(nd) row) seating positions have a 29.1% (Univariate Analysis, p<.0001, OR 1.29, 95% CI 1.22 - 1.37) increased odds of survival over the first row seating positions and the rear middle seat has a 25% (Univariate Analysis, p<.0001, OR 1.25, 95% CI 1.17 - 1.34) increased odds of survival over the other rear seat positions. After correcting for potential confounders, occupants of the rear middle seat have a 13% (Logistic Regression, p<.001, 95% CI 1.02 - 1.26) increased chance of survival when involved in a crash with a fatality than occupants in other rear seats. CONCLUSION: This study has shown that the safest position for any occupant involved in a motor-vehicle crash is the rear middle seat. IMPACT ON INDUSTRY: The results of this research may impact how automobile manufacturers look at future rear middle seat designs. If the rear seat was to be designed exactly like its outboard counterparts (headrest, armrests, lap and shoulder belt, etc.) people may choose to sit on it more often rather than waiting to use it out of necessity due to multiple rear seat occupants.     

Biofidelity Corridors for Sternum Kinematics in Low-Speed Side Impacts

Objective: Field data show that side impact car crashes have become responsible for a greater proportion of the fatal crashes compared to frontal crashes, which suggests that the protection gained in frontal impact has not been matched in side impact. One of the reasons is the lack of understanding of the torso injury mechanisms in side impact. In particular, the deformation of the rib cage and how it affects the mechanical loading of the individual ribs have yet to be established. Therefore, the objective of this study was to characterize the ribcage deformation in side impacts by describing the kinematics of the sternum relative to the spine.

Methods: The 3D kinematics of the 1st and of the 5th or 6th thoracic vertebrae and of the sternum were obtained for three Post Mortem Human Subjects (PMHS) impacted laterally by a rigid wall traveling at 15 km/h. The experimental data were processed to express the kinematics of the sternum relative to the spine throughout the impact event. Methods were developed to interpolate the kinematics of the vertebrae for which experimental data were not available.

Results: The kinematics of the sternocostal junction for ribs 1 to 6 as well as the orientation of the sternum were expressed in the vertebra coordinate systems defined for each upper thoracic vertebra (T1 to T6). Corridors were designed for the motion of the sternum relative to each vertebra. In the experiments, the sternum moved upward for all rib levels (1 to 6), and away from the spine with an amplitude that increased with the decreasing rib level (from rib 1 to rib 6). None of the differences observed in the kinematics could be correlated to the occurrence of rib fractures.

Conclusions: This study provides both qualitative and quantitative information for the ribcage skeletal kinematics in side impact. This data set provides the information required to better evaluate computational models of the thorax for side impact simulations. The corridors developed in this study provide new biofidelity targets for the impact response of the ribcage. This study contributes to augmenting the state of knowledge of the human chest deformation in side impact to better characterize the rib fracture mechanisms.     

The Contribution of Pre-impact Posture on Restrained Occupant Finite Element Model Response in Frontal Impact

Objective: The objective of this study was to discuss the influence of the pre-impact posture to the response of a finite element human body model (HBM) in frontal impacts.

Methods: This study uses previously published cadaveric tests (PMHS), which measured six realistic pre-impact postures. Seven postured models were created from the THUMS occupant model (v4.0): one matching the standard UMTRI driving posture as it was the target posture in the experiments, and six matching the measured pre-impact postures. The same measurements as those obtained during the cadaveric tests were calculated from the simulations, and biofidelity metrics based on signals correlation (CORA) were established to compare the response of the seven models to the experiments.

Results: The HBM responses showed good agreement with the PMHS responses for the reaction forces (CORA = 0.80 ± 0.05) and the kinematics of the lower part of the torso but only fair correlation was found with the head, the upper spine, rib strains (CORA= 0.50 ± 0.05) and chest deflections (CORA = 0.67 ± 0.08). All models sustained rib fractures, sternal fracture and clavicle fracture. The average number of rib fractures for all the models was 5.3 ± 1.0, lower than in the experiments (10.8 ± 9.0).

Variation in pre-impact posture greatly altered the time histories of the reaction forces, deflections and the rib strains, mainly in terms of time delay, but no definite improvement in HBM response or injury prediction was observed. By modifying only the posture of the HBM, the variability in the impact response was found to be equivalent to that observed in the experiments. The postured HBM sustained from 4 to 8 rib fractures, confirming that the pre-impact posture influenced the injury outcome predicted by the simulation.

Conclusions: This study tries to answer an important question: what is the effect of occupant posture on kinematics and kinetics. Significant differences in kinematics observed between HBM and PMHS suggesting more coupling between the pelvis and the spine for the models which makes the model response very sensitive to any variation in the spine posture. Consequently, the findings observed for the HBM cannot be extended to PMHS. Besides, pre-impact posture should be carefully quantified during experiments and the evaluation of HBM should take into account the variation in the predicted impact response due to the variation in the model posture.