Passenger muscle responses in lane change and lane change with braking maneuvers using two belt configurations: Standard and reversible pre-pretensioner

Abstract

Objective: The introduction of integrated safety technologies in new car models calls for an improved understanding of the human occupant response in precrash situations. The aim of this article is to extensively study occupant muscle activation in vehicle maneuvers potentially occurring in precrash situations with different seat belt configurations.

Methods: Front seat male passengers wearing a 3-point seat belt with either standard or pre-pretensioning functionality were exposed to multiple autonomously carried out lane change and lane change with braking maneuvers while traveling at 73?km/h. This article focuses on muscle activation data (surface electromyography [EMG] normalized using maximum voluntary contraction [MVC] data) obtained from 38 muscles in the neck, upper extremities, the torso, and lower extremities. The raw EMG data were filtered, rectified, and smoothed. All muscle activations were presented in corridors of mean?±?one standard deviation. Separate Wilcoxon signed ranks tests were performed on volunteers’ muscle activation onset and amplitude considering 2 paired samples with the belt configuration as an independent factor.

Results: In normal driving conditions prior to any of the evasive maneuvers, activity levels were low (<2% MVC) in all muscles except for the lumbar extensors (3–5.5% MVC). During the lane change maneuver, selective muscles were activated and these activations restricted the sideway motions due to inertial loading. Averaged muscle activity, predominantly in the neck, lumbar extensor, and abdominal muscles, increased up to 24% MVC soon after the vehicle accelerated in lateral direction for all volunteers. Differences in activation time and amplitude between muscles in the right and left sides of the body were observed relative to the vehicle’s lateral motion. For specific muscles, lane changes with the pre-pretensioner belt were associated with earlier muscle activation onsets and significantly smaller activation amplitudes than for the standard belt (P?<?.05).

Conclusions: Applying a pre-pretensioner belt affected muscle activations; that is, amplitude and onset time. The present muscle activation data complement the results in a preceding publication, the volunteers’ kinematics and the boundary conditions from the same data set. An effect of belt configuration was also seen on previously published volunteers’ kinematics with lower lateral and forward displacements for head and upper torso using the pre-pretensioner belt versus the standard belt. The data provided in this article can be used for validation and further improvement of active human body models with active musculature in both sagittal and lateral loading scenarios intended for simulation of some evasive maneuvers that potentially occur prior to a crash.     

Injury Severity Score alone predicts mortality when compared to EMS scene time and transport time for motor vehicle trauma patients who arrive alive to hospital

ABSTRACT

Objective: This study aims to identify the association, if any, between prehospital scene time, prehospital transport time, and Injury Severity Score (ISS) with in-hospital mortality.

Methods: A retrospective analysis was performed on patients at least 18 years of age who arrived to the hospital alive via emergency medical services (EMS) after a motor vehicle collision (MVC) between 1992 and 2016. These patients were divided into groups based on minutes spent at the scene and in transport. The ISS of the in-hospital mortalities, as well as the entire patient sample for each time frame, was collected. Patients without documented scene time, transport time, or ISS were excluded.

Results: Four thousand one hundred ninety-four patients were captured when analyzing scene time, though only 3,980 met inclusion criteria. In addition, 4,177 patients were captured when analyzing transport time, though only 3,979 met inclusion criteria. Scene time and transport time were not statistically significant predictors of in-hospital mortality (P = .31 and P = .458, respectively). ISS was found to be a statistically significant predictor of in-hospital mortality (P < .001).

Conclusions: ISS predicts mortality independent of scene time or transport time for patients who arrive to the hospital alive following an MVC at Guthrie Robert Packer Hospital. Limitations of our study include inability to capture prehospital deaths and inability to correlate ISS with prehospital injury severity scores.     

Development of injury risk models to guide CT evaluation in the emergency department after motor vehicle collisions

Abstract

Objective: The clinical evaluation of motor vehicle collision (MVC) victims is challenging and commonly relies on computed tomography (CT) to detect internal injuries. CT scans are financially expensive and each scan exposes the patient to additional ionizing radiation with an associated, albeit low, risk of cancer. Injury risk prediction based on regression modeling has been to be shown to be successful in estimating Injury Severity Scores (ISSs). The objective of this study was to (1) create risk models for internal injuries of occupants involved in MVCs based on CT body regions (head, neck, chest, abdomen/pelvis, cervical spine, thoracic spine, and lumbar spine) and (2) evaluate the performance of these risk prediction models to predict internal injury.

Methods: All Abbreviated Injury Scale (AIS) 2008 injury codes were classified based on which CT body region would be necessary to scan in order to make the diagnosis. Cases were identified from the NASS-CDS. The NASS-CDS data set was queried for cases of adult occupants who sought medical care and for which key crash characteristics were all present. Forward stepwise logistic regression was performed on data from 2010–2014 to create models predicting risk of internal injury for each CT body region. Injury risk for each region was grouped into 5 levels: very low (<2%), low (2–5%), medium (5–10%), high (10–20%), and very high (20%). The models were then tested using weighted data from 2015 in order to determine whether injury rates fell within the predicted risk level.

Results: The inclusion and exclusion criteria identified 5,477 cases in the NASS-CDS database. Cases from 2010–2014 were used for risk modeling (n?=?4,826). Seven internal injury risk models were created based on the CT body regions using data from 2010–2014. These models were tested against data from 2015 (n?=?651). In all CT body regions, the majority of occupants fell in the very low or low predicted injury rate groups, except for the head. On average, 57% of patients were classified as very low risk and 15% as low risk for each body region. In most cases the actual rate of injury was within the predicted injury risk range. The 95% confidence interval overlapped with predicting injury risk range in all cases.

Conclusion: This study successfully demonstrated the ability for internal injury risk models to accurately identify occupants at low risk for internal injury in individual body regions. This represents a step towards incorporating telemetry data into a clinical tool to guide physicians in the use of CT for the evaluation of MVC victims.     

Driver Injury Risk Variability in Finite Element Reconstructions of Crash Injury Research and Engineering Network (CIREN) Frontal Motor Vehicle Crashes

Objective: A 3-phase real-world motor vehicle crash (MVC) reconstruction method was developed to analyze injury variability as a function of precrash occupant position for 2 full-frontal Crash Injury Research and Engineering Network (CIREN) cases.

Method: Phase I: A finite element (FE) simplified vehicle model (SVM) was developed and tuned to mimic the frontal crash characteristics of the CIREN case vehicle (Camry or Cobalt) using frontal New Car Assessment Program (NCAP) crash test data. Phase II: The Toyota HUman Model for Safety (THUMS) v4.01 was positioned in 120 precrash configurations per case within the SVM. Five occupant positioning variables were varied using a Latin hypercube design of experiments: seat track position, seat back angle, D-ring height, steering column angle, and steering column telescoping position. An additional baseline simulation was performed that aimed to match the precrash occupant position documented in CIREN for each case. Phase III: FE simulations were then performed using kinematic boundary conditions from each vehicle's event data recorder (EDR). HIC15, combined thoracic index (CTI), femur forces, and strain-based injury metrics in the lung and lumbar vertebrae were evaluated to predict injury.

Results: Tuning the SVM to specific vehicle models resulted in close matches between simulated and test injury metric data, allowing the tuned SVM to be used in each case reconstruction with EDR-derived boundary conditions. Simulations with the most rearward seats and reclined seat backs had the greatest HIC15, head injury risk, CTI, and chest injury risk. Calculated injury risks for the head, chest, and femur closely correlated to the CIREN occupant injury patterns. CTI in the Camry case yielded a 54% probability of Abbreviated Injury Scale (AIS) 2+ chest injury in the baseline case simulation and ranged from 34 to 88% (mean = 61%) risk in the least and most dangerous occupant positions. The greater than 50% probability was consistent with the case occupant's AIS 2 hemomediastinum. Stress-based metrics were used to predict injury to the lower leg of the Camry case occupant. The regional-level injury metrics evaluated for the Cobalt case occupant indicated a low risk of injury; however, strain-based injury metrics better predicted pulmonary contusion. Approximately 49% of the Cobalt occupant's left lung was contused, though the baseline simulation predicted 40.5% of the lung to be injured.

Conclusions: A method to compute injury metrics and risks as functions of precrash occupant position was developed and applied to 2 CIREN MVC FE reconstructions. The reconstruction process allows for quantification of the sensitivity and uncertainty of the injury risk predictions based on occupant position to further understand important factors that lead to more severe MVC injuries.     

Decomposition analysis of the effects of vehicle safety technologies on the motor vehicle collision–related mortality rate from 1994 to 2015

Abstract

Objective: Though the mortality rate for motor vehicle collisions (MVCs) has been decreasing since the 1960s with the advent of the first federal seat belt laws in 1968, MVC remains a leading cause of death for individuals aged 1 to 44 years. The purpose of this study is to examine the effects of frontal (FABs) and side airbags (SABs) and electronic stability control (ESC) on the components of the MVC mortality rate.

Methods: The MVC mortality rate from 1994 to 2015 was separated into its components of exposure of vehicles, exposure of travel, collision density, injury incidence, and case fatality rate. Year was categorized on the availability of safety technology in vehicles: 1994–1997 (first-generation FABs mandated), 1998–2001 (sled-certified, second-generation FABs mandated), 2002–2006 (increasing prevalence of SABs and ESC), 2007–2011 (advanced airbags mandated), and 2012–2015 (ESC mandated, SAB in over 90% of vehicles, introduction of advanced safety systems). Relative contributions (RCs) of the components to changes in the MVC-related mortality rate were calculated as the absolute value of the component’s beta coefficient divided by the sum of the absolute values of all components’ beta coefficients. Negative binomial regression–estimated rate ratios (RRs) for the changes in the rate of each component by year category compared to the prior year category.

Results: Significant decreases in the MVC mortality rate were observed for 2007–2011 and 2012–2015. The decrease in 2007–2011 was due in most part to an 18% decrease in the injury incidence (RR?=?0.82, P?<?.0001, RC?=?63%), though there was a noted contribution by the decrease in vehicle miles traveled (RR?=?0.95, P?<?.0001, RC?=?15%). The continued decrease in mortality in 2012–2015 was due is most part to the 10% decreased case fatality rate (RR?=?0.90, P?<?.0001, RC?=?66%) because there was no significant change in the vehicle miles traveled and injury incidence.

Conclusions: The results of this study highlight the effects of vehicle safety technologies on the MVC-related mortality rate and can help direct prevention efforts. Through the study period, there was no meaningful contribution to decreases in the MVC-related mortality rate due to components related to exposure (i.e., vehicles per population and the rate of vehicle miles traveled), suggesting that prevention efforts at decreasing exposure prevalence would have little effect on the MVC-related mortality rate. Instead, prevention efforts should continue to focus on event-phase methods to decrease injury occurrence and mitigate injury severity during the collision.     

Lumbar Bone Mineral Density Phantomless Computed Tomography Measurements and Correlation with Age and Fracture Incidence

Objective: Low bone quality is a contributing factor to motor vehicle crash (MVC) injury. Quantification of occupant bone mineral density (BMD) is important from an injury causation standpoint. The first aim of this study was to validate a technique for measuring lumbar volumetric BMD (vBMD) from phantomless computed tomography (CT) scans. The second aim was to apply the validated phantomless technique to quantify lumbar vBMD in Crash Injury Research and Engineering Network (CIREN) occupants for correlation with age, fracture incidence, and osteopenia/osteoporosis diagnoses.

Methods: Quantitative CT (qCT) and dual-energy X-ray absorptiometry (DXA) were collected prospectively for 50 subjects and used to validate a technique to measure vBMD from 281 phantomless CT scans of CIREN occupants. Hounsfield unit (HU) measurements were collected from the L1–L5 vertebrae, right psoas major muscle, and anterior subcutaneous fat for all subjects and from 3 phantom ports with known mg/cc calcium hydroxyapatite values for the validation group. qCT calibration was accomplished using regressions between the phantom HU and mg/cc values to convert L1–L5 HU values to mg/cc. A phantomless calibration technique was developed where the fat and muscle HU values were linearly regressed against fat (?69 mg/cc) and muscle (77 mg/cc) to establish a conversion for L1–L5 HU measurements to mg/cc. vBMD calculated from qCT versus the phantomless method was compared for the 50 subjects to assess agreement and a mg/cc osteopenia threshold was established using DXA T-scores. CIREN HU measurements were converted to mg/cc using the phantomless technique and the mg/cc osteopenia threshold was used to compare vBMD to age, fracture incidence, and osteopenia comorbidity classifications in CIREN.

Results: Linear regression of lumbar vBMD derived from the qCT versus phantomless calibrations showed excellent agreement (R² = 0.87, P <.0001). A 145 mg/cc threshold for osteopenia was established (sensitivity = 1, specificity = 0.57) and 44 CIREN occupants had vBMD below this threshold. Of these 44 occupants, 64% were not classified as osteopenic in CIREN, but vBMD suggested undiagnosed osteopenia. Age was negatively correlated with vBMD in both sexes (P <.0001) and CIREN occupants with less than 145 mg/cc vBMD sustained an average 1.7 additional rib/sternum fractures (P =.036).

Conclusions: Because lumbar vBMD was estimated from phantomless CT scans with accuracy similar to qCT, the phantomless technique can be broadly applied to both prospectively and retrospectively assess patient bone quality for research and clinical studies related to MVCs, falls, and aging.     

The need to improve information on road user type in National Vital Statistics System mortality data

Objectives: Both the National Vital Statistics System (NVSS) and the Fatality Analysis Reporting System (FARS) can be used to examine motor vehicle crash (MVC) deaths. These 2 data systems operate independently, using different methods to collect and code information about the type of vehicle (e.g., car, truck, bus) and road user (e.g., occupant, motorcyclist, pedestrian) involved in an MVC. A substantial proportion of MVC deaths in NVSS are coded as “unspecified” road user, which reduces the utility of the NVSS data for describing burden and identifying prevention measures. This study aimed to describe characteristics of unspecified road user deaths in NVSS to further our understanding of how these groups may be similar to occupant road user deaths.

Methods: Using data from 1999 to 2015, we compared NVSS and FARS MVC death counts by road user type, overall and by age group, gender, and year. In addition, we examined factors associated with the categorization of an MVC death as unspecified road user such as state of residence of decedent, type of medical death investigation system, and place of death.

Results: The number of MVC occupant deaths in NVSS was smaller than that in FARS in each year and the number of unspecified road user deaths in NVSS was greater than that in FARS. The sum of the number of occupant and unspecified road user deaths in NVSS, however, was approximately equal to the number of FARS occupant deaths. Age group and gender distributions were roughly equivalent for NVSS and FARS occupants and NVSS unspecified road users. Within NVSS, the number of MVC deaths listed as unspecified road user varied across states and over time. Other categories of road users (motorcyclists, pedal cyclists, and pedestrians) were consistent when comparing NVSS and FARS.

Conclusions: Our findings suggest that the unspecified road user MVC deaths in NVSS look similar to those of MVC occupants according to selected characteristics. Additional study is needed to identify documentation and reporting challenges in individual states and over time and to identify opportunities for improvement in the coding of road user type in NVSS.     

Effects of work surface and task difficulty on neck–shoulder posture and trapezius activity during a simulated mouse task

Objectives. The purpose of this study is to evaluate the influence of the work surface and task difficulty on the head, upper back and upper arm postures and activity of the descending trapezius during a simulated mouse task. Methods. Healthy female university students (N?=?15) were evaluated. The work surface was positioned at elbow height (EH) and above elbow height (AEH) and the task difficulty was set at low (LD) and high (HD) levels. The postures were recorded by inclinometers. Trapezius activity was normalized by the maximum voluntary isometric contraction (MVIC). Results. Significantly higher head flexion was found at EH compared to the AEH condition, with an average difference of 2°–5° at the same difficulty level. The HD task significantly increased head (3°–6°) and upper back flexion (6°–7°) at the same table height. For upper arm elevation and trapezius activation, the AEH condition presented higher upper arm elevation (about 6°–8°) and trapezius activity (0.8–1.4% of MVIC), regardless of the difficulty level of the task. Conclusions. Head posture was influenced by the table height and task difficulty; the upper back posture by high difficulty; and upper arm posture and trapezius activity were only influenced by table height.     

Alcohol is a predictor of mortality in motor vehicle collisions

IntroductionIt is well recognized that driving while intoxicated increases the probability of a motor-vehicle collision (MVC). The effect of alcohol on the chance of surviving the MVC is less clear. Method: Using data from the Fatality Analysis Reporting System (FARS) we conducted analyses for the outcome of mortality using alcohol and other variables as predictors. We also selected alcohol positive (AP) and alcohol negative (AN) persons from the same MVC and vehicle to control for confounding characteristics. Results: The odds ratio (OR) for mortality for alcohol positive drivers was 2.57, (p < 0.001 for all the following OR). Other harmful predictive factors were age OR 1.01 per year, vehicle age OR 1.05 per year, male sex OR 1.23, avoidance maneuver OR 1.09, speed related OR 2.89, rollover mechanism OR 2.75, and collision with a fixed object OR 6.70. Protective factors were proper restraint use – OR 0.19 and collision with another moving vehicle, OR 0.21. In the multivariate analysis the OR of mortality for AP vs AN was 1.46. Proper restraint use (OR 0.27) remained protective along with collision with another moving vehicle. When AP and AN persons from the same MVC and the same vehicle were compared, the adjusted OR’s for mortality were 1.46 and 2.08, respectively. Conclusions: Alcohol is an independent predictor of mortality in an MVC. Proper restraint use is the strongest protective factor. This finding allows a more complete understanding of the risks of driving while intoxicated, not only a higher probability of an MVC, but decreased survival once the MVC occurs. Practical Applications: Identification of alcohol as an independent predictor of mortality in an accident may improve risk assessment and influence drivers to avoid driving while intoxicated.     

Potentially preventable prehospital deaths from motor vehicle collisions

Background: In 2011, about 30,000 people died in motor vehicle collisions (MVCs) in the United States. We sought to evaluate the causes of prehospital deaths related to MVCs and to assess whether these deaths were potentially preventable.

Methods: Miami–Dade Medical Examiner records for 2011 were reviewed for all prehospital deaths of occupants of 4-wheeled motor vehicle collisions. Injuries were categorized by affected organ and anatomic location of the body. Cases were reviewed by a panel of 2 trauma surgeons to determine cause of death and whether the death was potentially preventable. Time to death and hospital arrival times were determined using the Fatality Analysis Reporting System (FARS) data from 2002 to 2012, which allowed comparison of our local data to national prevalence estimates.

Results: Local data revealed that 39% of the 98 deaths reviewed were potentially preventable (PPD). Significantly more patients with PPD had neurotrauma as a cause of death compared to those with a nonpreventable death (NPD) (44.7% vs. 25.0%, P =.049). NPDs were significantly more likely to have combined neurotrauma and hemorrhage as cause of death compared to PPDs (45.0% vs. 10.5%, P <.001). NPDs were significantly more likely to have injuries to the chest, pelvis, or spine. NPDs also had significantly more injuries to the following organ systems: lung, cardiac, and vascular chest (all P <.05). In the nationally representative FARS data from 2002 to 2012, 30% of deaths occurred on scene and another 32% occurred within 1 h of injury. When comparing the 2011 FARS data for Miami–Dade to the remainder of the United States in that year, percentage of deaths when reported on scene (25 vs. 23%, respectively) and within 1 h of injury (35 vs. 32%, respectively) were similar.

Conclusions: Nationally, FARS data demonstrated that two thirds of all MVC deaths occurred within 1 h of injury. Over a third of prehospital MVC deaths were potentially preventable in our local sample. By examining injury patterns in PPDs, targeted intervention may be initiated.     

Effects of an integrated collision warning system on teenage driver behavior

IntroductionCrash warning systems have been shown to provide safety benefits, but no studies have examined how teenagers respond. This study sought to find out whether young, inexperienced drivers change behavior in response to warnings.MethodsForty 16–17 year-olds drove an instrumented vehicle equipped with a system that warned for lane departures and potential rear-end and lane change/merge crashes. Participants were randomly assigned to experimental or control groups, and their driving was monitored for 14 weeks during 2011–12. For the experimental group, this included a treatment period, when crash alerts were received by drivers, and baseline and post-treatment periods, when warnings were recorded but not received. The control group never received warnings. Data were analyzed to determine whether warnings were associated with changes in driving behavior.ResultsA total of 15,039 trips were analyzed. Lane drifts accounted for 73% of warnings. Forward collision warning rates doubled for all drivers during the treatment period and continued at an increased rate post-treatment. This was likely a result of the fact that, as time went on, all drivers spent more time following vehicles at close distances. Receiving alerts was associated with effects on following and lane-changing behavior, including more time spent following at close distances (17%), fewer lateral drifts (37%) and fewer unsignaled lane changes (80%). Receiving warnings wasn't associated with an increased likelihood of engaging in secondary tasks.ConclusionsWarning systems may result in improved lane-keeping and turn-signal behaviors by novice drivers, but there is some indication they may result in more close-following behaviors.Practical applicationsThere is some evidence that lane departure warning may improve turn-signal use for young drivers. While there is no evidence of safety benefits from the other types of warnings, there is some evidence of an increase in close-following behavior but no increase in secondary tasks due to the presence of those capabilities.     

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 useful field of view assessment predicts simulated commercial motor vehicle driving safety

Objective: The Useful Field of View (UFOV) assessment, a measure of visual speed of processing, has been shown to be a predictive measure of motor vehicle collision (MVC) involvement in an older adult population, but it remains unknown whether UFOV predicts commercial motor vehicle (CMV) driving safety during secondary task engagement. The purpose of this study is to determine whether the UFOV assessment predicts simulated MVCs in long-haul CMV drivers.

Method: Fifty licensed CMV drivers (M_age = 39.80, SD = 8.38, 98% male, 56% Caucasian) were administered the 3-subtest version of the UFOV assessment, where lower scores measured in milliseconds indicated better performance. CMV drivers completed 4 simulated drives, each spanning approximately a 22.50-mile distance. Four secondary tasks were presented to participants in a counterbalanced order during the drives: (a) no secondary task, (b) cell phone conversation, (c) text messaging interaction, and (d) e-mailing interaction with an on-board dispatch device.

Results: The selective attention subtest significantly predicted simulated MVCs regardless of secondary task. Each 20 ms slower on subtest 3 was associated with a 25% increase in the risk of an MVC in the simulated drive. The e-mail interaction secondary task significantly predicted simulated MVCs with a 4.14 times greater risk of an MVC compared to the no secondary task condition. Subtest 3, a measure of visual speed of processing, significantly predicted MVCs in the email interaction task. Each 20 ms slower on subtest 3 was associated with a 25% increase in the risk of an MVC during the email interaction task.

Conclusions: The UFOV subtest 3 may be a promising measure to identify CMV drivers who may be at risk for MVCs or in need of cognitive training aimed at improving speed of processing. Subtest 3 may also identify CMV drivers who are particularly at risk when engaged in secondary tasks while driving.     

Emergency department visits vs. fatalities among substance-impaired underage youths involved in motor vehicle crashes

IntroductionEmergency department (ED) visits resulting from motor vehicle crashes (MVCs) among individuals younger than 21 impaired by alcohol and/or drugs have been less studied than MVC fatalities.MethodUsing data from 2004 to 2011, we compare the magnitude and pattern of national ED visit and mortality data for alcohol- and drug-impaired youths involved in MVCs.ResultsTemporal patterns of ED visits are similar to those of fatalities, but the two differ in magnitude. The ratio of ED visits to fatalities is 3.5:1; alcohol related events involvement dominates other drugs in both categories.DiscussionThe volume of injuries serious enough to warrant ED visits imposes significant health, social, and financial burdens. In ED visits, alcohol is the prime source of MVC morbidity burden; other drugs consistently contribute less.Practical applicationsThese incidents are persistent and require interventions aimed at multiple levels of prevention, including stricter corrective steps earlier in the impaired driving career to reduce subsequent incidents. ED visits for MVC injuries can be important “teachable moments.” Limitations of the study indicate the need for improved surveillance of underage substance-involved crashes.     

Postural and Muscular Responses While Viewing Different Heights of Screen

This study aimed to examine the effects of visual display terminal (VDT) viewing angle on human postural angle and muscular activity. The participants’ neck, thoracic bending, and trunk inclination angles; and the activity of sternocleidomastoid, trapezius, splenius capitis, and erector spinae at 5 viewing angles (+40°, +20°,0°, –20°, and –40°) of a VDT screen were collected for 1 min. This study showed that neck and thoracic bending angles increased with viewing angle, while viewing angle did not significantly affect trunk inclination angle. In addition, the activity of trapezius and erector spinae increased when viewing a higher or lower VDT screen height compared with viewing a horizontal VDT screen height; however, the activity of splenius capitis decreased with viewing angle.     

Thoracic and lumbar spine responses in high-speed rear sled tests

Objective: This study analyzed thoracic and lumbar spine responses with in-position and out-of-position (OOP) seated dummies in 40.2 km/h (25 mph) rear sled tests with conventional and all-belts-to-seat (ABTS) seats. Occupant kinematics and spinal responses were determined with modern (≥2000 MY), older (<2000 MY), and ABTS seats.

Methods: The seats were fixed in a sled buck subjected to a 40.2 km/h (25 mph) rear sled test. The pulse was a 15 g double-peak acceleration with 150 ms duration. The 50th percentile Hybrid III was lap–shoulder belted in the FMVSS 208 design position or OOP, including leaning forward and leaning inboard and forward. There were 26 in-position tests with 11 <2000 MY, 8 ≥2000 MY, and 7 ABTS and 14 OOP tests with 6 conventional and 8 ABTS seats. The dummy was fully instrumented. This study addressed the thoracic and lumbar spine responses. Injury assessment reference values are not approved for the thoracic and lumbar spine. Conservative thresholds exist. The peak responses were normalized by a threshold to compare responses. High-speed video documented occupant kinematics.

Results: The extension moments were higher in the thoracic than lumbar spine in the in-position tests. For <2000 MY seats, the thoracic extension moment was 76.8 ± 14.6% of threshold and the lumbar extension moment was 50.5 ± 17.9%. For the ≥2000 MY seats, the thoracic extension moment was 54.2 ± 26.6% of threshold and the lumbar extension moment was 49.8 ± 27.7%. ABTS seats provided similar thoracic and lumbar responses. Modern seat designs lowered thoracic and lumbar responses. For example, the 1996 Taurus had ?1,696 N anterior lumbar shear force and ?205.2 Nm extension moment. There was ?1,184 N lumbar compression force and 1,512 N tension. In contrast, the 2015 F-150 had ?500 N shear force and ?49.7 Nm extension moment. There was ?839 N lumbar compression force and 535 N tension. On average, the 2015 F-150 had 40% lower lumbar spine responses than the 1996 Taurus. The OOP tests had similar peak lumbar responses; however, they occurred later due to the forward lean of the dummy.

Conclusions: The design and performance of seats have significantly changed over the past 20 years. Modern seats use a perimeter frame allowing the occupant to pocket into the seatback. Higher and more forward head restraints allow a stronger frame because the head, neck, and torso are more uniformly supported with the seat more upright in severe rear impacts. The overall effect has been a reduction in thoracic and lumbar loads and risks for injury.     

Trauma demography and clinical epidemiology of motorcycle crash–related head injury in a neurosurgery practice in an African developing country

Objective: Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries.

Methods: Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.

Results: Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle–motorcycle crashes. The HI was moderate–severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS–head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%.

MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27–6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).

Conclusions: Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.     

Computational modeling and analysis of thoracolumbar spine fractures in frontal crash reconstruction

Abstract

Objective: This study aimed to reconstruct 11 motor vehicle crashes (6 with thoracolumbar fractures and 5 without thoracolumbar fractures) and analyze the fracture mechanism, fracture predictors, and associated parameters affecting thoracolumbar spine response.

Methods: Eleven frontal crashes were reconstructed with a finite element simplified vehicle model (SVM). The SVM was tuned to each case vehicle and the Total HUman Model for Safety (THUMS) Ver. 4.01 was scaled and positioned in a baseline configuration to mimic the documented precrash driver posture. The event data recorder crash pulse was applied as a boundary condition. For the 6 thoracolumbar fracture cases, 120 simulations to quantify uncertainty and response variation were performed using a Latin hypercube design of experiments (DOE) to vary seat track position, seatback angle, steering column angle, steering column position, and D-ring height. Vertebral loads and bending moments were analyzed, and lumbar spine indices (unadjusted and age-adjusted) were developed to quantify the combined loading effect. Maximum principal strain and stress data were collected in the vertebral cortical and trabecular bone. DOE data were fit to regression models to examine occupant positioning and thoracolumbar response correlations.

Results: Of the 11 cases, both the vertebral compression force and bending moment progressively increased from superior to inferior vertebrae. Two thoracic spine fracture cases had higher average compression force and bending moment across all thoracic vertebral levels, compared to 9 cases without thoracic spine fractures (force: 1,200.6 vs. 640.8 N; moment: 13.7 vs. 9.2?Nm). Though there was no apparent difference in bending moment at the L1–L2 vertebrae, lumbar fracture cases exhibited higher vertebral bending moments in L3–L4 (fracture/nonfracture: 45.7 vs. 33.8?Nm). The unadjusted lumbar spine index correctly predicted thoracolumbar fracture occurrence for 9 of the 11 cases (sensitivity?=?1.0; specificity?=?0.6). The age-adjusted lumbar spine index correctly predicted thoracolumbar fracture occurrence for 10 of the 11 cases (sensitivity?=?1.0; specificity?=?0.8). The age-adjusted principal stress in the trabecular bone was an excellent indicator of fracture occurrence (sensitivity?=?1.0; specificity?=?1.0). A rearward seat track position and reclined seatback increased the thoracic spine bending moment by 111–329%. A more reclined seatback increased the lumbar force and bending moment by 16–165% and 67–172%, respectively.

Conclusions: This study provided a computational framework for assessing thoracolumbar fractures and also quantified the effect of precrash driver posture on thoracolumbar response. Results aid in the evaluation of motor vehicle crash–induced vertebral fractures and the understanding of factors contributing to fracture risk.     

Cervical musculoskeletal disorders and their relationships with personal and work-related factors among electronic assembly workers

IntroductionElectronics assembly workers are reported to have a high prevalence of musculoskeletal disorders (MSDs). This study investigated the prevalence of cervical MSDs and the complex relationships between cervical MSDs and individual, physical, psychosocial factors among electronics assembly workers. Methods: In this cross-sectional survey, self-administered questionnaires from 700 workers in electronics manufacturing workshops were analysed. Information concerning musculoskeletal symptoms, personal and work-related factors was collected. Finally, the prevalence of cervical MSDs was computed for different subgroups, and the relationships with different factors were analyzed using logistic regression and structural equation modeling (SEM). Results: The total 12 month prevalence of cervical MSDs among the survey population was 29.4%. Variables of gender, job tenure, twisting head frequently, neck flexion/extension for long time and work required to be done quickly showed significant associations with MSDs in a multivariate logistic regression (P < 0.05). The SEM analysis showed moderate and significant correlations between postural load (γ = 0.279), gender (γ = 0.233) and cervical MSDs, while there were weak but significant correlations between vibration (γ = 0.024), work stress (γ = 0.126), job tenure (γ = 0.024) and cervical MSDs. Both work stress and vibration affected the MSDs indirectly through postural load. Conclusions: The logistic regression results support previous general epidemiological MSD studies, and indicates that individual, physical, and psychosocial factors are related to cervical MSDs. The SEM provides a better approximation of the complexity of the relationship between risk factors and cervical MSDs. Improving awkward postures may be effective ways to control the influence of occupational stressors or vibration on MSDs. Practical Applications: The study is to improve prevention of MSDs among electronics assembly workers and promote their occupational health.