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.     

Continued trends in older driver crash involvement rates in the United States: Data through 2017–2018

Introduction: With the growing older adult population due to the aging baby-boom cohort, there was concern that increases in fatal motor-vehicle crashes would follow. Yet, previous analyses showed this to be untrue. The purpose of this study was to examine current trends to determine if previous declines have persisted or risen with the recent increase in fatalities nationwide. Methods: Trends among drivers ages 70 and older were compared with drivers 35–54 for U.S. passenger vehicle fatal crash involvements per 100,000 licensed drivers from 1997 to 2018, fatal and all police-reported crash involvements per vehicle miles traveled using the 1995, 2001, 2009, and 2017 National Household Travel Surveys, and driver deaths per 1,000 crashes. Results: Since the mid-1990s, fatal crashes per licensed driver trended downward, with greater declines for drivers ages 70 and older than for middle-aged drivers (43% vs. 21%). Fatal crash rates per 100,000 licensed drivers and police-reported crash rates per mile traveled for drivers ages 70–79 are now less than those for drivers ages 35–54, but their fatal crash rates per mile traveled and risk of dying in a crash remain higher as they drive fewer miles. As the economy improved over the past decade, fatal crash rates increased substantially for middle-aged drivers but decreased or remained stable among older driver age groups. Conclusions: Fatal crash involvements for adults ages 70 and older has recently increased, but they remain down from their 1997 peak, even as the number of licensed older drivers and the miles they drive have increased. Health improvements likely contributed to long-term reductions in fatal crash rates. As older drivers adopt vehicles with improved crashworthiness and safety features, crash survivability will improve. Practical Application: Older adults should feel confident that their independent mobility needs pose less risk than previously expected.     

Seat Belt Use in States and Territories with Primary and Secondary Laws -- United States, 2006

Problem

Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death.

Methods

Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement).

Results

In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws.

Discussion

Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts.     

Fatal crash between a car operating with automated control systems and a tractor-semitrailer truck

Abstract

Objective: The objective of this investigation was to evaluate the interaction between an SAE level 2 automated vehicle and the driver, including the limitations imposed by the vehicle on the driver.

Methods: A case study of the first fatal crash involving a vehicle operating with an automated control system was performed using scene evidence, vehicle damage, and recorded data available from the vehicle, and information from both drivers, including experience, phone records, computer systems, and medical information, was reviewed.

Results: System performance data downloaded from the car indicated that the driver was operating it using the Traffic-Aware Cruise Control and Autosteer lane-keeping systems, which are automated vehicle control systems within Tesla’s Autopilot suite. As the car crested the hill, a tractor trailer began its left turn onto a crossing roadway. Although reconstruction of the crash determined that there was sufficient sight distance for both drivers to see each other and take action, neither responded to the circumstances leading to the collision. Further, based on the speeds of the vehicles and simulations of the truck’s path, the car driver had at least 10.4?s to detect the truck and take evasive action. Neither the car driver nor the Autopilot system changed the vehicle’s velocity.

?At the time of the crash, the system performance data indicated that the last driver interaction with the system was 1?min 51?s prior when the cruise control speed was set to 74?mph. The driver was operating the vehicle using the Autopilot system for 37 of the 41?min in the last trip. During this period, the vehicle detected the driver’s hands on the steering wheel for a total of 25?s; each time his hands were detected on the wheel was preceded by a visual alert or auditory warning.

Conclusions: The National Transportation Safety Board (NTSB) determined that the probable cause of the Williston, Florida, crash was the truck driver’s failure to yield the right of way to the car, combined with the car driver’s inattention due to overreliance on vehicle automation, which resulted in the car driver’s lack of reaction to the presence of the truck. Contributing to the car driver’s overreliance on the vehicle automation was the car’s operational design, which permitted the driver’s prolonged disengagement from the driving task and his use of the automation in ways inconsistent with guidance and warnings from the manufacturer.     

Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients

Objective: To measure the effect of motor vehicle crash (MVC) involvement and readiness to change drinking and driving behaviors on subsequent driving and drinking behaviors among injured emergency department (ED) patients who use alcohol at harmful levels.

Methods: This was a secondary analysis of a randomized controlled trial of injured ED patients who screened positive for harmful alcohol use, who at recruitment reported driving in the past 12 months and received at least one of the intended intervention sessions (brief behavioral intervention versus attention placebo control; N = 407). Outcome variables were as follows: (1) change in 6 impaired driving behaviors and (2) report of MVCs and traffic violations in the 12 months following recruitment; predictor variables were as follows: (1) treatment assignment, (2) MVC involvement at recruitment, and (3) baseline readiness to change alcohol use and drinking and driving.

Results: Modeling of change in the 6 impaired driving variables indicated that neither the recruitment visits being MVC related nor baseline readiness to change alcohol use and drinking and driving behaviors predicted greater changes in impaired driving over time. Baseline reports of past moving traffic violations and the ED visit being MVC related predicted a greater likelihood of each behavior at 12 months following study recruitment.

Conclusions: This study and others have demonstrated that ED patients with harmful alcohol use are willing to engage in behavioral interventions directed at changing risky behaviors. However, this study did not demonstrate that patients considered having the potential to be more engaged with the intervention because their ED visit was MVC related and/or they had expressed intent to change their risky alcohol use and drinking and driving behaviors were more likely to change these risky behaviors.     

Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar

Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.

Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive.

Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49–2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31–7.38, P = .001) was significantly greater among unrestrained passengers.

Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.     

Investigating the effects of monthly weather variations on Connecticut freeway crashes from 2011 to 2015

IntroductionThe objective of this research is to investigate the effects of monthly weather conditions on traffic crash experience on freeways, considering the interactions between weather, traffic volumes, and roadway conditions. Methods: Data from the state of Connecticut from 2011to 2015 were used. Random parameters negative binomial models with first-order, autoregressive covariance were estimated for representative types of freeway crashes (front-to-rear, sideswipe-same-direction, and fixed-object), most severe crashes (i.e., fatal and injury crashes), and non-injury crashes (i.e., property-damage-only crashes). Results: Major findings are that variations in monthly traffic volumes, roadway geometry, and weather conditions explain much of the variations in monthly traffic crashes. Time effects exist in the panel monthly data for all types of crashes. Taking into account this effect improves model prediction results. When the raw weather measures are highly correlated, using dimension reduction techniques helps to extract more interpretable weather factors. By considering the interaction effects between roadway condition variables, additional findings were found. In general, lower temperature, more heavy fog days, decreased precipitation, lower wind speed, higher monthly traffic volumes, and narrower inside shoulder were found to be associated with higher monthly crashes. The effects of area type and outside shoulder width change dramatically as the number of through lanes changes. Practical applications: The findings of this research could help researchers and general readers gain a better understanding of the effects of monthly weather conditions and other roadway factors on freeway crashes and give engineers practical guidelines on improving freeway safety.     

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.     

Motor Vehicle Crashes on Bridges and Countermeasure Opportunities

There are approximately 600,000 highway bridges in the United States. These structures differ from surface streets and highways in terms of their physical properties and operational characteristics, which in turn, affect the risk of motor-vehicle crashes and the kinds of crashes that occur. The purpose of this study was to identify motor-vehicle crash patterns and contributing factors to bridge crashes and related countermeasure opportunities on four urban bridges in the New York metropolitan area. A crash typology was developed using the narratives and diagrams in police crash reports in addition to standard police classifications of crashes. The final dataset contained records of 1,381 police-reported crashes. The four bridges studied had higher crash rates than their respective approach roads. Four major crash types accounted for approximately 90% of the bridge crashes. Primary collision factors are reviewed, and potential countermeasures are discussed.     

Medical investigation after a motorcoach strikes the rear of a tractor semitrailer parked on the highway; 13 fatal

Abstract

Objective: The objective of this study was to examine the medical conditions of 2 commercial drivers and the effects of physical barriers to occupant egress in a crash involving a tractor trailer and a motorcoach in order to assess and identify the factors that caused the crash and had a significant effect on occupant extrication.

Methods: Physical evidence from the scene, video evidence, commercial driver information, phone records, toxicology findings, autopsy results, and personal medical information were reviewed.

Results: On October 23, 2016, at 5:16 a.m., a motorcoach carrying a driver and 42 passengers struck the rear of a stopped semitrailer occupied by its driver in the center-right lane of Interstate 10 at highway speed outside Palm Springs, California. The motorcoach driver and 12 passengers died; 11 passengers were seriously injured.

All traffic had been stopped on I-10 early that morning to allow electrical lines to be strung over the highway. Security camera footage showed that the truck arrived at the end of a traffic queue 2?min before traffic flow resumed. Physical evidence indicated that the truck’s parking brake was still engaged at the time of the collision about 2?min later. The truck driver had a body mass index (BMI) between 45.6 and 50?kg/m², which placed him at very high risk of moderate to severe obstructive sleep apnea; he also inaccurately recalled that he had been stopped for 20–25?min and had placed the vehicle in gear just before the collision.

The motorcoach driver was on the return leg of an overnight trip to a casino. Based on his phone records, known driving time, and security camera footage, at the time of the collision he had had 4?h of sleep opportunity in the preceding 35?h. There was no evidence that the motorcoach driver attempted any evasive action before the collision. In addition, postmortem testing revealed a hemoglobin A1C of 11.4%, indicating poorly controlled diabetes; this was apparently undiagnosed prior to the crash.

The motorcoach was equipped with a single loading door at the front of the vehicle; it was rendered inoperable by the collision. Emergency egress was initially carried out through the emergency exit windows, but they repeatedly swung shut, impeding passengers’ efforts to exit. Emergency responders eventually cut open the bus wall to create a larger means of egress. Overall, it took almost 3?h to extricate the occupants from the vehicle.

Conclusions: The National Transportation Safety Board (NTSB) determined that the probable cause of the accident was the truck driver’s falling asleep, most likely due to undiagnosed moderate-to-severe obstructive sleep apnea, and the motorcoach driver’s failure to identify the stopped truck as a hazard requiring evasive action, most likely as the result of fatigue. Additional easy-to-use emergency exits would have decreased the time to extricate the occupants.     

Age- and Sex-Specific Thorax Finite Element Model Development and Simulation

Objective: The shape, size, bone density, and cortical thickness of the thoracic skeleton vary significantly with age and sex, which can affect the injury tolerance, especially in at-risk populations such as the elderly. Computational modeling has emerged as a powerful and versatile tool to assess injury risk. However, current computational models only represent certain ages and sexes in the population. The purpose of this study was to morph an existing finite element (FE) model of the thorax to depict thorax morphology for males and females of ages 30 and 70 years old (YO) and to investigate the effect on injury risk.

Methods: Age- and sex-specific FE models were developed using thin-plate spline interpolation. In order to execute the thin-plate spline interpolation, homologous landmarks on the reference, target, and FE model are required. An image segmentation and registration algorithm was used to collect homologous rib and sternum landmark data from males and females aged 0–100 years. The Generalized Procrustes Analysis was applied to the homologous landmark data to quantify age- and sex-specific isolated shape changes in the thorax. The Global Human Body Models Consortium (GHBMC) 50th percentile male occupant model was morphed to create age- and sex-specific thoracic shape change models (scaled to a 50th percentile male size). To evaluate the thoracic response, 2 loading cases (frontal hub impact and lateral impact) were simulated to assess the importance of geometric and material property changes with age and sex.

Results: Due to the geometric and material property changes with age and sex, there were observed differences in the response of the thorax in both the frontal and lateral impacts. Material property changes alone had little to no effect on the maximum thoracic force or the maximum percent compression. With age, the thorax becomes stiffer due to superior rotation of the ribs, which can result in increased bone strain that can increase the risk of fracture. For the 70-YO models, the simulations predicted a higher number of rib fractures in comparison to the 30-YO models. The male models experienced more superior rotation of the ribs in comparison to the female models, which resulted in a higher number of rib fractures for the males.

Conclusion: In this study, age- and sex-specific thoracic models were developed and the biomechanical response was studied using frontal and lateral impact simulations. The development of these age- and sex-specific FE models of the thorax will lead to an improved understanding of the complex relationship between thoracic geometry, age, sex, and injury risk.     

Nationwide risk factors for hospital readmission for subsequent injury after motor vehicle crashes

Abstract

Objective: Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital.

Methods: The Nationwide Readmissions Database for 2010–2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash–related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (P < .05) variables on univariate analysis. Results were weighted for national estimates.

Results: During the study period, 1,008,991 patients were admitted for motor vehicle–related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR]?=?1.32; 95% confidence interval [CI], 1.20–1.45; P < .01) and a higher ISS (OR?=?1.38; 95% CI, 1.27–1.49; P < .01). Motorcyclists were more likely to suffer subsequent injury (OR?=?1.39; 95% CI, 1.32–1.46; P < .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR?=?2.49; 95% CI, 1.73–3.59; P < .01). Alcohol abuse was associated with subsequent injury (OR?=?1.12; 95% CI, 1.07–1.18; P < .01).

Conclusions: Nearly a third of patients suffering subsequent motor vehicle crash–related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements.     

Fatal crash trends for Australian young drivers 1997-2007: Geographic and socioeconomic differentials

Background

Little has been published on changes in young driver fatality rates over time. This paper examines differences in Australian young driver fatality rates over the last decade, examining important risk factors including place of residence and socioeconomic status (SES).

Methods

Young driver (17-25 years) police-recorded passenger vehicle crashes were extracted from New South Wales State records from 1997-2007. Rurality of residence and SES were classified into three levels based on drivers’ residential postcode: urban, regional, or rural; and high, moderate, or low SES areas. Geographic and SES disparities in trends of fatality rates were examined by the generalized linear model. Chi-square trend test was used to examine the distributions of posted speed limits, drinking driving, fatigue, seatbelt use, vehicle age, night-time driving, and the time from crash to death across rurality and socioeconomic status.

Results

Young driver fatality rate significantly decreased 5% per year (p < 0.05); however, stratified analyses (by rurality and by SES) showed that only the reduction among urban drivers was significant (average 5% decrease per year, p < 0.01). The higher relative risk of fatality for rural versus urban drivers, and for drivers of low versus high SES remained unchanged over the last decade. High posted speed limits, fatigue, drink driving and seatbelt non-use were significantly associated with rural fatalities, whereas high posted speed limit, fatigue, and driving an older vehicle were significantly related to low SES fatality.

Conclusion

The constant geographic and SES disparities in young driver fatality rates highlight safety inequities for those living in rural areas and those of low SES. Better targeted interventions are needed, including attention to behavioral risk factors and vehicle age.     

Development of a method to rate the primary safety of vehicles using linked New Zealand crash and vehicle licensing data

Objective: Vehicle safety rating systems aim firstly to inform consumers about safe vehicle choices and, secondly, to encourage vehicle manufacturers to aspire to safer levels of vehicle performance. Primary rating systems (that measure the ability of a vehicle to assist the driver in avoiding crashes) have not been developed for a variety of reasons, mainly associated with the difficult task of disassociating driver behavior and vehicle exposure characteristics from the estimation of crash involvement risk specific to a given vehicle. The aim of the current study was to explore different approaches to primary safety estimation, identifying which approaches (if any) may be most valid and most practical, given typical data that may be available for producing ratings.

Methods: Data analyzed consisted of crash data and motor vehicle registration data for the period 2003 to 2012: 21,643,864 observations (representing vehicle-years) and 135,578 crashed vehicles. Various logistic models were tested as a means to estimate primary safety: Conditional models (conditioning on the vehicle owner over all vehicles owned); full models not conditioned on the owner, with all available owner and vehicle data; reduced models with few variables; induced exposure models; and models that synthesised elements from the latter two models.

Results: It was found that excluding young drivers (aged 25 and under) from all primary safety estimates attenuated some high risks estimated for make/model combinations favored by young people. The conditional model had clear biases that made it unsuitable. Estimates from a reduced model based just on crash rates per year (but including an owner location variable) produced estimates that were generally similar to the full model, although there was more spread in the estimates. The best replication of the full model estimates was generated by a synthesis of the reduced model and an induced exposure model.

Conclusions: This study compared approaches to estimating primary safety that could mimic an analysis based on a very rich data set, using variables that are commonly available when registered fleet data are linked to crash data. This exploratory study has highlighted promising avenues for developing primary safety rating systems for vehicle makes and models.     

Simulated single-bicycle crashes in the VTI crash safety laboratory

Abstract

Objective: The objective of this study was to examine the influence of bicycle design and speed on the head impact when suffering from a single-bicycle crash, and the possibility to study this using crash tests.

Methods: Simulations of single-bicycle crashes were performed in the VTI crash safety laboratory. Two bicycle crash scenarios were simulated: “a sudden stop” and “sideways dislocation of the front wheel”; using four different bicycle types: a “lady’s bicycle”, a commuter bicycle, a recumbent bicycle and a pedelec; at two speeds: 15 and 25?km/h. In addition, sideway falls were performed with the bicycles standing still. All tests were done with a Hybrid II 50^th percentile crash test dummy placed in the saddle of the bicycles, with acceleration measurements in the head.

Results: The crash tests showed that a sudden stop, e.g. a stick or bag in the front wheel, will result in a falling motion over the handle bars causing a forceful head impact while a sideways dislocation of the front wheel will result in a falling motion to the side causing a more moderate head impact. The falling motion varies between the different bicycle types depending on crash test scenario and speed. The pedelec had a clearly different falling motion from the other bicycle types, especially at a sudden stop.

Conclusions: The study implies that it is possible to examine single-bicycle crashes using crash tests, even though the setup is sensitive to minor input differences and the random variation in the resulting head impact values can be large. Sideway falls with the bicycles standing still were easier to perform with a good repeatability and indicated an influence of seating height on the head impact.     

Validation of quasi-induced exposure representativeness assumption among young drivers

Objective: Young driver studies have applied quasi-induced exposure (QIE) methods to assess relationships between demographic and behavioral factors and at-fault crash involvement, but QIE's primary assumption of representativeness has not yet been validated among young drivers. Determining whether nonresponsible young drivers in clean (i.e., only one driver is responsible) 2-vehicle crashes are reasonably representative of the general young driving population is an important step toward ensuring valid QIE use in young driver studies. We applied previously established validation methods to conduct the first study, to our knowledge, focused on validating the QIE representativeness assumption in a young driver population.

Methods: We utilized New Jersey's state crash and licensing databases (2008–2012) to examine the representativeness assumption among 17- to 20-year-old nonresponsible drivers involved in clean multivehicle crashes. It has been hypothesized that if not-at-fault drivers in clean 2-vehicle crashes are a true representation of the driving population, it would be expected that nonresponsible drivers in clean 3-or-more-vehicle crashes also represent this same driving population (Jiang and Lyles 2010 Jiang XG, Lyles RW. A review of the validity of the underlying assumptions of quasi-induced exposure. Accid Anal Prev. 2010;42:1352–1358.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Thus, we compared distributions of age, gender, and vehicle type among (1) nonresponsible young drivers in clean 2-vehicle crashes and (2) the first nonresponsible young driver in clean crashes involving 3 or more vehicles to (3) all other nonresponsible young drivers in clean crashes involving 3 or more vehicles. Distributions were compared using chi-square tests and conditional logistic regression; analyses were conducted for all young drivers and stratified by license status (intermediate vs. fully licensed drivers), crash location, and time of day of the crash.

Results: There were 41,323 nonresponsible drivers in clean 2-vehicle crashes and 6,464 nonresponsible drivers in clean 3-or-more-vehicle crashes. Overall, we found that the distributions of age, gender, and vehicle type were not statistically significantly different between the 3 groups; in each group, approximately one fourth of drivers were represented in each age from age 17 through 20, half were males, and approximately 80% were driving a car/station wagon/minivan. In general, conclusions held when we evaluated the assumption within intermediate and fully licensed young drivers separately and by crash location and time.

Conclusions: It appears that the representativeness assumption holds among the population of young NJ drivers. We encourage young driver studies utilizing QIE methods to conduct internal validation studies to ensure appropriate application of these methods and we propose utilization of QIE methods to address broader foundational and applied questions in young driver safety.     

Behavioral pathways in bicycle-motor vehicle crashes: From contributing factors,pre-crash actions,to injury severities

Introduction: This study performed a path analysis to uncover the behavioral pathways (from contributing factors, pre-crash actions to injury severities) in bicycle-motor vehicle crashes. Method: The analysis investigated more than 7,000 bicycle-motor vehicle crashes in North Carolina between 2007 and 2014. Pre-crash actions discussed in this study are actions of cyclists and motorists prior to the event of a crash, including “bicyclist failed to yield,” “motorist failed to yield,” “bicyclist overtaking motorist,” and “motorist overtaking bicyclist.” Results: Model results show significant correlates of pre-crash actions and bicyclist injury severity. For example, young bicyclists (18 years old or younger) are 23.5% more likely to fail to yield to motor traffic prior to the event of a crash than elder bicyclists. The “bicyclist failed to yield” action is associated with increased bicyclist injury severity than other actions, as this behavior is associated with an increase of 5.88 percentage points in probability of a bicyclist being at least evidently injured. The path analysis can highlight contributing factors related to risky pre-crash actions that lead to severe injuries. For example, bicyclists traveling on regular vehicle travel lanes are found to be more likely to involve the “bicyclist failed to yield” action, which resulted in a total 44.38% (7.04% direct effect + 37.34% indirect effect) higher likelihood of evident or severe injuries. The path analysis can also identify factors (e.g., intersection) that are not directly but indirectly correlated with injury severity through pre-crash actions. Practical Applications: This study offers a methodological framework to quantify the behavioral pathways in bicycle-motor vehicle crashes. The findings are useful for cycling safety improvements from the perspective of bicyclist behavior, such as the educational program for cyclists.     

Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.

Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DR_MAIS) was also calculated for each injury. DR and DR_MAIS could range from 0 to 100% disability risk.

Results: The mean DR_MAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DR_MAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DR_MAIS value for flail chest compared to the other age groups.

Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.