Lower Leg Injury Reference Values and Risk Curves from Survival Analysis for Male and Female Dummies: Meta-analysis of Postmortem Human Subject Tests

Objective: Derive lower leg injury risk functions using survival analysis and determine injury reference values (IRV) applicable to human mid-size male and small-size female anthropometries by conducting a meta-analysis of experimental data from different studies under axial impact loading to the foot–ankle–leg complex.

Methods: Specimen-specific dynamic peak force, age, total body mass, and injury data were obtained from tests conducted by applying the external load to the dorsal surface of the foot of postmortem human subject (PMHS) foot–ankle–leg preparations. Calcaneus and/or tibia injuries, alone or in combination and with/without involvement of adjacent articular complexes, were included in the injury group. Injury and noninjury tests were included. Maximum axial loads recorded by a load cell attached to the proximal end of the preparation were used. Data were analyzed by treating force as the primary variable. Age was considered as the covariate. Data were censored based on the number of tests conducted on each specimen and whether it remained intact or sustained injury; that is, right, left, and interval censoring. The best fits from different distributions were based on the Akaike information criterion; mean and plus and minus 95% confidence intervals were obtained; and normalized confidence interval sizes (quality indices) were determined at 5, 10, 25, and 50% risk levels. The normalization was based on the mean curve. Using human-equivalent age as 45 years, data were normalized and risk curves were developed for the 50th and 5th percentile human size of the dummies.

Results: Out of the available 114 tests (76 fracture and 38 no injury) from 5 groups of experiments, survival analysis was carried out using 3 groups consisting of 62 tests (35 fracture and 27 no injury). Peak forces associated with 4 specific risk levels at 25, 45, and 65 years of age are given along with probability curves (mean and plus and minus 95% confidence intervals) for PMHS and normalized data applicable to male and female dummies. Quality indices increased (less tightness-of-fit) with decreasing age and risk level for all age groups and these data are given for all chosen risk levels.

Conclusions: These PMHS-based probability distributions at different ages using information from different groups of researchers constituting the largest body of data can be used as human tolerances to lower leg injury from axial loading. Decreasing quality indices (increasing index value) at lower probabilities suggest the need for additional tests. The anthropometry-specific mid-size male and small-size female mean human risk curves along with plus and minus 95% confidence intervals from survival analysis and associated IRV data can be used as a first step in studies aimed at advancing occupant safety in automotive and other environments.     

Effect of Aging on Brain Injury Prediction in Rotational Head Trauma—A Parameter Study with a Rat Finite Element Model

Objective: The aim of this study was to investigate the possible effects of age-related intracranial changes on the potential outcome of diffuse axonal injuries and acute subdural hematoma under rotational head loading.

Methods: A simulation-based parametric study was conducted using an updated and validated finite element model of a rat head. The validation included a comparison of predicted brain cortex sliding with respect to the skull. Further, model material properties were modified to account for aging; predicted tissue strains were compared with experimental data in which groups of rats in 2 different lifecycle stages, young adult and mature adult, were subjected to rotational trauma. For the parameter study, 2 age-dependent factors—brain volume and region-specific brain material properties—were implemented into the model. The models young adult and old age were subjected to several injurious and subinjurious sagittal plane rotational acceleration levels.

Results: Sequential analysis of the simulated trauma progression indicates that an increase in acute subdural hematoma injury risk indicator occurs at an early stage of the trauma, whereas an increase in diffuse axonal injury risk indicators occurs at a later stage. Tissue stiffening from young adult to mature adult rats produced an increase in strain-based thresholds accompanied by a wider spread of strain distribution toward the rear part of the brain, consistent with rotational trauma experiments with young adult and mature adult rats. Young adult to old age brain tissue softening and brain atrophy resulted in an increase in diffuse axonal injuries and acute subdural hematoma injury risk indicators, respectively.

Conclusions: The findings presented in this study suggest that age-specific injury thresholds should be developed to enable the development of superior restraint systems for the elderly. The findings also motivate other further studies on age-dependency of head trauma.     

Older Adults at Increased Risk as Pedestrians in Victoria,Australia: An Examination of Crash Characteristics and Injury Outcomes

Objectives: Engaging in active transport modes (especially walking) is a healthy and environmentally friendly alternative to driving and may be particularly beneficial for older adults. However, older adults are a vulnerable group: they are at higher risk of injury compared with younger adults, mainly due to frailty and may be at increased risk of collision due to the effects of age on sensory, cognitive, and motor abilities. Moreover, our population is aging, and there is a trend for the current cohort of older adults to maintain mobility later in life compared with previous cohorts. Though these trends have serious implications for transport policy and safety, little is known about the contributing factors and injury outcomes of pedestrian collision. Further, previous research generally considers the older population as a homogeneous group and rarely considers the increased risks associated with continued ageing.

Method: Collision characteristics and injury outcomes for 2 subgroups of older pedestrians (65–74 years and 75+ years) were examined by extracting data from the state police–reported crash dataset and hospital admission/emergency department presentation data over the 10-year period between 2003 and 2012. Variables identified for analysis included pedestrian characteristics (age, gender, activity, etc.), crash location and type, injury characteristics and severity, and duration of hospital stay. A spatial analysis of crash locations was also undertaken to identify collision clusters and the contribution of environmental features on collision and injury risk.

Results: Adults over 65 years were involved in 21% of all pedestrian collisions. A high fatality rate was found among older adults, particularly for those aged 75 years and older: this group had 3.2 deaths per 100,000 population, compared to a rate of 1.3 for 65- to 74-year-olds and 0.7 for adults below 65 years of age. Older pedestrian injuries were most likely to occur while crossing the carriageway; they were also more likely to be injured in parking lots, at driveway intersections, and on sidewalks compared to younger cohorts. Spatial analyses revealed older pedestrian crash clusters on arterial roads in urban shopping precincts. Significantly higher rates of hospital admissions were found for pedestrians over the age of 75 years and for abdominal, head, and neck injuries; conversely, older adults were underrepresented in emergency department presentations (mainly lower and upper extremity injuries), suggesting an increased severity associated with older pedestrian injuries. Average length of hospital stay also increased with increasing age.

Conclusion: This analysis revealed age differences in collision risk and injury outcomes among older adults and that aggregate analysis of older pedestrians can distort the significance of risk factors associated with older pedestrian injuries. These findings have implications that extend to the development of engineering, behavioral, and enforcement countermeasures to address the problems faced by the oldest pedestrians and reduce collision risk and improve injury outcomes.     

New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury

Objective: There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories.

Methods: Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization.

Results: The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience. Consensus was reached for AIS severity categorization for all injury-related ICD codes. There were 95 survey respondents, with a median of 8 years of injury coding experience. Approximately 15 survey responses were collected per ICD code. Results from the 2 activities were compared, and any discrepancies were resolved using additional qualitative and quantitative data from the in-person panel and survey results, respectively.

Conclusions: Robust maps of ICD-9-CM and ICD-10-CM injury codes to AIS severity categories (3+ versus <3) were successfully created from an in-person panel discussion and electronic survey. These maps provide a link between the common ICD diagnostic lexicons and the AIS severity coding system and are of value to injury researchers, public health scientists, and epidemiologists using large databases without available AIS coding.     

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.     

Formation of Two Xylem Frost Injuries in One Annual Ring in Siberian Spruce under Conditions of Western Siberian Forest-Tundra

The phenomenon of the formation of two damaged xylem layers in one frost ring is described in Siberian spruce grown in western Siberian forest-tundra. Temperature conditions providing for the formation of pathological cell and tissue structures are determined. The relationship between the formation of double frost injuries and cold periods is demonstrated.     

Biomechanics of Brain and Spinal-Cord Injury: Analysis of Neuropathologic and Neurophysiology Experiments

This study analyzes 46 brain and 48 spinal-cord impact experiments. The velocity of brain impact was 2.0-10.0 m/s and displacement, 0.75-5.0 mm (5.3-33% compression) using a controlled pneumatic impact. The velocity of spinal-cord impact was 1.5-6.0 m/s and displacement, 1.25-3.25 mm (25-65% compression). Brain injury varied from cortical contusion, diffuse axonal injury (DAI), to fatalities, and spinal-cord injury from temporary to complete loss of somatosensory-evoked potentials. Logist functions were determined for each injury severity and various biomechanical parameters, VC, C, V, and combinations. Brain and spinal-cord injury is most strongly correlated to VC, the viscous response. The goodness-of-fit was x² = 22.1, R-0.84 and p< 0.0000 for fatal brain injury, x² = 27.5, R = 0.96 and p< 0.0000 for cortical contusion, and x² = 17.7, R = 0.49 and p < 0.0001 for partial recovery of spinal-cord conduction. Neural tissue is viscoelastic, with a rate-dependent tolerance related to energy absorption. VC is a measure of energy absorption by impact deformation and is predictive of neural contusion, DAI, long-duration coma, spinal-cord dysfunction, and death. Tolerances for various severities of neural injury are presented. At the tissue level, VC is the product of strain and strain-rate, ε dε/dt. The research shows that strain is not a sufficient parameter of neural injury risk, and that the product of strain and strain-rate is a key biomechanical parameter for brain and spinal-cord injury.     

Should 'Cyrus the Centipede' take a hike? Effects of exposure to a pedestrian safety program on children's safety knowledge and self-reported behaviors

INTRODUCTION: We report the first evaluation of the popular "Cyrus the Centipede" child pedestrian safety program. METHOD: A pre-test/post-test control versus experimental condition design was used to assess Cyrus' impact on third graders' pedestrian safety knowledge, and self-reported pedestrian behaviors. RESULTS: Although some beneficial effects were observed, the program was not reliably effective. In particular, the impact of exposure to Cyrus was strongly influenced by the individual teacher who delivered it, likely due to the highly unstructured nature of the curriculum. SUMMARY: We suggest that: (a) the effectiveness and reliability of such programs be demonstrated before they are widely adopted; and (b) programs that focus on training children in actual or simulated traffic environments may be more effective than those that primarily focus on teaching safety facts and rules.     

土岩爆破作业安全评价与事故分析

用打分法对城市土岩爆破作业的严重伤害可能性进行评价,并运用事故树分析法,对其严重伤害可能性进行分析,找出导致事故发生的可能性因素及可采用的预防途径,为实际伤害事故的预防提供有益参考。