Low Delta-V Crashes Resulting in Serious Injury. Questions

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1 Low Delta-V Crashes Resulting in Serious Injury Mark Scarboro NHTSA May 16, Questions When occupants are seriously injured at low delta-v s, what contributes to the injury causation? What details are required to better analyze this issue? What does the field data tell us? 2 1

2 NASS Data CDS Data (98-05) Delta-V Distribution Criteria Ages 18+ Rollovers excluded 4 35% Percent of Cases 3 25% 2 15% 5% <=20 kmph >=21kmph UNKNOWN Delta-V 3 Percent of Cases NASS Data CDS Data (98-05) Delta-V and Injury Severity <=20 kmph >=21kmph UNKNOWN MAIS Criteria Ages 18+ Rollovers excluded 52,967 Occupants 12,180 Fatals 2

3 Study Group Inclusion Step 1 CIREN cases 1997 present Occupant must sustain an AIS3+ injury Ages 18 and up Winsmash DV <=20 kmph (12.4 mph) N=132 Delete any vehicle with a rollover (9) N=123 Delete any Special Interest cases (1) N=122 5 Review Vehicle Damage Crash investigator s estimate of Winsmash validity (Delta-V versus Crush and/or Intrusion) 10 mph? 6 8 mph? 12 mph? 3

4 Low Estimates Dropped Typical crashes of concern FLEE s & FREE s Narrow impacts with fixed objects Angled side impacts 43 (35%) cases rated as low estimate N=79 7 Optimal Restraint Use Only restrained occupants included Belt restrained or air bag and belt restrained Unbelted occupants excluded Regardless of Air bag deployment 21 occupants removed Occupants with documented belt misuse 2 occupants removed N=56 8 4

5 Acceptable Crash conditions and damage appear appropriate 9 Category Crash Type Frontal Occupants 20 Percent 36% Group Stats Side 36 64% Opposing Object Vehicle Fixed Object Vehicle Model Year 1998 and later Restraint Status Belted AB deployed Fatalities Due to injury Due to disease % 14% 59% % 7% 2% Category DV kmph (mph) Age MAIS ISS Height cm (in) Weight kg (lb) TLOS (days) Mean 16 (10) (67) 79 (175) 8 Min 9 (6) (58) 42 (93) 0 Max 20 (12) (78) 123 (271) 30 Gender Male 28 5 Female

6 Occupant Injury Distribution AIS 3+ Injury by Body Region Low Ext, 23% Brain / Skull, 29% Up Ext, 9% Spine, 9% Abdomen, 11% Chest, 45% 11 *56 occupants with 102 AIS3+ injuries AIS 3+ Injury Source 18% 16% 14% Percent of Injury 12% 8% 6% 4% 2% Air bag and/or cover Door panel Belt webbing/buckle Armrest/door hdw Center console/floor shifter External object Knee bolster Seat back Side window sill/frame Unknown Component 12 B-Pillar Floor pan Non-contact Other interior object Windshield 6

7 Contributing Factors All cases manually reviewed for factors influencing injury causation and severity (Bio-Tab method) Age (Elderly) Poor bone quality (osteoporosis) Calcification of vascular structures Intrusion Intruded component causes or exacerbates injury Pre-morbid Condition Medical condition affecting injury causation 8 Medications, obesity, implants (ortho/organ) Multiple Impacts / Out of Position Occupant s injury impact position is non-optimal 13 Contributing Factors Continued All cases manually reviewed for factors influencing injury causation and severity Stature Occupant proximal to injurious components 8 Seat track, seated height Compatibility Striking vehicle s height or stiffness is a factor 8 Usually coded as intrusion, head contact to V2 Cargo Cargo shifting or moving in the vehicle is a factor 8 Equipment, pets (large) 14 7

8 Contributing Factors Distribution (Several can apply) 5 45% 4 Percent of Occupants 35% 3 25% 2 15% 5% Age Intrusion Pre-morbid Cond. None OOP/Mult. Impacts Contributing Factor Stature Cargo Compatibility 15 Fatal (crash) 4 cases were fatal All case vehicles were pre-1998 Case 1 77 y.o. male, frontal impact, SDH-AB 8 Out of position, age and PMH Case 2 67 y.o. male, frontal impact, cerebral bleed-ab 8 Age Case 3 77 y.o. male, frontal crash, cerebral bleed-medicine cabinet 8 Cargo Case 4 91 y.o. female, side impact, liver lac-armrest 8 Intrusion and age 16 8

9 Brain and Skull Injury 16 Occupants with AIS3+ brain or skull injury (25 injuries) 17 kmph avg. (10.6 mph) Majority of brain injury are cerebral bleeds Primary source air bag and or related components 44% (7/16) of the occupants were in 1998 or newer vehicles 66% (4/6) of the occupants with AB sources were in 1997 and older vehicles Avg. age of group=69 - AB group=72 17 Percent of Brain/Skull Injury Percent of Brain/Skull Injury 45% 4 35% 3 25% 2 15% 5% Air bag and/or cover 3 25% 2 15% 5% Side window sill/frame Brain/Skull Injury Details Brain / Skull Injury Sources Cerebral contusion/hemor. Cerebral SDH Cerebral SAH Cerebral EDH Concussive Base skull fx Brain stem cont. External object Other interior object Belt webbing/buckle Center console/floor shifter Unknown Chest Injury Chest Injury Detail 25 occupants with AIS3+ chest injury (34 injuries) 15 kmph avg. (9.3 mph) Rib fractures, HTX, PTX and lung contusions are high frequency Percent of Chest Injury Door, armrest and belt are the primary sources 68% (17/25) of the occupants were in 1998 or newer vehicles Avg. age of chest group=61 18 Percent of Chest Injury 35% 3 25% 2 15% 5% Rib fx +/- HTX/PTX Door panel Belt webbing/buckle Armrest/door hdw Lung inj +/- HTX/PTX Heart cont/lac Chest Injury Sources B-Pillar Air bag and/or cover Diaphragm rupture Seat back Side window sill/frame Tracheal inj Unknown 9

10 Lower Extremity Injury Lower Extremity Injury Details 13 occupants with AIS3+ LE injury (19 injuries) 17 kmph avg. (10.6 mph) 54% (7/13) occupants were in side impact crashes Percent of LE Injury 5 45% 4 35% 3 25% 2 15% Pelvic fractures dominate the LE AIS3+ group 5% Pelvic fx Ankle fx Femur shaft fx Proximal tibia fx Distal femur fx Proximal femur fx Source is not isolated 62% (8/13) occupants were in 1998 or newer vehicles Avg. age of LE group=55 Percent of LE Injury 3 25% 2 15% 5% Lower Extremity Sources 19 Knee bolster Center console/floor shifter Door panel Floor pan Armrest/door hdw Belt webbing/buckle Examples 20 10

11 Case No Contributing Factors Case V = 1998 Jeep Wrangler Crosses center line, bumps curb and strikes 1991 Plymouth Acclaim PDOF = 0 DV=18 kmph y.o. male driver Belt and air bag No past medical Interview good recall No intrusion Min. crush No Factors 22 11

12 No Factors Right femur shaft fx IM rod surgical repair TLOS = 4 days Initial charges = $20, Case Contributing Factors Case V 1999 Ford Windstar van V Jeep Grand Cherokee T-intersection crash Nearside configuration PDOF 1 o clock (30 ) DV = 11 kmph (7 mph) 24 12

13 Case Contributing Factors 62 y.o. male right front passenger Pre-morbid conditions Aortic aneurysm Cancer Smoker (1 PPD) Anemic Hypertension Atherosclerosis (aorta/coronary) Belted no air bags deployed 5 cms related intrusion 17 cms crush 25 Case Contributing Factors Right rib fxs (7-12) Postero-lateral Flail chest Right lung contusion Right pneumothorax Right lung laceration Liver laceration (small) MAIS=4 ISS=

14 Case Contributing Factors Initial hospital stay of 21 days Multiple respiratory complications Readmission 3X = 26 days additional Occupant expired before 12 month F/U Medical charges 47 days = $171, Findings from CIREN Data Serious injury at low impact speeds Primarily an older occupant issue Not always Contributing Factors Must be captured and documented in detail Intrusion Much lower than current triage protocol Detailed past medical history Indicators for increased severity Multiple possibilities can apply 28 14

15 Next Steps - CIREN Bio-Tab coding to relate contributing factors directly to specific injury Continue to better define elderly New side impact vehicle investigation techniques Improved intrusion, contacts and SAB data Utilize DICOM images CIREN and other populations Document anatomical changes 29 Thank You Questions? 30 15

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