Long-term medical consequences to children injured in car crashes and influence of crash directions

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Long-term medical consequences to children injured in car crashes and influence of crash directions Katarina Bohman 1,2), Helena Stigson 2,3), Maria Krafft 3,4) 1) Autoliv Research, 2)

1 Long-term medical consequences to children injured in car crashes and influence of crash directions Katarina Bohman 1,2), Helena Stigson 2,3), Maria Krafft 3,4) 1) Autoliv Research, 2) Karolinska Institutet, 3) Folksam, 4) Umeå University Road Safety Authority International Conference on Children and Road Safety 2 of April 2015 Copyright Autoliv Inc., All Rights Reserved

2) Karolinska Institutet, 3) Folksam, 4) Umeå University Road Safety Authority International

2 Background Injury databases are using the abbreviated injury scale (AIS) Injury relates to fatality risk 8 body regions AIS1 to AIS6 from minor to maximum injury Correlation between initial injury and long-term consequences are not evident 1,2,3 Some injuries with high AIS scores (AIS3+) have low risk of long-term consequences Some injuries with low AIS scores (AIS1-2) have high risk of long-term consequences Source: 1) Nygren 1984, 2) Galasko et al. 1986, 3) Malm et al. 2008

1,2,3 Some injuries with high AIS scores (AIS3+) have low risk of long-term consequences Some injuries with low AIS

3 Aim The aim of the study was to specify injury patterns and risks of injuries resulting in permanent medical impairment of children (0-12 years) injured in motor vehicle crashes compare the permanent medical impairment outcome with adults investigate the crash directions contribution to the injuries resulting in medical impairment to the children

vehicle crashes compare the permanent medical impairment outcome with adults

4 Method Insurance files from car crashes with at least one injured child, months after the crash injury assessed by medical specialists Permanent medical impairment (PMI)

5 Examples of cases 11 year old girl, rear seated Near side impact AIS1 head injury (concussion without loss of consciousness) Years post-injury, the girl suffers considerably from headaches since the crash PMI of 4% 8 year old boy, rear seated Head-on collision with a bus AIS5 head injuries Brain trauma caused mental motor disturbance, hemianopia and speech defects PMI of at least 50% 9 year old girl, rear seated Rear end impact AIS1 cervical spine injury Years post-injury, the girl had persistent neck pain, pain radiating to the left shoulder and arm, headache, memory loss, and concentration problems when fatigued PMI of 5%

mental motor disturbance, hemianopia and speech defects PMI of at least 50% 9 year old girl, rear seated Rear end impact AIS1 cervical spine injury Years

Method Increased vehicle stiffness Increased average static stiffness measurements for vehicle model years 1982-2010 tested in NCAP 1) Increased crash pulse

6 Method Increased vehicle stiffness Increased average static stiffness measurements for vehicle model years tested in NCAP 1) Increased crash pulse severity for vehicle model years ) Car model year 63% introduced < % introduced >=1996 Source: 1) Swanson et al. ESV 2003, 2) Locey et al. AAAM 2012

pulse severity for vehicle model years 2000-2010 2) Car model year 63%

7 Method 2619 children, 3704 injuries 56 children, 59 injuries resulting in PMI

8 Results & Discussion

9 (%) Permanent medical impairment Neck + head 20 0 AIS1 & AIS2 AIS3+ Head Neck and head are prioritized body regions

10 Permanent medical impairment per body region Children 0-12 years Adults* Head 19% 4% Cervical Spine 57% 66% Face 5% 1% Upper Extremity 3% 6% Lower Extremity and Pelvis 5% 7% Thorax 0% 1% Thoracic Spine 3% 4% Abdomen 3% 0% Lumbar Spine 5% 6% External (Skin) and Thermal Injuries 0% 5% Adults and children have different injury patterns * Malm et al. AAAM 2008.

Thorax 0% 1% Thoracic Spine 3% 4% Abdomen 3% 0% Lumbar Spine 5% 6% External (Skin) and

11 Permanent medical impairment injuries to head and neck, divided by crash direction 70% Distribution 60% 50% 40% 30% Head Neck 20% 10% 0% Frontal Side Rear Rollover Unkown Neck injury risk: about 3% for all crash directions Head injury risk: highest in side and frontal impacts

0% Frontal Side Rear Rollover Unkown Neck injury risk: about 3% for

12 AIS1+ head injuries Use the restraint system Proper usage Side impact Frontal impact 1) Side interior Seat back No evidence of contact Tolerant system for maneuvers and oblique impacts Source: 1) Bohman et al. TIP 2011.

back No evidence of contact Tolerant system for

13 AIS1 Neck injuries proportion of injuries as function of vehicle model year in frontal crashes for children 6 years+ Model year Proportion symptoms >1 month (%) MY < % 3% MY % 5% Proportion of PMI (%)

6 years+ Model year Proportion symptoms >1 month (%)

14 AIS1+ neck injuries Children were 6 years or older Frontal collisions Increased risk in newer vehicles Increased vehicle stiffness Poor energy management in rear seat restraint systems Rear-end impacts Source: Osvalder et al. Ircobi, 2013

vehicle stiffness Poor energy management in rear seat

15 Conclusions Injury prevention for children needs to be based on pediatric data Head and neck injuries resulting in permanent impairment must be prioritized Source : Bohman K, Stigson H, Krafft M, Long-term medical consequences for child occupants 0-12 years injured in car crashes. Traffic Injury Prevention (In Press).

Source : Bohman K, Stigson H, Krafft M, Long-term medical consequences for

16 Thank you for your attention! Questions? Contact:

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Cyclist Injuries Leading to Permanent Medical Impairment in Sweden and the Effect of Bicycle Helmets Matteo Rizzi, Helena Stigson, Maria Krafft Abstract Cyclist injuries leading to long term consequences