Andrew Morris

Chest and abdominal injuries caused by seat belt loading

Injuries will inevitably occur when restraining loads are exerted on a car occupant by a seat belt during a crash. This study investigated the nature, frequency, and severity of such injuries to the chest and abdomen. Vehicle, occupant, and injury details were obtained from accidents occurring in the Midlands of England. The sample was chosen with emphasis on fatal and serious injuries while also representing slight injuries as rated by the British government scheme. All causes of injuries to 3,276 front-seat restrained occupants were considered. 29.6% had a minor (Abbreviated Injury Scale [AIS] 1) injury caused by seat belt loading, more than from any other cause. The study went on to focus on 1,025 occupants sustaining injuries caused solely by seat belt loading. Of those, 19.4% sustained chest/abdominal injuries rated at Maximum AIS > or = 2 with sternum fractures predominating, and 4.5% were rated at Maximum AIS > or = 3. Occupants were not excluded if they had injuries at other body regions enabling the frequency and severity of head injuries to be considered also. The role played by impact type, speed change at impact, seat belt usage problems, and some aspects of occupant characteristics were investigated. While females were at much greater risk of serious injury (AIS > or = 3) when aged > or = 70 years, the effects of aging were more obvious in the cases with chest injuries rated at AIS 2. Serious chest injuries were predominantly a function of higher speed changes at impact. Occupant height and weight were shown to influence injury outcome, and the study concluded that work is required to further define occupants most at risk. Comparisons were made with two studies into other types of injury at other body regions, and injuries rated AIS > or = 2 caused by seat belt loading were seen to be relatively unlikely. It must also be stressed that casualties sustained seat belt injuries would most likely have received more severe injuries had a seat belt not been worn.

Vertebral column injuries and lap-shoulder belts

OBJECTIVE To present cases of vertebral column fractures or fracture dislocations that occur to restrained front seat occupants where there is no evidence of body contact with interior car components based on both medical records and car inspection. MATERIALS AND METHODS Reviewed were car crash injury cases investigated at the University of Michigan Transportation Research Institute and at the University of Birmingham (England) as well as the National Accident Severity Study files of the National Highway Traffic Safety Administration. Medical records and car inspections in the cases presented did not indicate any evidence of body contact with interior car structures. MAIN RESULTS Vertebral fractures or fracture dislocations sustained by front seat occupants who were wearing lap-shoulder belts are rare, as evidenced by the relatively few cases identified in the literature and in the crash injury files reviewed. CONCLUSIONS Infrequently, in frontal crashes, vertebral fractures or fracture dislocations can occur to lap-shoulder belted front seat car occupants without head or torso impacts with interior car structures. Cervical spine injuries are due to neck flexion over the shoulder portion of the restraint. Thoracolumbar fractures can occur in the frontal crash even at low crash velocity.

Neck Injuries in the UK Co-Operative Crash Injury Study

Results are presented of a co-operative crash injury study on neck injuries in Great Britain. It is shown that although the risk of sustaining soft tissue neck injury is greatly increased in rear impact, over 50% of the injuries are in fact occurring in frontal impacts with a further 25% occurring in side impacts. Overall, the data show a clear value in conducting future work in engineering circles with regard to vehicle design. Language: en

HEAD INJURIES IN LATERAL IMPACT COLLISIONS

Individual non-minor injuries (Abbreviated Injury Scale (AIS) > or = 2) to the head that occurred to belted and unbelted drivers and front seat passengers on the stuck side of impacted vehicles were examined. Injury type, injury combination, collision severity in relation to type of injury as well as contact sources were assessed. Forty-eight percent of injuries were moderate in severity (AIS 2). The most common type of injury was the diffuse brain injury, typically marked by a short period of unconsciousness, which occurred in collisions of lower severity than focal brain and skull fracture injuries. One-hundred and five out of 216 (48.6%) of contact sources for all injury types originated from outside the vehicle and such exterior sources were more likely to result in high severity injuries. Thirty percent of injuries resulted from head contacts with other vehicles. The most frequent vehicle interior contact source was the side window glass. Diffuse injuries tended to occur independently of other injury types and were more likely to originate from an interior rather than exterior contact. Preventative measures for head injury reduction in lateral collisions are discussed. Overall, the data show that proposed and present European and U.S. lateral impact test methods do not address many head injury problems such as those included in this study.

Car Crashes and Non-Head Impact Cervical Spine Injuries in Infants and Children

The effects of child safety seats have been well documented in the medical literature. Scattered throughout the medical literature are individual case reports of cervical injury to children restrained in child restraint systems. A review of the literature is provided identifying previous documented cases. The authors also provide new case details of children with cervical spine injury without head contact. An overview of the growth of the infant and specific details in the cervical spine that may contribute to significant cervical injury without head impact is presented.

Vehicle crashworthiness and the older motorist

This study examines the relationship between age and the injury outcomes for belted drivers in road vehicle crashes in the United Kingdom. The sample of 1,541 drivers was divided into three age groups: 889 drivers were aged 17–39 years (young drivers); 515 were 40–64 years (middle-aged), and 137 aged 65–84 years (older drivers). Both frontal and side impact crashes in which the vehicles sustained sufficient damage to be towed away from the scene are considered. In-depth information obtained from examinations of the crashed vehicles was combined with clinical data obtained from hospitals to throw light on the mechanisms that led to the injuries. Results show that in crashes of approximately equal severity, older drivers were significantly more likely than middle-aged and young drivers to be fatally injured in both frontal (p<0.001) and side (p<0.05) impact crashes. The results also show that older drivers sustained more injuries to the chest (p<0.0001) and that this body region is particularly problematic. The main sources of the chest injuries were found to be the seat belt in frontal crashes and the door in side impact crashes. As the number of older car users will increase rapidly in most OECD countries in the coming decades, the results suggest that vehicle re-designs are required, including in-vehicle crashworthiness systems, to take into account older peoples relatively low tolerance of crash impacts.

The impact of injuries study. multicentre study assessing physical, psychological, social and occupational functioning post injury - a protocol

BackgroundLarge numbers of people are killed or severely injured following injuries each year and these injuries place a large burden on health care resources. The majority of the severely injured are not fully recovered 12-18 months later. Psychological disorders are common post injury and are associated with poorer functional and occupational outcomes. Much of this evidence comes from countries other than the UK, with differing health care and compensation systems. Early interventions can be effective in treating psychological morbidity, hence the scale and nature of the problem and its impact of functioning in the UK must be known before services can be designed to identify and manage psychological morbidity post injury.Methods/DesignA longitudinal multi-centre study of 680 injured patients admitted to hospital in four areas across the UK: Nottingham, Leicester/Loughborough, Bristol and Surrey. A stratified sample of injuries will ensure a range of common and less common injuries will be included. Participants will complete a baseline questionnaire about their injury and pre-injury quality of life, and follow-up questionnaires 1, 2, 4, and 12 months post injury. Measures will include health and social care utilisation, perceptions of recovery, physical, psychological, social and occupational functioning and health-related quality of life. A nested qualitative study will explore the experiences of a sample of participants, their carers and service providers to inform service design.DiscussionThis study will quantify physical, psychological, social and occupational functioning and health and social care utilisation following a range of different types of injury and will assess the impact of psychological disorders on function and health service use. The findings will be used to guide the development of interventions to maximise recovery post injury.

AIRBAG TECHNOLOGY IN AUSTRALIAN PASSENGER CARS: PRELIMINARY RESULTS FROM REAL WORLD CRASH INVESTIGATIONS

Airbags are expected to reduce vehicle occupant injuries, primarily by preventing head and chest contacts with the steering wheel and instrument panel. To date, however, there has been little evidence of airbag effectiveness in terms of field accident investigations. This paper presents some preliminary results from an ongoing case-control study of crashed vehicles equipped with Australian airbag technology. Vehicles were inspected and occupants interviewed according to the National Accident Sampling System (NASS). Data were available for 140 belted drivers involved in frontal crashes, including 71 airbag and 69 control cases. Analyses revealed significant reductions in the cost of injury and a strong indication of a reduction in overall injury severity among the airbag cases. Indications of airbag benefits were also found in terms of a reduction in the probability of sustaining a moderate and severe injury. Some evidence was found for an increase in minor injuries among the airbag cases. As expected, airbag technology seems to be reducing head, face and chest injuries, particularly those of at least a moderate severity. These results are compared with recent overseas findings.

MECHANISMS OF FRACTURES IN ANKLE AND HIND-FOOT INJURIES TO FRONT SEAT CAR OCCUPANTS: AN IN-DEPTH ACCIDENT DATA ANALYSIS

In this study an in-depth analysis of 200 Abbreviated Injury Score (AIS) 2+ injuries to the lower extremity in frontal collisions in the United Kingdom has been performed using impairment scales devised by the American Orthopaedic Foot and Ankle Society. The most important subgroup of injuries were identified as ankle/hindfoot injuries. There were 63 such injuries sustained by 53 occupants, and these were analyzed in greater depth. Inversion or eversion was identified as the mechanism of injury for 40% of injuries. However, in 70% of these fractures caused by inversion or eversion, minimal or no long-term impairment would be expected. Injuries associated with significant long-term impairment were attributed to axial forces (for instance loads perpendicular to the foot). Combined vehicle/injury analysis demonstrated a strong association between toe-pan intrusion and these injuries. Interaction between the occupant and the pedals was identified as a probable injury source in only 25% of injuries to the ankle and hindfoot. The results of the study are being used to plan a program of biomechanical research to establish injury risk functions for the ankle and hindfoot.(A) For the covering abstract of the conference see IRRD E201172.

Is naturalistic driving research possible with highly instrumented cars? Lessons learnt in three research centres

This paper provides an overview of the experiences using Highly Instrumented Cars (HICs) in three research Centres across Europe; Spain, the UK and Greece. The data collection capability of each car is described and an overview presented relating to the relationship between the level of instrumentation and the research possible. A discussion then follows which considers the advantages and disadvantages of using HICs for ND research. This includes the obtrusive nature of the data collection equipment, the cost of equipping the vehicles with sophisticated Data Acquisition Systems (DAS) and the challenges for data storage and analysis particularly with respect to video data. It is concluded that the use of HICs substantially increases the depth of knowledge relating to the drivers behaviour and their interaction with the vehicle and surroundings. With careful study design and integration into larger studies with Low(ly) instrumented Cars (LICs), HICs can contribute significantly and in a relatively naturalistic manner to the driver behaviour research.